We undertook this comprehensive inspection on the 20 of August 2018 and it was announced. This was because this service provides care to people in their own homes and we needed to ensure senior staff were available to speak with us. This was the first inspection of the service since it registered with the Commission.

Safe and Sound 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, some of who may be living with dementia.

Not everyone using Safe and Sound receives 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 the time of the inspection, there were 67 people receiving personal care from the agency. Safe and Sound provides care and support in the Radstock area.

The service had a registered manager in post. 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 staff did not work within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Capacity assessments and best interest decisions were not always in place where required. There were inconsistencies in seeking and recording consent for people with fluctuating capacity. Care records lacked detail on the specific decisions people who were assessed as lacking capacity would require support to make. Staff told us they sought people’s verbal consent before they provided care and support and recognised this was an important part of their role in promoting choice and independence.

Some people took responsibility for their own medicines management while staff supported others. For those who needed staff support, there was no audit of record to ensure staff had signed to indicate they had given people the prescribed medicine. There were no PRN protocols to inform staff when to offer people medicines that they may take ‘as required’.

People were supported by staff that were competent and had received training to ensure they had the skills and knowledge to carry out their roles. Staff received supervision and appraisals and felt recognised for their work.

People were supported by staff who used personal protective equipment correctly to reduce the risk of cross infection. Care plans contained risk assessments which identified potential risks to people. However, care plans were not person centred and did not contain important information relating to preferences or detailed routines required for staff to provide consistent and safe care.

People were supported by staff who had checks undertaken prior to being employed by the service. There was sufficient numbers of staff and people received support from a consistent staff team who were familiar with their needs.

Staff could demonstrate a good understanding of abuse and who to go to should they have concerns. Staff were kind and caring. Relatives told us they were notified whenever changes in their relative's condition had happened, and health professionals were referred to for advice and treatment.

Feedback and views of people using the service were sought and people and relatives were complimentary about the office management team. They felt able to raise concerns with the registered manager who they felt was accessible.

The service had a quality assurance system which had not identified shortfalls in the medicines administrative records audit. Care plan audits had not identified inconsistences in the recording of people’s mental capacity.

We found one breach of the Health and Social Care Act 2008 (Regulat

The inspection took place on 05 January 2016 and was announced. We gave the service 24 hours' notice of the inspection. This was to ensure that people who used the service were available to meet with us. It was also so that the registered manager and staff could be available. The service was last inspected in July 2014 and met with legal requirements at that time.

Safe & Sound Homecare Services are registered to provide a domiciliary care service to people in their own homes.

There was a registered manager for 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.

The provider had systems in place to minimise risks to people and to keep them safe from abuse. People spoke highly about all of the staff who visited them. They told us staff were always kind and caring towards them. People who used the service told us they interacted in a positive and warm way with the staff who provided their personal care and other support.

People were assisted with their needs by staff who were monitored and supervised in their work. People also benefited because they were supported by staff who were well trained to understand their needs.

People spoke highly about the care and support they received from the staff. Examples of comments people made included, "They’re all marvellous without exception, great” and "We have found the service fantastic the carers are all so kind ". Care records were informative and clearly showed how to effectively assist people so that their care needs were met.

People felt they were able to make complaints about the service the agency provided if they needed to. There was a system in place to ensure that regular checks on the quality of care and service were carried out. When it was needed, actions were put in place to improve quality of the care and service people received .

People who used the service and the staff thought highly of the registered manager and the provider. The staff team understood the visions and values of the organisation and said they followed them in their work. These included providing personalised care to ensure people were treated as unique individuals.

At the last inspection in October 2013, we had concerns about staff training and the quality monitoring systems in place. We received an action plan that informed us of a new quality monitoring system was being implemented, and that staff training was being managed and planned to ensure the provider met their mandatory training requirements.

At this inspection we spoke to four people who used Safe and Sound Homecare Services, and all of these people spoke positively about their experiences of care.

We spoke to two members of staff who told us about the new quality assurance system and training system that has been put into place following our last inspection.

We looked at ten sets of employment and training files and saw that the training has taken place in accordance with the action plan which was submitted following our last inspection. Safe and Sound Homecare Services had forward planned dates for training on a calendar so that the management can see what training is required at a glance and maintain the levels of training in future.

We saw that the new systems in place were aiding the manger in responding to issues and risk assessing situations promptly. This meant that Safe and Sound Homecare Services have improved their monitoring systems to adequately provide safe and effective care for people who used the service.

We observed care workers providing person-centred care in three people's homes and spoke to three people and two relatives of people receiving care from the agency.

We looked at three care plans of people using the service and found full assessments of needs and consent forms in place for people using the service. Risk assessments were in place in all cases for risk of tissue breakdown and moving and handling.

Three people we visited had positive things to say about the people that provided care in their homes. One said “sometimes they do things above the call of duty”. Another person said “not one amongst them I could find fault with”.

We spoke to two care workers who told us that they felt supported and listened to by their employers.

We saw a training matrix and noted that out of the 19 staff on the matrix, four had current medication training, seven had first aid training, and seven had moving and handling. This level of training did not meet the mandatory requirements that the provider had set themselves.

The quality monitoring systems were not always effective enough to identify issues and therefore to improve services.