Pathways to Opportunities is a domiciliary care agency. It supports people to live in their own homes in the community and provides personal care to people with learning disabilities and any other additional needs. At the time of the inspection the registered provider was providing support to 19 people.

At the last inspection, which took place in December 2015. The service was given a rating of 'Good'. At that time we also found one breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. This related to the lack of appropriate systems to record and respond to complaints. At this inspection we saw improvements had been made and the service was meeting all regulations at this time.

This inspection took place on 8 March 2018 and was announced.

At this inspection we found the service remained 'Good'. We found that these standards had been maintained and improved further. The service was very well-led. Skilled and caring staff supported people in a person centred way. Staff embraced people's diversity and this was reflected in the care plans we saw.

There was a registered manager at the time of the 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 2008 and associated Regulations about how the service is run.

The registered manager was based at the office five days per week supported by a team of management personnel. There was a manager available by telephone at all times.

During this inspection we reviewed a range of care records. Care plans were detailed, consistent and contained up to date information. Risk assessments were regularly reviewed and were updated accordingly.

Medicine management systems were in place. Medicine was only administered by staff who had received the appropriate training. Regular medicine audits were taking place and people received all medicines which were prescribed for them.

People were protected from abuse and supported to make their own choices. Risks were identified and managed effectively to protect people from avoidable harm. Recruitment processes were in place to make sure that people were protected from staff being employed that were not suitable.

People received support from a staff team that was well trained and supervised. Staff had the skills and support needed to deliver care to a good standard.

People benefitted from a staff team that was caring and respectful. Staff knew each person well and worked with them in a calm, caring and professional way. People's rights to confidentiality, dignity and privacy were respected. They were enabled and encouraged to develop and maintain their independence wherever possible.

Staff told us they enjoyed working at the service and felt supported by the registered manager.

Quality assurance systems were in place and regularly carried out by both the provider and registered manager. Feedback was sought from people who used the service, staff and relatives, this information was analysed, and action plans produced when needed.

The provider continues to work in partnership with other organisations and has taken part in good practice initiatives, designed to further develop the service and support other providers to develop their services.

Pathways to Opportunities is a provider that offers three types of service for people. The domiciliary care service provided personal care and support to people living in their own homes. This aspect of the service is registered by the Care Quality Commission (CQC). In addition the provider had a day service that people can attend, and an outreach service that gave people the opportunity to develop their personal and social skills.

People had their care needs assessed regularly. They had been asked about their preferred routines and their likes and dislikes. People told us they were treated respectfully by care workers. Their comments included “Staff are prompt; they listen and don’t rush me” and “I would recommend the service and already have”.

Care workers understood the process for making a safeguarding referral if they thought a person was being abused. Safeguarding training was provided for staff during their induction process.

The provider had an in-depth recruitment process to help confirm staff members were of good character and had the required skills to perform their work.

The provider had a quality assurance and risk assessment system in place to protect people from the risk of inappropriate or unsafe care.

We undertook an announced inspection of Pathways to Opportunities on the 4 December 2015 and spoke with people who use the service and their relatives on the 16 December. The inspection was announced 48 hours prior to our visit to ensure that the registered manager or other responsible person would be available to assist with the inspection.

Pathways to Opportunities is a service that provides care to people within their own home or out in their local community. The main office is situated centrally to Oldham and support is provided to people in and around Oldham. The services provided include personal care, assistance with medication, cooking meals, daily activities and shopping. At the time of our inspection 15 people used the service.

The service had a registered manager 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.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives were confident they would be listened to and any action would be taken to resolve their concerns. However the register manager did not have a formal method of recording complaints.

Support workers who had been recently recruited told us they had been through a robust recruitment process. We saw that Pathways to Opportunities recruitment and selection policy had been followed in the recent employment of support workers. We looked at the training records for all support workers. Newly recruited support workers had received induction training when they started their employment and had shadowed existing staff.

Care plans were in place that reflected the needs of the people. This included information about how people wanted to be supported, their likes and dislikes, when support was required, and how this was to be delivered. We saw evidence of people and their relatives being involved in the decision making process throughout the initial assessment and during reviews of their care.

We looked at the medication administration record (MAR) charts for all the people who used the service. The recording of medicines was done in line with current guidance.

Information regarding people’s dietary needs was included in people’s care plan, and detailed guidance for support workers was provided in order to ensure that they met these requirements. Any specific dietary requirements were clearly documented, and all allergies were written in bold so support workers were aware of any risk to a person’s health.

Support workers were able to respond to people’s individual needs by following care plans. We spoke with three people who confirmed they received support to access the community to participate in leisure activities. One person confirmed that their support worker’s would accompany them to attend health appointments or request health professionals to visit the home if needed.

All support worker had undertaken training in the Mental Capacity Act (MCA) or were allocated a date for completing training in MCA; this legislation provides legal safeguards for people who may be unable to make their own decisions. The registered manager explained that they worked alongside the local authority and would agree people’s capacity to consent to the care and treatment prior to any service being commenced. This was evidenced and documented in the care plans.

People who used the service provided positive feedback about the staff who supported them. During the inspection we noted warm, friendly and respectful interactions between the support workers and the people they were supporting.