Orwell Mencap Genesis is a domiciliary care agency for adults with learning disabilities. It provides personal care to people living in their own houses and flats. Not everyone using the service receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of this announced inspection of 10 and 12 January 2018 there were five people who used the service.

The provider was given up to 48 hours’ notice because we wanted to be certain the registered manager and key staff would be available on the day of our inspection. We also wanted to give them sufficient time to make agreements with people and their relatives so we could meet and talk to them to find out their experiences of the service. This service was registered with CQC on 11 January 2011.

At our last inspection 8 December 2015 we rated the service as overall good, however safe was rated as requires improvement. There were inconsistencies in the recruitment processes and risks to people were not always assessed and reviewed appropriately. At our inspection 10 and 12 January 2018 we found that improvements had been made and contributed towards people consistently receiving safe, effective, compassionate and high quality care.

A registered manager was in post. 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.

Orwell Mencap Genesis provided a safe service to people. This included systems intended to minimise the risks to people, including from abuse, mobility, nutrition and with accessing the community. Support workers understood their roles and responsibilities in keeping people safe.

Recruitment checks were carried out with sufficient numbers of support workers employed who had the knowledge and skills through regular supervision and training to meet people’s needs.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services. At the time of this inspection no one was being supported with their medicines however systems were in place to provide this support safely when required.

People and relatives had developed good relationships with the support workers and the registered manager. People received care that was personalised and responsive to their needs. People’s care records were accurate and reflected the support provided.

People were supported to have maximum choice and control of their lives and support workers supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were able to express their views and support workers listened to what they said and took action to ensure their decisions were acted on. Support workers consistently protected people’s privacy and dignity.

Support workers received training in infection control and food hygiene and understood their responsibilities relating to these areas. Systems were in place to reduce the risks of cross infection.

The service listened to people’s experiences, concerns and complaints and took action where needed. People, relatives and staff told us the registered manager was accessible, supportive and had good leadership skills. The service had a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to progress.

The inspection took place on 8 December 2015.

Genesis is a domiciliary care service that provides people with personal care in their own homes. At the time of the inspection seven people were using the service.

The service is required to and did have 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.

The way staff were recruited needed to improve in terms of how references were obtained and recorded but in general recruitment processes were safe and robust. Risks were not always assessed and reviewed appropriately although staff knew people very well and were able to keep them safe.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the framework of the Mental Capacity Act 2005 (MCA). Management understood their responsibilities under the Act.

People were given support and choices in their daily lives from staff that knew them well and were passionate about the care they provided. Staff were well trained and supported to ensure good quality care was delivered to people.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. People were supported to identify their own interests and pursue them with the assistance of staff.

The service had an open culture and everyone, including people, relatives and staff felt that management were approachable and they felt well cared for and valued.

Systems were in place to make sure that people’s views were gathered. These included regular reviews of people’s care, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. The service was assisted to run effectively by the use of quality monitoring systems carried out by the management team, which identified any improvements needed. A complaints procedure was in place and people and relatives were confident to raise concerns if needed.

Orwell Mencap Genesis currently provides personal care to four people in their own homes. We spoke with three relatives on behalf of the people who used the service. They confirmed they were satisfied with the care, treatment and support provided and had been part of developing the care arrangements in place.

We looked at two people’s care records which provided information for staff on how to meet people’s individual health and care needs. We saw that people’s choices and preferences were reflected in the care records and written in a way that promoted their independence.

The care records showed that people's needs were assessed and care and treatment was planned in line with their individual care plan.

We saw the provider’s policies and procedures, which included safeguarding vulnerable adults from abuse, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw that the safeguarding policy included information of the local procedures for reporting abuse. This included reporting to the local authority safeguarding team, who were responsible for investigating concerns of abuse.

We looked at staff records and spoke with two members of staff who told us they were being appropriately supervised and supported. Staff we spoke with were knowledgeable about the people they supported and how to meet their needs.

We saw that the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided.

We spoke with three relatives of people who used the service and two members of staff. The relatives told us that the support workers who provided care, treated people who used the service with respect and consulted them and their relatives on the care that they required and how they would like it delivered. One relative told us that, "The staff all have the skills they need and if there were any issues I would feel confident to say straight away."

The staff we spoke to were very complimentary about the support they received, the recruitment process and the ongoing supervision and training. One member of staff said "If I saw something I felt was not right I would have no hesitation in raising it and I know I would have the backing to deal with it."

We spoke with one person who used the service and the relatives of three people who used the service. All told us that the care workers treated the people who used the service with respect and supported them in the ways that they needed and preferred. They were consulted about the care and support that was provided.