This inspection took place on 13 September 2018 and was announced.

The Care Quality Commission (CQC) received anonymous concerns in relation to staff using unsafe lifting techniques, issues related to supporting people with meals and language barriers. Because of these concerns we undertook this responsive comprehensive inspection.

At the last inspection in February 2016, we judged the service as Good overall with requires improvement in the key question of effective. We found procedures for protecting people's rights where they lacked capacity needed improvement.

Reliance care Solutions Limited is registered to provide the regulated activity of personal care. It provides personal care to people living in their own homes in the community. The service is provided to people who have a range of needs to include, Dementia, Learning disabilities or autistic spectrum disorder, physical disabilities, Mental Health, or eating disorders. At the time of inspection this was a small service providing care and support to 20 people. The Care Quality Commission (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 consider any wider social care provided.

At this inspection in in September 2018 we found the provider did not always identify, assess and mitigate risks to people to ensure they received consistent safe care. Staff were not using safe techniques to move a person. The support plan was not updated to provide information to staff to deliver care safely. The provider had not taken steps to reassess a person’s care package to reduce known risks and assure themselves they could continue to meet the person’s needs safely. The provider did not recognise or report the incident as a potential safeguarding concern.

Whilst people told us they were happy with the support they had from staff to take their medicines, we found medicines were not always administered in a safe way.

The providers systems and processes to audit and monitor the quality of care was not effective in ensuring good working practices amongst all staff. The providers checks and audits had not been effective at identifying matters that needed to improve. Previous inspections had shown the provider had a history of not meeting regulations, and having previously made improvements we found that they had not sustained these.

You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post at the time of the 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.

People felt safe with staff in their home. Staff had completed safeguarding training but did not always recognise when people could be at risk of harm. The provider had systems in place to ensure staff were suitable to work with people in their own homes. People were happy they had regular staff and that staff stayed the duration and sometimes over as needed.

Staff had training to ensure they had the skills to support people. However, training and on-going support was not sufficiently informative to ensure best practice so that people were always supported in the right way. People told us that staff sought their permission before providing care and support. However, the provider needs to evidence people's consent was sought and recorded in line with the MCA legal framework.

People were supported with their meals and were happy with these arrangements. People were supported with their health and to access the doctor or other services when they needed. However the provider had not always followed professional’s recommendations to ensu

This inspection took place on 18 February 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. The inspection was undertaken by one inspector.

We last inspected the service on 24 April 2014; there were four legal requirements that were not met at that inspection. During this inspection we found that the provider had taken action to comply with the regulations.

Reliance Care Solutions provides personal care to people living in their own homes. They currently provide care to people living in Birmingham and Walsall. At the time of inspection this was a small service providing care and support to 14 people.

There was a registered manager in post 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.

People felt the staff supporting them were trained and competent to do so. The majority of staff were trained to provide the care and support people needed. Whilst the majority of staff were trained to deliver care and support, there were occasions where all the necessary training was not provided.

People were asked for consent to provide their day to day care. Some improvement was needed to the process for obtaining consent from people in order to ensure people’s rights were protected at all times.

People confirmed they received a safe service. Procedures were in place to ensure that people received a service that was safe; staff followed the procedures to ensure the risk of harm to people was reduced. The risk of harm to people receiving a service was assessed and managed appropriately; this ensured that people received care and support in a safe way. Where people received support from staff with taking prescribed medicines, this was done in a way that ensured the risk to people was minimised.

People received care from staff that were suitably recruited, supported and in sufficient numbers to ensure people’s needs were met.

People were able to raise their concerns or complaints and these were investigated and responded to, so people were confident they were listened to and their concerns taken seriously.

Everyone spoken with said they received a good quality service. The management of the service was stable, with processes in place to monitor the quality of the service. People were asked to comment on the quality of service they received and the information was used to improve the service.

When we visited Reliance Care Solutions the service was providing care and support to eleven people within their own homes. We spoke with one person who used the service and with the relatives of three people who used the service. Some people were unable to speak with us because of their care needs. We also spoke with the manager, deputy manager and four staff members.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Two of the relatives we spoke with told us that the provider’s staff cared for people in a safe and effective way. However one person who used the service and another relative told us that they were not happy with the way care and support was provided.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This meant that the service could identify and minimise the risks to people.

Staff were supported to undertake training that was relevant to the needs of the people they cared for.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. This meant that staff understood what to do in an emergency.

Staffs had undertaken training relating to the Mental Capacity Act 2005 and were able to explain how they would comply with the Deprivation of Liberty Standards. This meant that people’s independence and liberty were being maintained

Is the service effective?

People’s initial care needs were assessed before they started to receive care, and plans of care were developed. However there was no record of reviews of care plans unless people’s care needs had changed.

Some relatives and people who used the service told us that they were unhappy about how care and support was delivered.

Is the service caring?

We spoke with the one person and the relatives of three people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was varied, for example; “Everyone has been very helpful and understanding”. “The carer’s are fantastic, they are always on the ball and responsive”. One relative asked; “Do they employ people from a caring background, or is it just bums on seats”? Another person told us that they did not believe that their carer’s understood the complexity of their condition and how they should be cared for.

When speaking with staff they said that they understood the needs of the people they looked after and explained the training they had undertaken to enable them to support people with complex needs.

Is the service responsive?

Not all the people we spoke with knew how to make a complaint if they were unhappy. One person who had made a complaint told us that their complaint had not been resolved and that they were still experiencing the same issues.

We reviewed the records of complaints and found that they had been investigated but there were no formal records of a response. The provider did have a complaints policy, however it did not contain a timescale in which people could expect to receive a response.

Satisfaction surveys had been completed. These survey results had been collated and where shortfalls or concerns were raised these were taken on board and dealt with, however the effectiveness of the measures in place had not been reviewed.

The service had recorded the details of accidents and incidents that had occurred. These had been investigated and the cause of the issues identified.

Is the service well-led?

A registered manager was in place.

We found that staff meetings had taken place to discuss issues related to people’s care. This meant that improvements could be made to the way the people’s care and support was delivered.

The service had a quality assurance system. Two incidents that had been reported had been investigated and dealt with appropriately. This meant that the service had reviewed the standard of care delivered and had taken steps to prevent incidents re occurring.

There were 12 people who used the service on the day of our inspection. We spoke with the manager, deputy manager and four members of staff that worked in the office. We spoke with three relatives of people who used the service and two members of staff on the telephone following our inspection.

Before our inspection we were informed by Birmingham City Council, who commissioned the service for people who needed care, that the contract with the provider had been temporarily suspended. This was because of concerns that the provider could not deliver the care that people with complex needs who used the service required. On the day of our inspection the provider was informed that their contract would be reinstated but would be reviewed regularly to ensure that the improvements they had made were sustained.

Staff had the information they needed to know how to support people who used the service to meet their individual needs. “The staff know how to care for my relative and do what they need to do, I have no concerns.”

Systems were in place to ensure that people who used the service were safeguarded from harm and abuse.

Recruitment processes ensured that staff were employed who had the appropriate skills and knowledge to safely meet people’s needs.

Staff were supported to ensure they received the training they needed to meet the needs of people who used the service. One relative told us, “The staff were always on time and had the training they needed so they could care for my relative.”

People, their relatives and staff were asked for their views about the service and these were listened to.

The deputy manager told us that there were six people who received personal care in their own homes from staff employed by the agency. We spoke with three members of staff in the office and three on the telephone. We spoke with four relatives of people who used the service by telephone. The people who used the service were not able to communicate with us by telephone due to their needs. We looked at the records of three people who received care.

People had the information they needed about the service and were involved in their care. People were involved in their care plan and this showed staff how to support the person in the way the person preferred.

People were supported by staff to meet their needs and ensure their safety and well being. One relative said, “Staff want the best for my relative and look after them as I do.”

Systems were in place to ensure that people were safeguarded from harm. Staff knew what to do if they witnessed or suspected abuse to ensure that people were safe.

Staff received most of the training they needed to know how to support the people who used the service. Staff told us they were well supported in their role.

People were asked for their views about the service and these were listened to. One person said, "I am asked for my views and they listen to me." Audits were completed and action taken where needed to make improvements.