The inspection was unannounced and took place on 18 April 2017.

The service was last inspected in December 2014 where we rated the service good. At this inspection we found the service remained good.

Barchester Prestbury Beaumont Domiciliary Care Agency (DCA) is located one mile outside Prestbury town centre. This domiciliary care service is managed from Prestbury Beaumont Care Home, which is on the same site. The DCA service is available for people living in the bungalows and apartments on site owned by the people themselves. Many of the services provided to the people living in these were from staff and resources within the home. For example meals could be prepared and served in the home and people could join in with any social activities organised. This inspection focussed on the domiciliary care provided by Prestbury Beaumont DCA. At the time of the inspection the service offered support to nine people, however only one person received care and support which involved an activity the provider was registered for with the Care Quality Commission.

Prestbury Beaumont DCA has 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 saw that staff were recruited safely, appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care. Staffing levels were observed to be sufficient to meet the needs of the people receiving support from the agency.

We saw that the service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

People we spoke to confirmed that staff were kind, patient and knew them and their needs well and they received continuity of care as it was the same set of carers who assisted them on a regular basis.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005. This meant that the staff members were aware of people's rights to make their own decisions.

The care plans were person centred and reviewed when needed, so staff knew if any changes in care provision had been made. This helped to ensure that people’s needs continued to be met.

Staff members we spoke with were positive about how the agency was being managed. The staff members we spoke with were positive about the service and the quality of the support being provided.

The service had a complaints procedure and whilst no-one had raised any complaints, people knew who they could complain to and were confident this would be dealt with effectively.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the services, staff and resident meetings as well as spot checks to check the quality of the service as well as gain the views of the people receiving a service. The provider had an internal clinical governance system into which the registered manager submitted monthly information based on the audits undertaken within the agency to the company’s head office.

During our unannounced inspection on 24 July 2013 we spoke to the registered manager, five members of staff and three of the five people who used the service. We conducted this responsive inspection to follow up on some concerns that we had from a previous inspection.

People using the service confirmed that improvements had been made, one told us; “There has been a general improvement recently."

One member of staff told us; “Staffing is much improved, even with one staff member off sick and one on holiday, we have enough regular staff to cover the shifts.”

The home had recently been awarded the maximum five star rating for its food hygiene by the Food Standards Agency.

We looked at the procedures for dealing with complaints, one staff member told us; “We have been trained in dealing with complaints, I am comfortable I know what to do.”

During our inspection, we requested folders and documentation for examination. These were all produced quickly and contained the information that we had anticipated. This meant that the provider was keeping and storing records effectively.

We spoke to three of the ten people currently using the service, all of whom appeared very capable of making their own decisions. One said “I discussed and agreed the care I needed with the manager; I was comfortable making those decisions.”

The provider failed to review people’s care plans in a timely manner. Care plans were not reflecting people’s current care needs.

The people we spoke to told us they felt safe and protected. One person said; “I feel safe and secure here, it is comforting for my family to know I am safe and cared for.”

We asked the manager about the concerns that staff and people using the service had regarding low staffing levels. The manager accepted there were issues relating to staff numbers.

The people we spoke to were very satisfied by the skills and abilities of the staff delivering their care. One person said; “The best thing about this place are the staff. That’s everyone, the kitchen, cleaners and carers, everyone.”

We found that not all records were accurate or available for examination.

We spoke to people who use the service and they said:

“The staff are very kind and I have lived here for a number of years”.

“I like the food here”.

“The staff are pleasant and friendly”.

“My privacy is respected and the staff are warm and friendly”.

“The staff are all right”.

“They provide very nice independent care. I have access to meals, laundry and care support. The meals are mostly good and there is always a choice. The staff team is very good and they are pleasant and courteous. More staff and a wider range of activities would be good”.

We spoke with staff and they commented:

“The training is good here. I enjoy my job.”

“We do not have formal supervision.”

"I have worked here a long time and have seen a lot of changes.”

“I like my work. The training is good.”

“More staff would be good.”

The inspection was unannounced and took place on the 18 December 2014. An arranged visit to complete the inspection was then undertaken on the 22 December 2014.

The last inspection took place on the 24 July 2013 when Prestbury Beaumont Domiciliary Care Agency [DCA] was found to be meeting all the regulatory requirements looked at and which applied to this kind of service.

Barchester Prestbury Beaumont DCA is located one mile outside Prestbury Town Centre. This Domiciliary Care Service is managed from Prestbury Beaumont Care Home, which is on the same site. The DCA service is provided to people in the fourteen bungalows and nine apartments owned by the people themselves.

Prestbury Beaumont DCA is required to have a registered manager. 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. The provider had appointed a new management team with responsibility for the DCA and Prestbury Beaumont care home approximately six months before this inspection visit. As part of this re-structure a new home manager was appointed in May 2014, she is also the registered manager for the DCA.

New systems such as the arrangement of regular resident/relative meetings and a manager’s surgery had been put into place. The meetings and surgeries enabled people to discuss any issues.

At the time of the inspection six people living in the bungalows and apartments were receiving a service from the agency. Many of the services provided to the people living in these were from staff and resources within the home. For example meals could be prepared and served in the home and people could join in with any social activities organised. The ‘Independent Living’ accommodation also has an emergency call system so that the people living in them could summon assistance if needed.

Since the previous inspection the care home had undergone a refurbishment and the lounge and dining areas that can be used by the people living in the bungalows and apartments had been re-furnished and redecorated. In addition a new Spa providing a range of treatments such as manicures and a hydro pool had been built and had opened approximately two weeks before the inspection took place. This can be used by the people living in the independent living accommodation. One person using the DCA told us, “it is the best of all worlds. I can spend time in the home [care home]. The care is great – so well cared for. The best move I ever made”.

We saw that the service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

There had been no new staff members specifically employed to work in the DCA so we looked at the files for the three most recently appointed staff members who were employed to work in the care home to check that effective recruitment procedures had been completed. We found that the appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

The provider had their own induction training programme that was designed to ensure any new staff members had the skills they needed to do their jobs effectively and competently.

We asked two staff members working in the DCA about training and they both confirmed that they received regular training throughout the year and that it was up to date.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005. This meant that the staff members were aware of people's rights to make their own decisions.

We saw that the relationships between the people using the service and the staff employed were warm and respectful.

The care plans were reviewed when needed so staff knew what changes in care provision, if any, had been made. The two care plans which the service called, assisted living care profiles we looked at all explained what each person’s care needs were. This helped to ensure that people’s needs continued to be met.

Staff members we spoke with were positive about how the agency was being managed. The staff members we spoke with were positive about the service and the quality of the support being provided.

The provider, Barchester also had its own monthly internal clinical governance system into which the registered manager had to submit monthly information based on the audits undertaken within the agency to the company’s head office. This included, care plans, accidents, incidents, safeguarding allegations and complaints.