This announced inspection took place on 27 February, 12 and 13 March 2018. This service is a domiciliary care agency and provides care and support to adults living in their own houses and flats. Not everyone using Percurra receives 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. During our inspection, 24 people were provided with ‘personal care’ by Percurra.

The service had a registered manager 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 a 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 and were supported by staff who knew what action they should take if they suspected abuse. Risks to people’s health and safety were assessed and measures were in place to reduce the risk of harm to people. People’s needs were met and the provider was taking action to ensure they continued to have a sufficient amount of staff. People were provided with medicines by staff who received the required training. The provider was in the process of implementing a new system to improve the administration of medicines. People were protected by the prevention and control of the spread of infection and action was taken in response to any accidents or incidents which occurred when the service was being delivered.

People were supported by staff who had received an induction when they commenced working at the service and training relevant to their role. People were supported to eat and drink enough and were supported with their health care needs. Information was available in the event that people needed to move between services. Staff were provided with information about people’s health conditions and the support they required with this. 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.

People were supported by staff who were kind and caring. Staff respected people’s preferences and wishes about how their support was delivered. People were supported to maintain their privacy and dignity. The provider was aware of support available to people to help them express their views and wishes and told us this would be considered if a person needed this support. People were supported to maintain their independence as much as possible.

People’s needs were assessed before they started using the service. People told us they received care and support at the time and in the way it was needed. People were supported to maintain their interests and important relationships. People were given opportunities to make a complaint or raise concerns about the service they received, however it was not always clear whether complainants were happy with the response provided. We have made a recommendation about ensuring that complaints were fully responded to. People were supported in line with their wishes at the end of their life.

People and staff told us that improvements were required with communication as they were not always informed of changes or received feedback. Systems were in place to monitor and improve the quality of the service and changes were being made to ensure that timely and accurate information was available to staff. A registered manager was in place who was aware of their responsibilities. The provider sought and acted upon people’s feedback in relation to the service they received.

This inspection was announced and took place on 8 November 2016. Percurra provides a service to adults living in their own homes. The service provides care and support to adults with a learning disability, mental health conditions, physical disabilities and sensory impairment. At the time of the inspection there were approximately 24 people using the service who received personal care.

The service had a registered manager in place 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.

At our inspection on 26 January and 4 February 2016, we asked the provider to take action to make improvements to staffing levels. Action had been taken by the provider and the recruitment of staff was on-going, however people and staff told us there were not sufficient numbers of staff. This resulted in people not always receiving the support which was planned.

People were kept safe by staff who understood their responsibilities with regard to protecting people they were caring for from harm or abuse. Potential risks to people’s safety had been assessed and responded to.

People who required support to take their medicines received assistance to do so. Staff who provided this assistance to people had been trained and assessed as competent to do so.

People were cared for by staff who received the training and support they required to carry out their roles effectively.

People were asked for their agreement to their care and had opportunities to provide written consent. People were supported to maintain their health and have sufficient to eat and drink.

People had positive relationships with their care workers. People and their relatives felt that their relation was treated with kindness and people’s privacy and dignity were respected.

People, who used the service, were encouraged to contribute to the planning and review of their care.

At our inspection on 26 January and 4 February 2016 we asked the provider to take action to make improvements to ensure care was planned which met people’s needs and preferences, and this action had been completed. People’s care plans contained sufficient information to guide staff and people told us that staff provided care and support in the manner they preferred.

At our inspection on 26 January and 4 February 2016 we asked the provider to take action to make improvements to ensure complaints were dealt with effectively. We found this action had been completed. People were provided with information about how to make a complaint and complaints were responded to.

At our inspection on 26 January and 4 February 2016 we asked the provider to take action to make improvements in relation to the governance of the service. We found that improvements had been made and we were receiving notifications as required. However further improvements were required to quality monitoring systems to ensure they were effective in identifying and responding efficiently to issues such as whether people were receiving visits in line with their needs and preferences.

People had mixed views on how well the service was run. People told us that when problems had been encountered this was as a result of poor communication.

This announced focused inspection took place on 25 August 2016. Percurra provides care and support to adults with a learning disability, mental health conditions, physical disabilities and sensory impairments who are living in their own homes. At the time of our inspection there were 23 people using the service who received personal care.

We carried out an announced comprehensive inspection of this service on 26 January and 4 February 2016. Breaches of legal requirements were found. We issued a warning notice in relation to one of these breaches.

We undertook this focused inspection to confirm that the provider had met the requirements of the warning notice. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Percurra on our website at www.cqc.org.uk.

The service had a registered manager in place 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 and associated Regulations about how the service is run.

At our last inspection on 26 January and 4 February 2016, we asked the provider to take action to ensure people were protected from the risk of abuse by effective systems and processes. This was because we found that procedures had not always been followed when allegations of abuse had been made.

During this inspection, we found that the required action had been taken by the provider to ensure that procedures were followed when safeguarding concerns were identified.

We could not improve the rating for effective from requires improvement because to do so requires consistent good practice over time. We will check this during or next planned comprehensive inspection.

This announced inspection was carried out on 26 January and 4 February 2016. Percurra provides a service to adults living in their own homes. The service provides care and support to adults with a learning disability, mental health conditions, physical disabilities and sensory impairments. At the time of the inspection there were approximately 30 people using the service who received personal care.

The service had a registered manager in place 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.

Where people had experienced, or were at risk of experiencing abuse or harm, the procedures in place to protect them were not followed. People did not always receive the care and support they wanted because there were insufficient staff to provide this.

People may not always receive their care or any medicines they take as safely as they could do because the safest practices for them to do so were not always recognised or followed.

There were times where people were supported by staff who did not have the right skills and knowledge to meet their needs.

People were asked for their agreement to their care and had opportunities to provide written consent. People were supported to maintain their health and have sufficient to eat and drink.

People did not always have a caring experience due to systems not always being effective in allocating the right staff. People were able to request flexibility with their care and support.

People who had raised concerns and complaints about their care did feel these had been considered and rectified. People’s plans of care were not kept up to date and did not contain all the information staff needed to meet their needs.

People had mixed views on how well the service was run. Where people came across problems they did not have a positive experience but other people who did not encounter problems spoke positively about the service. There was not the information available to ensure quality monitoring systems identified where there were problems within the service, and how these could be corrected.

The provider has not notified us of events there were required to.

We found a number of 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 report.

People using the service were involved in decisions about their care and support. They were supported to be involved in the implementation and review of their support plan.

We spoke with seven people who were using the service and they all said they were happy with the care and support staff gave them. Comments we received included, "The support I get is very good. I can’t fault it”, “I am really happy with them [the service]”, “I can’t fault them. I am cared for well” and “The staff listen to what I say about my care but they know me inside out too.” We spoke with one relative who said, “Generally everything is absolutely super. With regards to care it’s bang on.”

People we spoke with told us they felt safe with the staff and that if they had any concerns they could raise them with the manager or other staff. One person said, “If there are any problems I can call the office and they put it right.”

We found that staff were supported to receive appropriate training and development. People spoke positively about the staff working for the service. One person said, “Staff are super, they know what they are doing.”

We saw the provider measured the quality of the service and recognised improvements that needed to be made. There were systems in place to gain the views of people using the service.

We saw appropriate records and documents were kept at the office and were available to staff. Records we requested were located promptly by staff.