Quality Homecare is a domiciliary care agency. At the time of our inspection they provided personal care to 456 people living in their own homes. It provided a service to people with dementia, physical disability, ill health related to age and some younger adults with a physical or learning disability.

Not everyone using Quality Homecare received the 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.

At our last inspection in May 2017, the service was rated 'Requires Improvement' because the provider had not always acted on feedback given to them and the systems that monitored the quality of the service had not identified this. At this inspection we found the provider had taken the right action and the service was now rated ‘Good’.

The service had 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.

As far as possible, people were protected from harm and abuse. Staff knew how to recognise the signs of abuse and what they should do if they thought someone was a risk. There were enough staff to support people to stay safe and meet their needs. Staff knew how to report incidents and accidents, and if these did occur, they were properly investigated. Risk assessment and risk management practices were robust.

People were supported to express their choices and preferences and they experienced care that met their needs. People were supported by kind, caring staff. People had their privacy and dignity respected, and staff knew what to do to make sure people’s independence was promoted. People experienced person centred care and were supported to make their end of life care wishes known.

People were supported to eat and drink enough and were able to access the healthcare they needed to remain well. Medicines were safely managed. People had their care needs regularly assessed, and people were involved in their care reviews. People experienced care and support that was in line with current guidance and standards.

Staff were supported with training, supervision and appraisals to make sure they had the skills they needed to provide good quality care. Specialist training had been arranged where needed, for example, in caring for people who lived with dementia Staff recruitment procedures ensured checks were made that staff were safe to work with people.

People were asked for their consent before any care was given, and staff made sure they always acted in people’s best interests. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and any decisions were made in people’s best interests.

People had access to a complaints process, and said they would be happy to raise a complaint if they ever needed to. The registered manager and staff knew what action to take if a complaint were made, and complaints were properly investigated and resolved.

The service was well-led and staff felt supported. People’s views were sought and acted on to improve the service. Regular checks and audits were carried out to make sure people experienced good quality care and staff provided good support. The service had met all the fundamental standards and the registered manager and staff had improved the service so it was now good.

Further information is in the detailed findings below.

This inspection took place on 28 April and 2 May 2017 and was announced. We gave the provider 24 hours’ notice because we needed to be sure the right people would be available to talk to us when we visited. Quality Homecare provides personal care to people living in their own homes. The service was supporting 580 people at the time of this inspection, who had a range of needs including dementia, physical disability or ill health related to age.

We carried out an announced comprehensive inspection of this service on 23 March 2016. One breach of legal requirements was found and there were areas of practice that required improvement. We undertook this inspection to check they now met legal requirements.

There is a registered manager at the service. 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 the inspection in March 2016 we found the provider had not notified us of certain events, as they are required to do so by law so were in breach of regulation. At this inspection we found this regulation was now being met, and the registered manager had sent all of the relevant notifications to us. We also found there was lack of continuity of staff and inconsistent care visit times. Some people commented there was poor communication at times, and their calls or messages were not always returned. At this inspection we found the provider had made good improvements to the timing of calls and their communication. However, this area of practice needed time to be developed and improved further.

Although the registered manager made sure they monitored the quality of the service they provided, they had not always identified where improvements continued to be required. People had concerns about the timing of their care visits and the inconsistency of care workers at the weekends, although people did acknowledged some improvements had been made in these areas.

At the last inspection we found the provider needed to make improvements in the areas of staff appraisal and we recommended the provider ensured staff had training in the Mental Capacity Act (2005) (MCA). This legislation provides a legal framework for acting and making decisions on behalf of adults who lack the capacity to make decisions for themselves.

At this inspection we found appraisals had improved and MCA training had been completed. Staff had a basic understanding of the MCA and the registered manager was taking action to ensure they reviewed each person’s lasting power of attorney if they had one in place. An LPA is a legal tool that allows people to appoint someone to make financial or health and social care decisions on their behalf. People were asked for their consent appropriately.

There were enough staff to meet people’s care needs and staff had regular training, supervision and appraisal to support them. Appropriate pre-employment checks had been completed before staff began working for the provider.

People who used the service told us they felt safe. Staff knew how to recognise the signs of abuse and what to do if they thought someone was at risk. Risk assessments had been completed and plans to manage identified risks were in place. People were supported to take their medicines safely when needed.

Incidents and accidents were investigated and action taken to reduce the risk of them being repeated. The registered manager and staff understood the importance of learning from incidents so they could make improvements to the service.

People gave us positive feedback about the care they received. People were able to express their views and preferences about their care and these were acted on. People were treated with respect and their privacy was protected. People were supporte

This inspection took place on 23 March 2016. To ensure we met the registered manager and staff at the service’s main office, we gave short notice of our inspection.

This location is registered to provide personal care to people in their own homes.

The service provided personal care support to 500 people in the community. People who used the service were younger and older adults with either physical or mental health needs or learning disabilities and people with palliative care needs.

The service had 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.

We have not been routinely informed by the registered person of all reportable incidents which occurred at the service.

The lack of statutory notifications to inform us of incidents occurring at the service is a breach of regulation18 of the Care Quality Commission (Registration) Regulations 2009.

Staff appraisals were in place to review staff performance and development needs. Staff appraisal forms did not always contain sufficient detail for the appraisal to be utilised fully. One staff member needed to improve their timekeeping. Constructive feedback was not always recorded as to how performance could be improved, support provided and whether the issue had been resolved.

We have made a recommendation about the staff appraisal system.

Staff were observed in practice to monitor that care was provided in an appropriate way which met people’s preferences and needs. Where issues with staff practice were identified it was not always clear what action the provider had taken to address the shortfall in practice. Telephone monitoring calls were made to people to monitor their satisfaction levels with the service provided. One record stated that a person had said, ‘Lateness of staff if carers are off sick’ The provider’s response to this concern was not clear and had not been recorded.

We have made a recommendation about records management.

Some staff had completed training in the principles of the Mental Capacity Act 2005 (MCA). However some staff said they could not recall having completed this training. Staff we spoke with were able to explain how they obtained people’s consent to care provided and protected people’s rights to make their own decisions.

We have made a recommendation that staff attend training in MCA 2005 and DoLS.

Some people reported concerns about late calls and lack of continuity of care staff to meet their care needs. No care calls had been missed. Some people said they had experienced calls at times they had not agreed and with different staff visiting them. The lack of consistency of care in these cases caused people anxiety and frustration and did not meet their preferences. The registered manager was continuously implementing improvements to improve continuity of care staff to meet people’s needs.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

There were sufficient staff available to meet people’s needs. Staffing levels were adjusted according to people’s changing needs.

There were safe recruitment procedures in place which included the checking of references. Staff recruitment was carried out on an on-going basis to meet people’s needs.

Risk assessments were centred on the needs of the individual. Each risk assessment included clear control measures to reduce identified risks and protect people from harm. Risk assessments took account of people’s right to make their own decisions.

Accidents and incidents were recorded and monitored to identify how the risks of reoccurrence could be reduced.

Medicines were administered and

We visited the agency and spoke with the manager, director, training manager; four office based care workers who allocated the work to staff, and six care workers who provided personal support for people living in their own homes. We contacted 20 people by telephone and sent out 60 questionnaires. We spoke with 18 people who used the service, or their representative, if appropriate. We received 18 completed questionnaires.

People told us that staff did not always ask for their consent before providing care. One person said they had at first but, “Had been coming for a long time and now just get on with it.” Staff said they asked people for their permission to enter their home, and they asked people for their consent before providing support.

We looked at the care planning system and found that the records showed the care and support people wanted and needed. People told us that they were treated with dignity and respect and that the regular agency staff were excellent. One person said, "Nothing is too much trouble.”

We looked at the medication policies and procedures. We found that appropriate systems were in place and regular audits were completed, which ensured people were assisted with medication safely.

We looked at the staff rotas and staffing levels. We found that the agency arranged for people to be supported by the same agency staff, and there were systems in place to cover for holidays and sickness.

A complaints procedure was in place. Not all the people we spoke with were aware of this, but they said they would not hesitate to contact the office if they had any concerns.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We visited four people in their own homes as part of this inspection and spoke with them and their relatives about their experiences of the support they had received. We spoke with two senior managers as well as staff responsible for training and supervision at the time of our visit to the office. We spoke with six care workers, some of whom covered roles such as assessing people using the service, care worker support and quality monitoring.

We spoke with 12 people who received a service from this agency over the telephone, as well as six relatives. Everyone we spoke with told us that they felt respected by the care workers from the agency. One relative said "All carers treat [the person who uses the service], me and my home with respect". One person who used the service told us that the care workers "treat me like a human being, not just something to move about".

A few people who used the service told us that they would prefer different times for some of their visits and two people said they did not always know which care worker would be coming for every visit. Another person told us that they had a good discussion about the times of the visits and that this had been adhered to.

Everyone we spoke with told us that their care was personalised to their needs. One person said that the agency liaised with the hospital so that a care worker always came in when they had been discharged home. People's preferred names were used even when there were changes to care workers. People were happy that their care workers adapted well when changes were made to care.

A few people could not recall or were not aware of the detail of their care plan. However, most confirmed they had been involved in discussing and reviewing their care with senior staff from the agency. One person said they had a "good discussion about needs and who may be coming".

People felt that staff were well trained and understood their needs when providing personal care. People told us that the agency responded to any comments or concerns raised with them. People told us that they felt safe, and they knew how to contact the agency if they had concerns.