About the service: PCT Care Services Ltd Head Office is a domiciliary care service. They provide personal care and support to people living in their own homes. At the time of our inspection 73 people were using the service and it employed 35 care staff.

People’s experience of using this service:

¿Risk assessments and associated care plans, including those relating to people’s medicines, required some improvements.

¿Potential safeguarding incidents had been robustly responded to but had not always been discussed and referred to the local authority adult safeguarding team.

¿We have made a recommendation that the service reviews relevant guidance regarding MCA and deprivation of liberty in community settings.

¿People received timely and responsive support from consistent staff who were kind, caring, and supportive of people’s dignity and independence.

¿Staff supported people with their healthcare needs and ensured people had enough to eat and drink.

¿Staff had a good knowledge of people’s individual needs, wishes, and preferences. This was supported by life story work that staff undertook with people.

¿Staff supported people in achieving goals and wishes for the future, this included accessing community resources and helping them to participate in activities and hobbies.

¿The service was well run, it engaged in learning opportunities and strove to develop high quality person centred care. There was a clear ethos and wish to improve people’s overall quality of life.

¿People, relatives, and staff were happy with the service and the quality of care provided.

Rating at last inspection: At our last inspection, the service was rated "good". Our last report was published on 21 July 2016.

Why we inspected: We inspected this service in line with our inspection schedule for services currently rated as Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any information is received that we need to follow up we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 15 and 16 June 2016 and was announced.

The agency provides support to people in their own homes. The support people receive varies from help with bathing or washing, medicines and meal preparation, to support with activities. At the time of our inspection, there were 79 people using the service.

The agency had a registered manager in post. A registered manager is a person who has registered with CQC 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.

At our last inspection in March 2015, we found that the agency needed to improve in all areas. The service had breached two regulations, for ensuring proper staff support and training, and for monitoring the quality and safety of the service properly. We asked the provider to make improvements in these areas. The provider also told us how they would make improvements in all other areas and we found they had worked hard to do so.

The safety of the service people received, if they needed support to manage their medicines, had improved. Staff had better training in the safe administration of medicines and assessments of their competence to do this safely.

People received assistance from sufficient numbers of staff to meet their needs safely. Recruitment processes contributed to protecting people from the employment of staff who were unsuitable to work in care. Staff were aware of their obligations to report concerns that people may be at risk of harm or abuse. Staff providing care also took into account the risks to people's safety and wellbeing and knew what they needed to do to promote people’s safety.

Significant improvements had been made in the way that staff were trained and supported to meet people's needs competently. People felt that staff understood how to support them properly. Staff training in the Mental Capacity Act 2005 was still under-developed. This provides guidance for staff about supporting people who may find it difficult to make informed decisions about their care. However, staff recognised the importance of seeking people's consent before they started to deliver care.

Staff understood the importance of making sure that people had enough to eat and drink, where this was part of their care package. They were alert to changes in people's health and welfare so they could seek advice promptly to help people recover or stay well.

People were more involved and consulted about their care than they had been before. Staff reviewed people's needs more regularly with them, to see whether they needed to make changes. Staff were aware of the specific, individual needs of the people they supported.

People received support from kind and compassionate staff who treated them with respect for their privacy and dignity. People were confident that staff and the management team would listen to and address any concerns or complaints they had.

The new management team had made improvements in the way that the quality and safety of the service was monitored. They had also improved the way that the views of people using and working in the service were taken into account. They listened to people's suggestions and views and told people what they were doing about these. They were aware of the need to make further improvements and to sustain the improvements they had already made.

This inspection took place on 16 March 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We needed to be sure that someone would be available in the office. The inspection was carried out by one inspector.

PCT Care Services Head Office provides support and care to people in their own homes across East Anglia. The agency support varies from help with bathing or washing and meal preparation, to support with activities. Support is also provided to some families.

There was 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.

At our last inspection there was a breach of regulations for the recruitment of staff. Recruitment practices were not sufficiently robust to ensure people were protected from staff who were unsuitable for care work. At this inspection we found that improvements had been made to meet the relevant regulation.

People were safe in the service and staff knew what to do if they suspected someone was being abused. Risks to people’s safety and welfare were assessed. However, where staff needed to assist them with medicines, these were not always given as the prescriber intended. There were enough staff to ensure that people were not left without support although expected schedules could not always be adhered to.

Staff did not always receive training and support to ensure they had the skills and knowledge required to support people effectively. There was a lack of training for staff in the Mental Capacity Act 2005 about supporting people who may not be able to make informed decisions about their care. Staff understood the importance of ensuring people had enough to eat and drink where this was a part of their care package.

Staff were kind to people, respecting their privacy and promoting their dignity. However, people or their relatives were not always involved in decisions about their care plans.

People’s needs were assessed and care was planned that would meet each person’s needs but this was not kept under regular review to see if changes were necessary. People knew who to contact to make a complaint but were not always sure about what they could expect from the provider’s procedure for dealing with these.

Although people were satisfied with the quality of support they received, the systems for monitoring the quality of the service were not wholly effective in identifying where improvements were needed. Progress made was not always sustained and the views of people using and working in the service were not consistently used to drive improvements.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in April 2015. You can see what action we told the provider to take at the back of the full version of the report.

We found that people's needs were assessed, including risks to which they were exposed. People told us that they had been involved in deciding what care was needed. People spoken with (or family members if people found it difficult to speak on the telephone) all confirmed that staff checked with them whether there was anything else that needed doing before they finished their visit. One person said, "They always check what needs doing." They described their carers as "so experienced they take changes into account and listen to suggestions." Another commented about their care and said, "It's very good. I wouldn't fault it really."

The provider and manager were aware of the importance of protecting people from abuse and of working with other agencies to ensure concerns were properly responded to. People using the agency said that they felt safe with the staff. One person said, "All I can say is that they are extremely gentle and I feel very secure. I trust them to help me when I need it." Another person told us, "The carers are very good. I haven't found a wrong one yet."

There were shortfalls in the level of supervision that staff received to support them in their work and discuss development needs. However, people felt that the staff supporting them were competent and caring. A relative said, "They do appear well trained and I know they go to structured training events. They know what they are doing." A person using the service told us, "I would like to say they go beyond the bounds of their duties." Another commented that there were "...no shortfalls. They are very competent."

We found that improvements were needed to the way the quality of the service was monitored by the provider. However, people spoken with had no concerns about the quality of the support that the agency provided.

An inspector for adult social care carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with 12 people who used the service or their family members if they found it difficult to communicate on the telephone. We also spoke to the owner, the registered manager and six other members of staff. We reviewed records relating to the management of the service which included six sets of care records, staff records and quality assurance survey results.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Risks to people using the service were assessed. Staff had guidance and training for safely assisting people with mobility difficulties. They also had training and equipment (such as gloves and aprons) to ensure people were protected from the spread of infection and people needing assistance confirmed that staff used it.

Recruitment procedures were not wholly robust and thorough. Although background checks were made to ensure people were not barred from working with vulnerable adults, the interview process did not routinely provide for exploring the skills, experience and full employment histories of prospective employees. In addition, there was inadequate accounting for any issues to ensure there were no concerns for people's safety in respect of unsuitable members of staff. We have asked the provider to tell us what they are going to do to improve the effectiveness of their recruitment procedures.

We received positive comments from people about staff. For example, one person said, "I feel safe. I couldn't fault them at all. I couldn't have anyone better. They really are top rate."

Is the service effective?

People's health and care needs were assessed with them or their relatives if they found this difficult because of confusion or communication difficulties. People told us they were involved in developing their plans of care and staff provided the support they needed.

Staff received supervision, appraisal and training to make sure they were able to meet people's needs effectively. Staff were able to tell us about someone's needs and the information they gave us matched with the person's care plan and information from their relative. This showed that staff understood what was expected of them to promote people's health and welfare.

Is the service caring?

People using the service or their relatives told us that staff were caring and kind in their approach. One relative told us that that staff always asked, "Is it okay to do this?" They felt that staff asked permission about doing things, involved the person and told us, "That makes you feel more than human." Another said, "They speak to us really nicely. They're like friends some of them, they're all great." One person commented, "They're all civilised and listen to what I think. They're very polite. We laugh and joke but they don't overstep the mark."

People felt that they were given sufficient time during staff visits for their needs to be met and for them to do what they could for themselves without being rushed. The agency does not take contracts for 15 minute visits. All visits are a minimum of half an hour to allow for staff to meet people's needs properly.

Is the service responsive?

People told us that, where they had needed to raise any issues about their care or about staff, the management team responded to these. They also told us that staff always checked if there was anything else that needed doing before they concluded their visit. Where staff had raised concerns about people's welfare or safety, the manager took prompt action to secure additional advice or equipment. A relative also told us that staff were quick to spot when someone's health changed and to ensure that medical advice was taken as and when required.

Is the service well-led?

There were assessments of risks relating to the delivery of care, including any risks posed to staff working in people's own homes. These were documented and recorded to ensure they were minimised. Staff felt that they could raise suggestions for improvement and any concerns with the management team. People using the service also described the office staff as approachable if they had any issues.

There was a quality assurance system which provided for consulting with people and their relatives. Where shortfalls or concerns were identified, these were addressed promptly. People told us that, if they had needed to raise any concerns, these were dealt with promptly so that the service was improved. Senior staff, including the manager, were involved in spot checks on staff to make sure they were carrying out their duties as expected and so any shortfalls could be addressed.