We undertook an announced inspection on 16 January 2017 of Peepal Care. Peepal Care is a small domiciliary care agency care agency registered to provide personal care to people in their own homes. The service mainly caters for the Gujarati community and some of the care workers are live in carers as well

At the time of the inspection, the service was providing care and supporting nine people. There were eight care workers employed by the service.

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 on 21 December 2015, the service did not meet Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found risks to people’s needs were not assessed appropriately, care workers performance had not been assessed effectively, care records were not person centred and auditing processes were not robust enough to monitor and improve the quality of the service. This meant the quality rating we awarded was requires improvement.

Following our December 2015 inspection we received an action plan from the service telling us what action they would take. At this inspection the registered manager was able to demonstrate that measures had been put in place since the last inspection to respond to the issues identified and meet regulations. Positive feedback was also received by people using the service and relatives.

Systems and processes were in place to help protect people from the risk of harm and care workers demonstrated that they were aware of these. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risks to people were assessed and identified according to people’s specific needs.

People and relatives told us that they were confident that most care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers spoke positively about their experiences working for the service. Spot checks were in place to assess care worker’s competency.

Staff were informed of changes occurring within the service through regular staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

People received care that was responsive to their needs. People's daily routines were reflected in their care plans and the service encouraged and prompted people's independence. Care plans included information about people's preferences.

There was consistency in the level of care people received. People using the service and relatives told us their care workers turned up on time and they received the same care worker on a regular basis. The service had a system in place to monitor care workers punctuality.

Care workers had a good understanding of the importance of treating people with respect and dignity. Feedback from relatives indicated that positive relationships had developed between people using the service and their care worker and people were treated with dignity and respect.

Arrangements were in place in respect of medicines. Care workers had received medicines training and policies and procedures were in place.

Systems were in place to monitor and improve the quality of the service. We found the service had obtained feedback about the quality of the service people received through review meetings, telephone monitoring and satisfaction surveys. Records showed positive feedback had been provided about the service. The service also undertook audits of the quality of the service and took action to improve the service as a r

We spoke with two people who used the service and two relatives of people who used the service. One person who used the service told us “I am very happy with the care provided”. Another person said “carers provide good support”. People told us that they had been treated with respect and dignity. One relative told us that they were “very happy with the care” and had no concerns. Another relative told us that the agency was “very helpful and accommodating”.

We spoke with five members of staff who were aware of the importance of treating people with respect and ensuring that people were always offered a choice.

The care of people had been assessed and care plans prepared. These were signed by people receiving the care which indicated that they agreed and understood their care plans. There was evidence that care plans and risk assessments were reviewed and updated where necessary.

We observed that the provider had an effective system to assess and monitor the quality of service that people receive.

Records we looked at were accurate and fit for purpose.

We spoke with two people who used the service and one carer on the telephone to seek their views on the quality of the service provided. They told us that they were satisfied with their care workers and overall the service that was provided. One of them told us that ‘Everything is running smoothly’.

We looked at various care records and satisfaction survey forms and saw that people gave positive feedback indicating that the service improved the quality of their lives.

We also spoke with two members of staff on the telephone. They told us they were happy with the support and training that was provided by Peepal Care. They also told us they got on well with the people they provided care for.

We found that people were provided with information regarding the service and provided a flexible service to meet individual wishes and needs. We also found that there were appropriate procedures in place to safeguard people from abuse and to monitor the services in order to ensure people’s welfare and safety.

We undertook an announced inspection on 21 December 2015 of Peepal Care. Peepal Care is a small domiciliary care agency care agency registered to provide personal care to people in their own homes. The service mainly caters for the Gujarati community and some of the care workers are live in carers as well. The agency currently provides care to 28 people.

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 on 25 September and 3 October 2014, the service did not meet Regulations 11 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to Regulation 13 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. At this inspection the registered manager was able to demonstrate that measures had been put in place since the last inspection to address the issues identified. This regulation has now been met.

People using the service experienced consistency in the care they received and had regular care workers.

Risks to people were identified. Although the risk assessments were specific to people’s individual needs, it was sometimes unclear as to whether identified risks were being managed appropriately and what measures were in place to minimise risks.

Records showed and staff told us they received regular training and received support from the registered manager. Appropriate checks were carried out when staff were recruited. However, care worker levels of competency were not being assessed effectively.

There were some arrangements in place to obtain, and act in accordance with the consent of people using the service. People’s care plans contained a ‘Capacity for Decision Making’ section which indicated they had given their consent for the care to be provided. However care plans contained limited information about a person’s mental capacity and levels of comprehension.

People using the service were treated with dignity and respect and their independence was promoted.

People’s plans consisted of a health and support plan and risk assessments, however information was task focused.

There was a management structure in place with a team of care workers and the registered manager. People using the service and relatives told us the registered manager was approachable and easily contactable.

We noted that the registered manager was responsible for the majority of work that needed to be done in the service. The registered manager told us that they may consider an additional member of staff in the office to support the registered manager and enable the service to be managed more effectively.

We have made two recommendations about arrangements for people using the service and relatives to express their views on people’s care and the management of medicines.

We found four breaches 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 this report.