Our inspection of Respect Care Services Limited took place on 12 and 18 December 2017. We gave the provider 48 hours’ notice of both visits as this is a domiciliary care service and we wanted to ensure that the registered manager who may be out of the office conducting assessments was available when we attended.

Respect Care Services Limited is a domiciliary care service. It provides personal care to people living in their own houses and flats in the community. The majority of people supported by the service are older adults, some of whom are living with dementia. At the time of our inspection the service was working with 180 people.

The service has 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.

At our previous inspection of the service on 5, 6, 7 and 10 October 2016 we found five breaches of regulations in relation to safe care and treatment, consent, person centred care, submitting notifications to the CQC and good governance.

Following this inspection, asked the provider to complete an action plan to show what they would do and by when to address these and to improve the service.. During this inspection we found that the provider had taken action to address the breaches identified at our previous inspection.

People who were supported by the service had detailed risk assessments in place. These showed that individual risks had been identified and that guidance was provided to support staff members to manage and reduce these.

Assessments of people’s capacity to make decisions were included in their care files. Where people were able to do so, we saw that that they had signed to show that they agreed with their care plans and risk assessments. People and family members told us that the service involved them in decision making about their care and support.

People had plans of care to enable staff members to address their needs effectively. The care plans that we saw showed that these were regularly updated to reflect people’s current needs. Staff members had completed records of the care and supported provided at each visit that they made. The provider regularly monitored the quality of care records.

Some people were supported by staff to take prescribed medicines. We saw risk assessments were in place for medicines administration and that the records of medicines administration were accurately completed and regularly audited by the service. Staff members had received training in the safe administration of medicines and their competency in doing so had been assessed.

People receiving care and support spoke positively about the staff members who visited them. Staff members demonstrated caring and respectful attitudes towards the people they supported.

Staff records showed that checks of their suitability for the work they were undertaking had taken place. New staff did not start working with people until they had successfully participates in an induction training programme. An on-going training programme was in place for all staff members. Staff members received regular supervision from a manager to ensure that they remained competent in their roles.

People and family members told us that the service was responsive to their needs. We saw that care plans and risk assessments had been updated where there had been any changes to the support that people required. Staffing rotas showed that people received care and support from the same staff members. Where people had specific cultural, religious or communication needs the service made efforts to ensure that care staff were able to support these.

The provider had developed an on-line system for ensuring that the quality of the service was regularly monitored and t

We conducted an inspection of Respect Care Services on 5, 6, 7 and 10 October 2016. The inspection was announced. We gave the provider 48 hours’ notice to ensure the key people we needed to speak with were available. At our last inspection on 24 January 2014 the service was meeting the regulations looked at. The service provides care and support to people living in their own homes. There were 400 people using the service when we visited.

There was 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.

Risk assessments and care plans contained some information for staff, but we saw some examples of incomplete or inconsistent record keeping that could have placed people at risk of avoidable harm.

Medicines were accurately recorded when care workers prompted people to take their medicines. We were told by the registered manager that she checked medicines records upon receipt in the office and archived them immediately upon checking them.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard people they supported. Staff had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. However, records did not always contain details of people’s capacity and senior staff did not ascertain whether signatories to documentation had the legal authority to make decisions. Some records had not been signed to demonstrate that people had given their consent to their care and support.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. However, care records contained very limited details about people’s needs or preferences.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role.

Care workers were provided with appropriate training to help them carry out their duties. Care workers received regular supervision of their performance, but appraisals were not conducted regularly. There were enough staff employed to meet people’s needs.

People were supported to maintain a balanced, nutritious diet where this formed part of their package of care. However, people’s care plans did not always contain sufficient information for staff about how to meet people’s needs in relation to their health and nutrition.

People using the service and staff gave positive feedback about the registered manager and told us they provided feedback about the service. They knew how to make complaints and told us they felt listened to and there was a complaints policy and procedure in place.

The organisation did not have effective systems in place to monitor the quality of the service. Audits were not conducted of care records. Information was not reported to the CQC as required. We found evidence of two safeguarding incidents that were not reported in line with requirements. We saw evidence that feedback was obtained from people using the service and the results of this was positive.

We have made a recommendation about safe medicines management. We found five breaches of regulations in relation to safe care and treatment, consent, person centred care, submitting notifications to the CQC and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Before people started using the service they underwent an assessment where they (and their family and friends if appropriate) were asked what help and support they wanted and how they wanted it to be provided. These were then used to draw up care plans for each individual that were tailored to their particular needs and preferences. People were asked to sign their care plan to indicate that they agreed with it. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We sent a survey to people using the service. All 27 respondents rated the care provided by the service as either "excellent" or "good". The majority of people indicated that their care workers mainly arrived on time, stayed for the full length of the allotted visit and were able to complete the agreed tasks within this time. Before people started using the service they were assessed by staff to ascertain what their needs were and whether the service could meet them. There were policies and procedures in place for what to do in a medical emergency or if someone did not answer the door when staff arrived, which staff were aware of.

People were prompted to take their medications and this was appropriately recorded. The number of staff attending a visit and their specific skills and training were matched to individual people and their needs.

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

People who use the service were given appropriate information about what help was available and what they could expect from the service. They were involved in making decisions about what care and support they received and staff treated them in a respectful manner.

People who used the service described it as "brilliant" and "absolutely perfect". They told us that staff arrived at their homes on time and were "conscientious" and "dependable". Full risk assessments were undertaken by staff when a person started using the service to ensure that care and support was provided in a safe way. Staff had received training in meeting the specific needs of the people they cared for and had been trained in what to do in emergency situations.

People said that they felt "safe" when using the service and that they trusted staff. Staff had been trained in safeguarding vulnerable adults. They knew how to recognise the signs of abuse as well as how to escalate concerns, including informing others such as the local authority.

Appropriate checks were made on staff before they started working for the service. The recruitment and selection process tested their skills as well as assessing the suitability of their character.

People who use the service told us they would be "happy to" raise any concerns they had about the service with staff. There was a procedure in place for handling complaints, including their investigation and making changes to the way services were provided.

People who use the service told us that they were treated with respect and spoke positively of the quality of the care provided. They were involved in decisions about their care and their needs and preferences are taken into account. People felt safe using the service and that they could raise any issues they had with the carers or the management staff of the agency.