About the service: Short Notice Care Services is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 59 people with personal care in their own homes at the time of our inspection

People’s experience of using this service:

Records relating to medication administration required improvement. Staff required further guidance on how to administer ‘as and when’ required medication such as prescribed creams. The way in which the manager assessed people’s competency to administer required further development.

We spoke with the manager about the improvements that needed to be made to medication management. They told us they would address this without delay. Shortly after our inspection we received confirmation of the improvements the manager had started to introduce. At our next inspection we will check these improvements have been sustained.

The majority of people’s need and risks were properly assessed with sufficient guidance for staff to follow in the provision of safe and appropriate care. Information on people’s needs and skin integrity required improvement. The manager told us they would address this without delay.

Staff had person centred information on people’s preferences and choices with regards to their support and the support provided was personalised to them and their individual requirements.

People told us the support provided was good and that they felt safe with staff. They said staff members were kind, caring and respectful.

People’s daily records showed that people received the support they needed in accordance with their care plan.

People and their relatives confirmed that staff turned up on time and provided the support they needed in accordance with the people’s needs and wishes.

Records showed and people told us that where their needs or choices changed, the management team tried their best to accommodate these changes.

From the records we viewed and the feedback we received it was obvious that people’s care was planned and well organised.

Everyone we spoke with was happy with the care they received. No-one we spoke with had any complaints about the service. Records showed that any complaints that had been received were minor and had been responded to in a timely and appropriate way.

People’s visits records showed that people’s visits were rarely missed. Visits were made on time and staff told us that they had sufficient time to provide people with the support they needed. This indicated that staffing levels were sufficient to ensure people received the support they needed.

Staff were recruited appropriately with the required pre-employment checks undertaken prior to employment to ensure staff members were safe and suitable to work with vulnerable people.

Staff were sufficiently trained to do their job supported by the management team. Staff morale was good. Staff told us they felt supported and that the management team were approachable and open. Staff felt they provided a good service to people. The people and relatives we spoke with agreed with this.

The systems and processes in place to monitor the quality and safety of the service were adequate and appropriate for the size of the service. The management team demonstrated a good knowledge of their regulatory responsibilities with regards to people’s care and managed the service well.

Rating at last inspection and why we inspected: This was a scheduled inspection. At the last inspection the service was good. At this inspection, the service was rated good again.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection was carried out on 5 May 2016 and was announced.

Short Notice Care Services is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of our visit the agency was providing a service to 74 people. The frequency of visits and duration across the service varied dependent on individual needs and circumstances.

There was a manager in post who was present during our inspection. The manager had applied to become the registered manager of 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.

People were confident that staff knew how to support them safely and protect them from abuse. Staff were able to recognise the different signs of abuse and who to report concerns to. Risks to people’s safety and wellbeing had been assessed and staff were aware how to protect people from harm.

There were enough staff to meet people’s needs. Staff were allocated sufficient time to meet people’s needs and people never felt rushed. The provider completed checks to ensure potential new employees were suitable to work with people who used the service before they started working with people.

People received support to take their medicines as prescribed. Staff monitored people’s health and reported any concerns to the relevant health professionals.

People were supported by staff who had received training relevant to their role. Staff felt well supported by the management team and were able to contact them for support at any time.

Staff sought people’s consent before supporting them. People were given information in a way they could understand to enable them to be involved in decisions about their care and support.

People were positive about the support they received. People felt staff were kind and considerate. Staff promoted people’s dignity and supported them to remain as independent as possible.

People receive care and support that was individualised. People felt listened to and their preference for care delivery was respected. People’s care plans were kept under regular review and the service was responsive to any change in people’s needs or circumstances.

The provider actively sought people’s views on the service and people were comfortable to raise any concerns with staff or the manager. The provider had a complaints process and where concerns had been raised these were dealt with appropriately.

There was positive working culture with open and honest communication. The manager had a number of checks in place to monitor and develop the service.

We carried out this inspection to review the improvements made following our inspection in February 2013 and to check on the care and welfare of people using this service. We found shortfalls in all of the outcomes we assessed in February 2013 and told the provider to take action to put things right. The provider sent us a report setting out the action they would take to meet the standards.

We spoke with seven people, including four people who used the service, three relatives, six staff and the registered manager.

Everyone we spoke with told us that they were satisfied with the care and support that they received. People shared positive comments about their care. They said, "Everything they do is very good." "I am perfectly satisfied."

We saw the agency had satisfactory systems to protect people and report allegations of abuse. All the staff we spoke with said training for this matter had improved and they were more knowledgeable their responsibilities about recognising and reporting abuse.

Improvements to care management systems meant that care plans fully recorded people's needs and had been reviewed promptly to make sure they were up to date. Detailed individual risk assessments had been introduced to make sure staff knew how to keep people safe.

Improvements to management systems meant that equipment used to care for people in their homes was safe for staff to use.

The agency had improved their recruitment procedure, which made sure new staff were checked thoroughly. Action had been taken so that existing staff records could demonstrate all personnel employed were fit to work with vulnerable people.

We saw the service had improved their range of training and development opportunities for staff. This meant they were kept up-to-date with current practice and the service could demonstrate how their care workers were competent to meet people's needs.

Further development of the management team had meant the service had been able to introduce systems to demonstrate that they listened and responded to the needs of the people they were supporting. We saw they demonstrated how they learned from feedback to show the service was run for the benefit of the people using it.

We spoke with fourteen people, including four people who used the service, two relatives, eight staff and the registered manager.

People shared a variety of comments abo their care. They said, "I am very happy we have a good rapport with the care workers.” “The carers do a good job. It seems to be the office that isn't organised sometimes.” "Things have not been as good as they should be recently. They were very late on a couple of occasions over one weekend recently and never let me know why."

Care plans recorded most of people's needs but were not always reviewed promptly to make sure they were up to date. Individual risk assessments were not in place to keep people safe.

Systems set up during our last inspection visit to make sure that equipment was safe had not been sustained.

The agency had improved their recruitment procedure, and new staff were checked thoroughly. They had not taken action to ensure previous shortfalls were audited and corrected. This meant that vulnerable people could still be at risk.

Lack of monitoring of staff meant the service could not be sure their care workers were competent to meet people’s needs. Staff expressed serious concerns about the conduct of some of their colleagues and the safety of people being cared for.

Slow progress to improve inconsistent management systems, meant the service was not able to demonstrate that people’s welfare and safety was protected.

We spoke with the registered manager, five staff, two people who use the service and three relatives.

Care plans recorded most of people's needs but were not always reviewed promptly to make sure they were up to date.

Systems were not set up make sure that equipment was safe and maintained but they were put in place after our visit.

Measures were not in place to make sure that only suitable staff worked at the agency. This meant that people who used the service were not protected from the risk of abuse. Staff were provided with induction and ongoing training. The agency had only recently started to offer staff formal supervision. There were not enough management systems or time to support care reviews or supervision of staff in a timely way.

The agency had a complaints system that was given to people when they started using the service. Not all people who received a service felt they could make a complaint and be listened to.

Some systems were in place to find out what people thought about the service. Negative comments had not been addressed. Individual risk assessments were not in place to keep people safe.

We spoke with five people who use the service, three representatives, a stakeholder and five staff who work for the agency. People were generally positive about the service and the quality of care being provided. Many told us that the agency was recommended to them by people they know or by health and social care professionals.

People told us that the agency met with them and discussed their needs prior to them being offered a service. They told us that they liked the carers who provided their support and described them as “very good” and “good” and considered they were confident and competent in their work. Some people told us that their carers were sometimes late but had not experienced missed calls. They said, “The timing isn’t that good and staff often arrive late, particularly at weekends”. Another person said, “I panic if they don’t arrive on time, although this is rare”. Five people told us that they did not get the same regular staff and were not informed of any changes to staff in advance. Comments included, “I would prefer the same regular staff as I never know who to expect through my door”. “I never know whose coming and I’m not made aware of any changes but I do know most of the staff”. “I’m the customer therefore I should be able to have the same carers”.

People told us that staff respected their privacy and dignity when providing personal care and all the staff spoken with provided good examples of they promoted this in their everyday practice. One staff member said, “We are all sensitive to the needs of service users and I treat them as I would my own parents and grandparents”. All of the people we spoke with said that they were satisfied with the overall service provided. One person said, “I couldn’t wish for better”.

Staff told us that they enjoyed working for the agency and considered they were well supported by managers who are “very helpful” and open to suggestions for improvement. They told us that they are provided with some training opportunities to develop their skills and knowledge however most spoken with considered that training opportunities could be improved.

Most staff considered that they were provided with sufficient time to meet the individual needs of the people they cared for. However some concerns were raised about staff being provided with little or no travelling time between clients impacting on them arriving on time. One person said, “The management are very fair but they need to tighten up on most things to include care plans and training”. Another person said, I’m very happy, I love my job”.

We identified issues in relation to care planning, staff recruitment and training which may impact on people’s lives. Issues are detailed in the main body of the report.