About the service: Riseup Healthcare Ltd is a domiciliary care service. It provides personal care to people living in their own homes.

People’s experience of using this service: There were enough staff available to make sure people received their care visits. However, we received mixed views from people as to whether the care they received consistently met their needs and preferences. This was particularly in relation to the times they received their care visits.

The provider’s governance systems had been effective at monitoring the quality of care in some areas but not all, resulting in issues not always being identified and therefore improved where required.

People had been involved in the planning of their care and they told us they were encouraged to give their views about the quality of care they received. They gave us mixed feedback as to whether they felt these views had been fully listened to and consistently acted upon.

People told us they received care from staff who were kind and caring and who treated them compassion and respect. Most people told us they saw the same staff so they could get to know them well and build caring and trusting relationships with them. People’s independence was encouraged to help them remain at home for as long as possible.

The staff who provided people with care and support had in most cases been trained to do so safely. Their ability to provide people with safe care had been regularly monitored and assessed and they were supported to complete qualifications in health and social care.

Systems were in place to protect people from the risk of abuse and avoidable harm. Risks to people’s safety had been assessed and staff understood how to reduce these risks for the benefit of people using the service. Where people received help to take their medicines, this was done safely and appropriately.

People told us their consent had been obtained when required and records showed it had been received in line with the relevant legislation. Any incidents or accidents that had occurred had been learnt from to try to reduce them from re-occurring.

Where staff supported people to eat and drink, this was completed to meet people’s needs. People told us they received support to maintain their health when needed. Staff worked well with other professionals to ensure that people received the care they needed at the time they required it.

There was an open culture at the service. The management team and staff were approachable and people and staff told us they could contact them when they needed to.

Rating at last inspection: The rating at the last inspection was Requires Improvement (published October 2017) and remains the same at this inspection.

Why we inspected: This was a planned inspection based on the previous rating.

The inspection took place on 3 August 2017 and the inspection was announced. We gave the service 48 hours in line with our methodology for domiciliary care services. The agency was registered in 2015 and has not had a ratings inspection since its registration. The service had a registered manager who has since left and the registered provider has applied to be registered manager. Their fit person’s interview with the Care Quality Commission was scheduled for the week after the inspection. They have since been successfully registered with the CQC.

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 service is registered for personal care. At the time of our inspection there were 40 people using the service. The service is able to provide different levels of support including assistance with personal care, a sitting service and domestic support.

The service had gradually increased the number of people it supports and recently secured a contract with Norfolk County Council. Most people using the service had been referred through the council, a small number of people paid for their care. The recent growth in the service has not compromised the delivery of care but the service is stretched and some concerns were expressed about the timings of calls and hour’s staff were working so this needs to be closely monitored.

Staff received training in all key areas of practice. Staff understood what to do to safeguard people from the risk of harm or abuse. People were given information of who to contact should they have any concerns or had experienced potential or actual abuse.

Systems were in place to ensure people’s care needs were clearly identified and documented. Staff where required supported people to take their medicines. Staff received training to enable them to do this safely but the manager was not able to demonstrate that all staff had all been assessed as competent to do so.

The service only employed staff after they had completed an interview and demonstrated they had the right skills and attitude for the job. Pre-employment checks were carried out to check their suitability for the role.

The service offered a range of training to staff in key areas of practice. Staff completed a probationary period and were required to undertake an induction course into care, and attend training as relevant. Training was of a high standard but the timing of the training meant some staff new to care were perceived by some people and other staff as not having enough knowledge or experience to deliver the care required. All staff were offered regular face to face supervision, appraisal of their performance and direct observation of their practice.

Staff worked lawfully to ensure people were consenting to the care and support they received and support was provided in line with people’s assessed needs.

People’s needs were assessed before staff provided a service. Some people required specific support to ensure they were eating and drinking enough and this was documented. If people had specific health care needs this was provided by staff who had the necessary training and guidance.

The service was responsive and staff provided considered, respectful care. They supported people’s independence.

The service took into account people’s wishes and acted on their feedback. There was an established complaints procedure.

Risks to people’s health, safety and welfare were documented but it was not always clear how risks were clearly mitigated or how the service monitored risk. Care plans gave information about people’s needs but could be further developed to give more detail to help staff really get to know the person and help them give more person centr