About the service: People in Action Domiciliary Care – Worcester provides a service to people with learning disabilities and autism living in their own homes. People’s support is based upon their individual needs and can range from a set number of hours each week to 24-hour care. At the time of this inspection the service was supporting five people with personal care.

People’s experience of using this service: Staff knew how to safeguard people and report suspected abuse. The relatives we spoke with told us they were happy with the support people received. Where incidents had taken place these were analysed, lessons were learnt and embedded into practice. Risks to people were assessed and staff were guided as to the actions to take to minimise the risks identified. Staff received the training they needed to carry out their roles. People were supported with their medicines by trained staff who had been assessed as competent in this area.

At the last inspection of the service the provider had not tested that the actions they had taken, which were in line with the person's best interests, might amount to depriving the person of their liberty. This issue had been addressed at this inspection. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service was flexible in meeting people’s needs in an individualised way.

People received a personalised service. The service manager and provider carried out checks and audits and sought feedback to make sure that the service was delivering a high standard of support to people. A system for recording and responding to complaints was in place. The management team worked with other agencies and professionals to support people fully.

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

Rating at last inspection: At the last inspection the service was rated good overall with effective rated as requires improvement (report published July 2016). The overall rating at this inspection remains the same and the effective domain had improved to good.

Why we inspected: This was a planned inspection to check that the service remained good.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

This inspection took place on 20 May 2016 and was announced. We made phone calls to people, relatives and staff who use the service on 23, 24 and 26 May 2016. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because People in Action provide personal care for people who live in their own homes and we needed to be sure that someone would be available at the office.

At the time of our inspection eight people used the service.

The registered manager had left the organisation two months prior to our inspection. We were not notified that the registered manager had left or what plans the provider had in place to register a new manager with the CQC. We only discovered this information when we gave notice to the provider of our inspection. On the day of our inspection there was a branch manager and a deputy manager. The branch manager had worked for this service for 12 months and explained that their area manager would be applying to become registered manager. Throughout the inspection we spoke with the branch manager as the area manager was unavailable 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 2008 and associated Regulations about how the service is run.

People felt safe with the staff who provided their care and felt they were protected from the risk harm. Staff recognised signs of abuse and knew how to report this. The branch manager ensured people’s risks had been looked at and took actions to minimise risks without taking away people’s right to make their own choices.

People told us there were enough staff to support them at the times they needed them. Staff told us they felt there were enough staff to provide safe care and support to people. The branch manager told us that advanced planning of staffing levels meant they knew that people’s needs were able to be met. People’s medicines were checked and managed in a safe way.

We found that the care and support people received was in-line with the Mental Capacity Act (MCA). However the provider had not tested that the actions they had needed to take, which were in line with the person’s best interests might amount to depriving the person of their liberty. The provider had not discussed this with the local authority, so that the Local Authority could submit an application to the Court of Protection to ensure the person was not being unnecessarily deprived of their liberty.

People were supported to eat a healthy balanced diet and were supported with enough fluids to keep them healthy. Staff supported people with access to healthcare professionals, and provided flexible times to ensure they made their doctor or hospital appointments.

People and where appropriate, family members, were involved in the planning around their care. People’s views and decisions they had made about their care were listened to and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected.

People knew how to make a complaint and felt comfortable to do this should they feel they needed to. People were provided with the information they needed should they wish to raise a complaint. The provider had not received any complaints over the last 12 months.

We found that the checks the provider completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to ensure that lessons were learnt and used to improve staff practice. Staff felt supported by the branch manager to carry out their roles and responsibilities effectively.

At the time of our inspection the provider did not have a registered manager in post.

At the time of this inspection, the agency provided personal care for 11 people in their own homes. During this inspection we spoke on the telephone with one person who used the agency and three relatives. We spoke with the two service managers, operations manager, one person who used the agency and three staff at the agency office.

People were complimentary about the care and support that they received. People told us: “I like my carers”. “They are nice to you”.

We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff received the training and support needed to ensure people received appropriate care.

The provider had systems of audit in place to enable them to monitor the quality of the service provided and ensure that people received appropriate care and treatment.

We found that any comments and complaints people made were responded to appropriately.

We inspected the agency office and spoke on the telephone with four people who used the agency. We also spoke with four members of staff who provided care to people. We found that people were able to express their views and had been involved in making decisions about their care and treatment.

People were complimentary about the care and support that the agency provided. One person told us, “They’re fine. We get on well with the girls.” Another person said, “They’re absolutely excellent. Very supportive.” This meant that people felt the agency were meeting their individual needs.

We found that people who used the agency were protected from the risk of abuse.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had systems in place to regularly assess and monitor the quality of service that people received.

We carried out this review to check on the care and welfare of people using this service.

We contacted eight people that used the service by telephone. When we made the telephone calls we spoke with the person who used the service or a relative.

People who used the service complimented the care and support they received from the agency. They told us that they had been involved in the initial assessment process and were happy to make changes to their care plans and direct care workers in the care they needed. People who used the service told us they felt supported both at home and in the community when attending an activity or college course.

People who used the service told us that they had a regular group of care workers. If a new care worker had been appointed they had been introduced to the person and the care worker had shadowed their usual care workers. They were able to request a different care workers if they had felt things were not working well. One family had told us that this had happened on one occasion and that the agency had responded well.