The inspection took place on 11 December 2017 and was announced. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection.

At our last inspection in April 2015 we found a breach of the legal requirements. This was because staff did not undertake regular training about safeguarding people and robust checks were not in place to monitor any monies spent on behalf of people. At this inspection we found improvements had been made and that they now met the previous legal breaches.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of our inspection they were supporting 74 people with personal care.

The service was safe and had practices in place to protect people from harm. Staff had training in safeguarding and knew what to do if they had any concerns and how to report them. People who used the service told us they felt safe and protected from harm.

Risk assessments were personalised and detailed. Staff had the information they needed to mitigate risks.

Staffing levels were meeting the needs of people who used the service.

Recruitment practices were safe and records confirmed this.

Systems were in place to promote the safe administration of medicines. Staff undertook training before they were able to support people with medicines.

Systems were in place to prevent the spread of infection in people’s homes; care workers had access to protective clothing and gloves.

The service documented and learned from incidents and put procedures in place for prevention.

Training for care staff was provided on a regular basis and updated regularly. Staff spoke positively about the training they received.

Care workers demonstrated a good understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis.

People were supported with maintaining a balanced diet and had a choice of food and beverages.

People were supported to have access to healthcare services and receive on-going support.

Staff demonstrated a caring and supportive attitude towards people who used the service and people and their relatives told us they were happy with the care provided.

The service promoted the independence of the people who used the service and people felt respected and treated with dignity.

Concerns and complaints were encouraged and listened to and records confirmed this. Relatives of people who used the service told us they knew how to make a complaint.

The registered manager had a good relationship with staff, people who used the service and their relatives. People spoke positively about the registered manager and their management style.

The service had robust quality assurance methods in place and carried out regular audits.

This inspection took place on 22 April 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. The service met all outcomes that we looked at when we last inspected in October 2013.

The service provides support with personal care to adults living in their own homes. At the time of our inspection they were supporting 23 people with personal care. This included some people who were supported with end of life care.

The service had a registered manager in place. 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.

Not all staff had undertaken training about how to safeguard adults and robust systems were not in place for checking and monitoring money spent on behalf of people by the service.

People told us they felt safe using the service. The service had a safeguarding adults procedure in place. Risk assessments were in place which provided information about how to support people safely. There were enough staff to meet people’s needs and checks were carried out on staff before they began working at the service. People were provided with support to take medicines in a safe manner.

Staff received training and supervision to support them to carry out their role effectively. People were able to consent to care provided and the service supported people to make choices in line with the Mental Capacity Act 2005. People were supported to eat and drink in a way that met their individual needs. The service supported people to access healthcare professionals.

People said they were treated with dignity and respect. Staff had a good understanding of how to promote people’s independence, choice and privacy. We saw staff interacted with people in a caring manner.

People told us the service understood their needs and how best to support them. The service carried out assessments of people’s needs and care plans were in place. These were regularly reviewed. The service had a complaints procedure in place and people knew how to make a complaint.

The service had a clear management structure in place and people that used the service and staff said they found the registered manager to be approachable and accessible. Various quality assurance and monitoring systems were in place. Some of these included seeking the views of people that used the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

People and their relatives told us they were always asked for their consent before care was provided. One person said, "Staff wouldn't do anything without my permission." Staff told us they would respect people's wishes and people had signed contracts which supported their care plans.

We found that people's needs were assessed and they had individual care plans with risk assessments. Some care plans required updating. People and their relatives told us, “they give good care. I’m happy with it” and "they get to know you well: it's like a family."

People told us they were happy with carers' standards of cleanliness. We found that the service had infection control policies and staff training in place. Staff were aware of when they should use protective clothing and gloves.

We found evidence that staff had previous experience in care work or were given an appropriate induction. The service employed enough staff to cover any absence. People and their relatives said "staff are good" and "they are really helpful."

Staff told us they felt supported by management. We found evidence that staff received supervision and had opportunities to discuss personal development. Staff were able to access training and further relevant qualifications.

We found that staff recorded the care they provided to an adequate standard and that records were appropriately stored. People and their relatives told us “staff always write things down” and “they keep records of everything they do.”

People’s diversity, values and human rights were respected. People said they were treated with respect by staff. One person said they were “happy with everything. Carers respect us as if we are their parents.”

People received consistent care and told us they always had the same care workers and that they arrived on time. We reviewed four care plans and found they contained information on people’s needs and support. Risk assessments were in place but those seen were not in an accessible format and did not clearly show how to mitigate or reduce risks.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person we spoke to, said they would not hesitate to speak out if they were worried about anything and another said “I do feel safe when I am being cared for. That was my problem, I was not feeling safe before.”

We found that recruitment checks had been carried out. We looked at four staff files and found that the provider had established people’s identity, reference and criminal records check.

The provider had an effective system to regularly assess and monitor the qulaity of service that people received.