Person Centred Care is based in Cheltenham and provides personal care to over 48 people living in their own homes in Gloucestershire. Personal care is provided to older people, people living with dementia, a physical disability, a learning disability and mental health needs. Additional services can be provided and a further three people were receiving these without the provision of personal care.

At the last inspection on 20 August 2015, the service was rated Good. At this inspection we found the service remained Good.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People received individualised care which reflected their personal preferences, wishes and routines. Staff understood people really well and had developed positive relationships with people. They treated people with respect, dignity and sensitivity. People said, “Staff are doing a wonderful job”, “Very pleased with the whole team” and “Staff are top notch - absolutely dedicated.”

People were supported by staff who had been through a recruitment process to assess their skills and aptitude for their role. Staff completed an induction programme and training to equip them with the knowledge they needed to carry out their duties. They said communication between themselves and the office was good and they felt supported in their roles. The registered manager monitored the practice of staff through spot checks and from feedback from people and their relatives. Staff understood how to protect people's rights. People felt safe with the service they received.

The quality of care was monitored closely and the management team met weekly to review the service being provided. People, their relatives and staff were invited to take part in annual surveys of their experience of the service. A complaints process was in place and people knew who to raise issues or concerns with. Relatives commented, “We are extremely satisfied with the level of care given” and “We have been fortunate in the agency we chose.”

Further information is in the detailed findings below.

This was an unannounced inspection which took place on the 10 January 2017. Person Centred Care provides personal care for older and younger people, people living with dementia, people with a physical disability and a sensory disability who live in their own homes in Gloucestershire.

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.

We carried out an announced comprehensive inspection of this service on 20 August 2015. A breach of legal requirements was found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements in relation to a breach of regulation 17. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Person Centred Care on our website at www.cqc.org.uk”

At the comprehensive inspection of this service on 20 August 2015 a breach of legal requirements was found. After this comprehensive inspection, we asked the provider to take action to:

• ensure there was an accurate, complete and contemporaneous record in respect of each person in relation to the care being provided.

At this inspection we found action had been taken to make sure each person had an individualised and up to date care plan which reflected their needs and the support and care they required. Quality assurance systems had been introduced to monitor and review people’s care needs and to ensure their care records reflected the care and support currently being provided.

The provider had displayed the rating for this service on their website.

This was an announced inspection which included a visit to the offices of Person Centred Care on the 20 August 2015. This was followed up with visits to people in their own homes on 21, 24 and 26 August 2015.

Person Centred Care provides personal care to people living in their own homes in areas around Cheltenham and Gloucester. At the time of our inspection personal care was being provided to 15 people.

Person Centred Care has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

People’s care plans did not reflect the personalised and individualised care they were receiving. Staff understood how people liked to receive their care and the routines important to them but this information was not captured in people’s care plans. Staff did not have access to information about people’s background or history but learnt this during their interactions with people. This information had not been included in people’s care records.

People told us it was really important to them to have continuity of care and to have staff who they knew and who understood their needs. For the most part this was achieved and people felt they were given time and space to do things for themselves when they could and to be supported to maintain their life skills and independence. People gave positive feedback about the staff providing their care and were seen to have positive relationships with them. People were treated respectfully and sensitively by staff who were professional and kind. People were safeguarded from harm and staff understood how to keep people safe in their homes.

People benefited from staff who had been recruited using robust systems to make sure they were the right people for the right job. They had access to an effective training programme and to individual support helping them to develop professionally. Staff confirmed they felt supported and worked well as a team. They were valued by the provider and had incentives to recognise when they worked efficiently and well. People gave mixed feedback about whether there were sufficient staff to meet their schedule of visits effectively. Some people reported feeling rushed and visits being late but others said they had their visits as scheduled and staff had enough time to support them.

The service was well managed and resources were available to make improvements to systems to improve efficiency. The registered manager was aware of the challenges of providing a service of high standards. They worked closely with staff to promote their vision of “putting people first” and enabling people to continue living in their homes independently.

We found a 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 this report.

Our inspection of 4 April 2014 found effective recruitment procedures had not been operated to make sure staff were fit for the work they performed. There was no evidence that gaps in employment history or the reason for leaving former employment with vulnerable adults or children were obtained. This meant that people could potentially be put at risk of abuse. The provider sent us an action plan telling us what they had done to ensure this information was obtained. They provided us with copies of a new reference form which they had put in place to request information about the reason why staff left former employment with children or vulnerable adults.

We visited the provider and checked recruitment files for two new members of staff. All information required by the Health and Social Care Act 2008 had been obtained. Records for other staff had been checked to make sure all information had been put in place. This meant people were safe because the service followed effective recruitment practices.

We did not speak with people who use the service as part of this inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This inspection was completed by one inspector. They visited the office and also a person in receipt of personal care. This is a summary of what we found based on our observations, speaking with a person who used the service, talking with three staff and looking at records.

Is the service safe?

A person told us they felt safe with the team of staff supporting them. They were confident if they had any concerns the provider would listen to them and respond in a timely fashion. Staff spoken with told us how they would recognise abuse and how they would report it. They were aware of which other agencies and professionals needed to be alerted to alleged abuse.

A person told us they were fully involved in the assessment of their needs and care planning. They had discussed any hazards to them or in their home. They were confident staff understood these and how to support them safely. We found hazards were identified but records were not clear how these were being minimised. Systems were in place to record accidents and incidents although there had been none to report.

Recruitment practice was ineffective. All of the necessary checks were not being completed. Some staff files did not have copies of the application form. On the application forms we looked at there were gaps in employment history and the reason why people had left previous employment in care had not been obtained. The character and fitness of staff were not being checked to make sure they were able to do the work. This could potentially put people at risk of harm.

Is the service effective?

People were given information about the service they could expect to receive. A person told us,"the care is excellent, they look at the whole person". We observed a person being treated with dignity and respect. They confirmed care records reflected their wishes and preferences about how their personal care was to be delivered. Systems were in place to review these records.

Staff spoken with had a good understanding of people’s needs. New staff completed induction training to equip them with the skills and knowledge to meet people’s needs.

Is the service caring?

Staff spoken with were caring and professional about their role and the people they supported. A person told us the service they received was “tremendous” and “reassuring”. The provider had also received feedback from other people they supported including, “your valuable contribution is appreciated”. One relative commented they had seen considerable improvements in their relative since the provider had been supporting them.

A person told us their care was provided in accordance with their preferences and wishes. They said they were able to do things at their own pace and this was really important to them.

Is the service responsive?

An assessment was completed to make sure people's needs could be met. Reviews took place to keep this assessment up to date. A person told us if there were changes in their care needs the provider took action in a timely fashion. There were systems in place for staff to raise concerns about changes in people's needs with the provider. They said the provider would take the necessary action.

People were given information about how to make a complaint. A person said they would talk to staff or management if they had any concerns. They were confident they would be listened to and they would have an appropriate response.

A person told us they had made suggestions to the provider and these had been considered and put into action. Staff also commented that they felt they could influence change within the agency.

Is the service well led?

People and staff said they had made suggestions to the provider which had resulted in improvements to the service delivered. A quality assurance system was being developed which included feedback from people who used the service and staff. The provider checked on the quality of service provided by observing staff practice. They were also developing a range of monitoring and audit tools.

Staff had a good understanding of their roles and responsibilities. They said communication with the provider was robust and they felt well supported. They said management were always available whether in person or over the telephone.