This inspection took place on 31 January 2017 and was unannounced. At our last inspection in August 2015 we found that the provider had made improvements to governance and quality assurance, however we wanted to see that these improvements were sustained.

Orchids Care provides personal care and support to people in their own homes. At the time of this inspection, they were providing a service to 90 people with a variety of care needs, including people living with physical frailty or memory loss. The service is managed from an office based in Doncaster.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. 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.

People who used the service, their relatives, staff and professionals told us the provider had a clear, supportive management structure in place. The registered manager and senior staff were actively involved in the day-to-day running of the service and knew people well, stepping in to help deliver care if needed and monitoring and reviewing people's care as their needs changed.

People were protected from risks to their health and wellbeing and were protected from the risk of abuse. Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.

Staff were suitably trained and supported in their work and knew how to meet people's needs. Staff received training and supervision to enable them to do their jobs safely and to a good standard.

People were treated with respect and their privacy and dignity was promoted. People said their care workers were kind and caring. Staff were responsive to the needs of the people they supported and enabled them to maintain their independence as much as possible.

People's health and well-being was assessed with measures put in place to ensure people's needs were met in an individualised way. Medicines were managed well and staff handling medicines were only allowed to do so after completing their training and being assessed as competent. Where included in their care package, people were supported to eat and drink enough.

People received support that was individualised to their specific needs. Their needs were monitored and care plans reviewed regularly or as changes occurred. People's rights to make their own decisions, where possible, were protected and promoted by staff.

People benefitted from receiving a service that was managed well. Quality assurance systems were in place to monitor the quality of the care, the support being delivered and the running of the service.

We carried out an unannounced comprehensive inspection of this service on 27 and 28 November 2014 in which a breach of the legal requirements was found in relation to quality assurance of the service. This report relates to that breach. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Orchids Care’’ on our website at www.cqc.org.uk.

We carried out this focused inspection on 12 August 2015 to ensure improvements planned by the provider had been implemented to address this breach of Regulation. We found that action had been taken to improve the quality assurance of service provision.

Orchids Care is registered to provide personal care to people living in their own homes. The service aims to provide care and support to older people. Care and support was co-ordinated from the service’s office which is based at the same address.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this focused inspection we found quality and assurance for the services provided had been improved. We saw how the service had develop their quality assurance system to help them to gain a wider insight into the services that they provided and how this would lead onto further improvements within the service.

We also looked at the safeguarding adults and complaints record in the service, these records had been updated and were informed that there were plans for these to be improved further at a later stage.

We will review our rating for this service at our next comprehensive inspection to ensure the improvements made and planned, continue to be implemented and have been embedded into practice.

People’s privacy, dignity and independence were respected. A relative told us: “The staff who visit my wife are always polite and respectful, they never rush us.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People we spoke with were complimentary about the service they received. One person told us: “I can’t speak highly enough of them, they are like your own family.” One relative said: “The care plan is very comprehensive and up to date; it has changed over time with changing needs.”

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. One person told us: "They (staff), always remind me to take my medicines, they also watch me take it."

There were enough qualified, skilled and experienced staff to meet people’s needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People experienced care, treatment and support that met their needs and protected their rights. We were told "I am quite satisfied with the service I receive", "the carers I have now are very good and they know what I need and how I like things to be done". One relative told us "my mum’s carer is great".

People were protected from the risk of infection because appropriate guidance had been followed. Staff records showed appropriate infection control training had been received by staff.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work. This included carrying out a Criminal Records Bureau (CRB) check, taking up references from previous employers and checking evidence of the identification of new staff.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

People we spoke with told us they were looked after well; they understood their care and treatment. They told us they had copies of their care plan and were aware of what was written in the plan.

One person told us, “I am very happy with my carers, I am looked after very well”.

People we spoke with told us staff were very good, looked after them very well and that they were given choices.

People we spoke with also told us staff explained any care and treatment before it was delivered, and staff listened to their comments and views.

Two people we visited in their homes who received a service showed us their plan of care. They told us they had involvement in the plan and their choices and preferences were included

We inspected Orchids Care on 27 and 28 November 2014. The inspection was unannounced. Orchids Care was last inspected in October 2013, no concerns were identified at that inspection.

Orchids Care provides personal care for people in their own homes. On the day of the inspection approximately 70 people were receiving personal care services from the provider. The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

During our inspection we spoke by telephone with 16 people who used the service and three relatives. We also spoke with three care staff, the deputy manager of the service and the registered manager.

During our visit to the service we looked at the care records for seven people and looked at records that related to how the service was managed.

People who used this service were safe. The care staff knew how to identify if a person may be at risk of harm and the action to take if they had concerns about a person’s safety. The care staff knew the people they were supporting and the choices they had made about their care and their lives. People who used the service, and those who were important to them, were included in planning and agreeing to the care provided.

The decisions people made were respected. People were supported to maintain their independence and control over their lives. People received care from a team of staff who they knew and who knew them. The registered manager had procedures for informing people which staff would be carrying out each visit. This meant people knew who would be coming to their homes.

People were treated with kindness and respect. People we spoke with told us, “I have never had a concern about my helpers and feel very safe with them.”

The registered manager used safe recruitment systems to ensure that new staff were only employed if they were suitable to work in people’s homes. The staff employed by the service were aware of their responsibility to protect people from harm or abuse. They told us they would be confident reporting any concerns to a senior person in the service or to the local authority or CQC.

There were sufficient staff, with appropriate experience, training and skills to meet people’s needs. The service was well managed and took appropriate action if expected standards were not met. This ensured people received a safe service that promoted their rights and independence.

Staff were well supported through a system of induction, training, supervision, appraisal and professional development. There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to maintain their independence.

The service was not consistently well-led. There was not a comprehensive, formal quality assurance process in place. This could mean that not all aspects of the service was formally monitored to ensure good care was provided and planned improvements and changes may not be implemented in a timely manner. You can see what action we told the provider to take at the back of the full version of the report.

There were good systems in place for care staff or others to raise any concerns with the registered manager.