What life is like for people using this service:

The service had continued to provide a quality service. People using the service spoke positively about the management team and staff and confirmed their package of care was being delivered in a way and at a time that met their needs.

People were assisted to have maximum choice and control over their lives. It was evident through discussions with people that staff felt supported and morale was good. Everyone was committed to ensuring people received care and support based on their preferences and life choices. People who used the service, relatives and staff members spoke positively about the service and the management team.

Systems and processes within the service were continually reviewed to ensure people were safe. Relatives told us staff knew people well and had built positive relationships in a manner that promoted dignity.

People had an active say in how the service operated and managed, through face to face discussions with the registered manager or care coordinators. The care package was reviewed in consultation with people using the service and changes to the package accommodated.

Good governance systems and processes were in place to ensure the service operated safely and within current legislation. Staff files provided evidence, safe recruitment practices were in place and all staff were suitable to work with vulnerable people. Care plans and risk assessment for people who used the service were in great detail and provided staff with clear directions on how the person wished their care to be delivered.

Care was delivered in a person centred way and always with the consent of the person. People were protected against abuse, neglect and discrimination through good safeguarding processes. Staff understood what constituted abuse and the subtle signs to look for. They confirmed they had received safeguarding training and knew the reporting process well.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 15 March 2016).

About the service:

IHI is a home care agency and provides care and support to 51 people in the community living in and around Smethwick and surrounding areas. The office is centrally located in Smethwick for people to access or a member of the management team will carry out a home visit to provide information about the service.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained rated good overall.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme or if any issues or concerns are identified.

Our inspection was announced and took place on 15 March 2016.

At our last inspection of April 2014 the provider was meeting all of the regulations that we assessed.

The provider is registered to provide personal care to adults. People who used the service received their support and care in their own homes within the community. At the time of our inspection 25 people received personal care and support. They had needs mainly relating to old age and/or a physical disability.

The manager was registered with us as is required by law. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager was also the registered provider. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had processes in place that they and staff followed to prevent people experiencing any miss treatment or abuse.

Risk assessments were undertaken and staff knew of the actions they needed to take to keep people safe and reduce any potential risk of accidents and injuries.

Staffing levels ensured that people received a consistent service from staff they liked and were familiar with who knew of and met their needs.

People were supported to take their medicines as they had been prescribed by their doctor.

Staff felt that the induction training and the support they received on a day to day basis ensured that they did their job safely and provided support in the way that people preferred.

Staff training records showed and staff confirmed that they had received the training they required to meet people’s needs and to keep them safe.

People were enabled to make decisions about their care and they and their families were involved in how their care was planned and delivered.

Staff understood that people have the right to refuse care and that they should not be unlawfully restricted.

Staff supported people to have sufficient diet and fluids to prevent them experiencing ill health due to malnutrition and dehydration.

People were cared for and supported by staff who were kind and caring.

Staff supported people to be as independent as possible. People were encouraged and supported to undertake daily tasks and attend to their own personal hygiene needs.

The service was responsive to people’s changing needs and requests.

Complaints processes were in place for people and their relatives to access if they were dissatisfied with any aspect of the service provision.

People told us that they had confidence in the management team and that the quality of service was good. This was also the view of relatives and staff we spoke with.

The service supported 20 people. We sampled six care files; spoke with the manager, coordinator, four care staff and six people that used the service and / or their relative.

During our inspection in July 2013 we found non-compliance with three essential outcome areas; consent to care, care and welfare and the monitoring of the service. We carried out this inspection to find out if improvements had been made. We saw that there had been improvements in all assessed areas.

All of the staff we spoke with told us the service was much more organised. One staff member said, “We have had additional training about how to record the care delivered. We have staff meetings. I feel much more involved in my job.”

People said that staff asked for their consent before providing care. One person said, “They always ask me if it’s ok to give me a wash or if I am ready for my lunch.” Systems were now in place to ensure that people’s mental capacity to consent to their care was documented.

People’s needs were assessed and planned to ensure they received care that met their needs. Risk assessments had been reviewed and updated, with the involvement of healthcare professionals or relatives where appropriate. People told us they were happy with the care they received. One person said, “The service is excellent. I am very happy with the care my relative gets.”

Monitoring processes had improved but were still not sufficiently robust to ensure people received a good, safe service.

We carried out this inspection to check the care and welfare of people. We spoke with four people, five relatives, three staff, the office manager and the owner.

People told us that staff respected them and ensured that their privacy and dignity was maintained. One person said, “The staff involve me at every step and they are very respectful.”

Records showed that people’s care was planned appropriately. People we spoke with told us they received the care that they had requested and agreed to. One person told us, “They are very dedicated and understanding towards me and my needs.”

We found that arrangements were in place to ensure that people were safeguarded from harm.

We found that selection and recruitment processes were in place to ensure that only suitable staff were employed to work with vulnerable people.

We found that systems were in place to identify any shortfalls. People we spoke with were satisfied with the care and service they received. One relative said, “I would call the office to complain, but they call us quite frequently to have a quick chat to make sure things are OK.”

We visited the offices of IHI Limited to look at records. We spoke with the registered manager. We later spoke with five staff that provided care about the service they provided. On the day of the inspection the service supported around 25 people. We spoke with five people who received care and / or their relatives to ask them about their experience.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five questions that we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they received regular training and support to enable them to deliver care and support safely.

Everyone that we spoke with said that they were happy with their care and said they felt safe with the staff that supported them. One relative we spoke with said, “They ring me if they have any worries about my mum and are always reliable. I know she is safe.”

The provider had an up to date infection control policy which staff were aware of and followed. People who received care had no concerns about infection control. All the people spoken with told us that staff wore personal protective clothing whilst providing personal care. One person said, “They always wash their hands before they start and they wear gloves and aprons. They have hand gel as well." We found that people were protected from the risk of infection because appropriate guidance had been followed and staff had received regular training updates.

The registered manager told us that some new staff had commenced employment since our last inspection. We saw that staff files contained the required pre-employment checks. This meant that the provider ensured that people employed were suitable to work with vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) when applied to care homes. We spoke to the provider about the court ruling regarding DoLS, and whilst no one currently using this service was subjected to a Deprivation of liberty safeguard. The registered manager told us and records showed that all staff had received DoLS training and training in the mental Capacity Act 2005. This ensured that staff had an understanding of their responsibilities in protecting the rights of people who received care from the service.

Is the care effective?

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people could influence the care they received.

We saw that people’s cultural, dietary and linguistic needs were met by staff with the appropriate skills. For example, we saw that people were supported by care staff that were matched to their needs and understood their language or cultural requirements.

We asked staff about the help they provided to people. All staff spoken with were able to give us good detail about the support they provided. One member of staff said, “I always give them choices of what to wear or meals and drinks.” People told us that they were supported by the same staff on most care calls which meant people received continuity of care from staff they felt comfortable with and who understood their needs.

Is the service caring?

People told us they were happy with the care they received and that staff treated them with respect. We saw that respectful language was used whenever staff described the identified support needs of people in their care records. We saw from daily records sampled that where staff had concerns about people’s health, additional visits were made and advice sought from healthcare professionals. We saw that people’s involvement with other healthcare professionals was recorded and their advice was followed. One person told us, “The staff are so kind. They really help me. Nothing is too much trouble.”

Is the service responsive?

People told us that staff did what they wanted them to do. They told us that if their care workers were going to be late they were kept informed either by the care or office staff. One person told us, “If my carer is going to be late they always let me know.” A relative told us, “They come when they should and they listen to what my relative has to say; they treat her well and with kindness. I know we can rely on them.”

Records sampled showed that there were systems in place to gather the views of people who use the service and staff. This showed that the service developed and took into consideration the views of people who received a service and staff and improvements or changes were made where needed.

People told us that they were aware of who they should contact if they were unhappy about the service provided. People spoken with told us they were happy with the service and had not needed to make any complaints. There was a system in place to handle concerns and complaints. We saw records which showed that two complaints had been received by the provider since our last inspection in November 2013. We saw that these had been investigated sensitively in a timely way.

Is the service well led?

We saw that the service had a staffing structure that enabled the service to be managed appropriately. This included a manager that we have registered to be responsible for the running of the service. People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.

At our last inspection the systems to audit the quality of recording of care delivery failed to identify gaps in records about the care that had been delivered. Records sampled at this inspection showed that quality assurance systems had improved. Records sampled showed that audits now identified problems or opportunities to change things for the better and these were addressed promptly. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities and received regular newsletters and had frequent staff meetings. Staff had a good understanding of the service and of the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

Spot checks on staff skills and work practices took place regularly. We saw that findings were detailed and feedback was provided to staff.

Records sampled showed and staff spoken with told us that they received regular supervision and training. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.