About the service: Silver Service Carers Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It currently provides a service to older adults. At the time of the inspection, 10 people were receiving support with personal care.

People’s experience of using this service:

• The provider met the characteristics of ‘Good’ in three areas, however in two they did not. Those two areas have been rated as ‘Requires Improvement’. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. More information about this is in the full report.

• People received safe care from staff. We did note that the risks to people’s safety had not always been fully assessed when forming care plans. However, people told us they felt safe when staff supported them.

• The provider’s quality assurance processes were not fully effective in identifying potential risks to people’s safety.

• Some staff training was not up to date, with some staff requiring refresher training in key areas such as; infection control and safeguarding of adults. The frequency of staff supervision was not sufficient to ensure their practice was monitored effectively.

• People were protected by staff who understood how to protect them from avoidable harm. Staff arrived for their calls on time and always completed all required tasks. People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection. The provider had made efforts to support staff when mistakes were made.

• People were provided with care and support which protected them from discrimination. People received the support they needed with their meals and they had access to other health and social care agencies where needed. People were supported to make decisions about their care, the provider ensured these were made in accordance with appropriate legislation.

• People found staff to be kind, caring and they were treated with respect and dignity. People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

• People received person centred care and support that considered their personal choices and preferences. People had access to information in a format they could understand. Complaints were handled appropriately and line with the provider’s complaints policy. People did not currently receive end of life care.

• Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. People and relatives told us they would recommend this service to others.

Rating at last inspection:

At the last inspection the service was rated as Good. (7 January 2016).

Why we inspected:

This was a planned inspection.

Follow up:

We will continue to monitor this service and will return within the next 12 months to ensure they have improved in the key areas identified.

This announced inspection was carried out on 7 January 2016. Silver Service Ltd provides support and personal care to adults living in the Nottinghamshire town of Newark and surrounding villages. On the day of the inspection there were 22 people using the service who received personal care.

The service had a registered manager in place 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 were supported by staff who knew the risks people could face and how to make people feel safe. People were supported with the minimum use of any restrictions on their independence as possible.

People were visited by staff they knew, who worked together well as a team, to provide a flexible service to suit the circumstances of each person they visited. People received any support they required to take their prescribed medicines safely when they needed to.

People were provided with the care and support they wanted by staff who were trained and supported to do so. People’s human rights to make decisions for themselves were respected and they provided their consent when needed.

People were given support to eat and drink sufficient amounts to promote their wellbeing, and staff supported their healthcare needs where needed.

People were treated with respect and individuality by staff who demonstrated compassion and understanding. People were able to express their views on their care and were treated as they wished to be in a respectful manner.

People were able to influence the way their care and support was delivered and they could rely on this being provided. People were encouraged to express any issues of concerns they had so these could be acted upon.

Although the service was well managed they was a lack of systems to identify where problems and shortfalls may occur. The registered manager provided leadership that gained the respect of staff and motivated them as a team.

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with two people who used the service and three relatives and asked them for their views. We also spoke with two care workers, a senior care worker and the registered manager. We looked at some of the records held in the service including the care files for three people.

Below is a summary of what we found. The summary describes our findings from 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?

Staff knew how to respond to any allegation of abuse and were effective in making people who used the service feel safe. A person who used the service told us, “I feel safe with them.” Another person said, “I really do trust them, they are the best carers I have ever had.” A relative told us, “If everyone could have what we have got there would be no elderly people abused or treated badly.”

We found the recruitment practices followed when recruiting staff ensured people were cared for by staff who were of good character, had the appropriate skills and experience. A person who used the service told us, “They have staff who are suitable.” All care workers were issued with a uniform and given an identification badge (ID) so they could be identified as being from the agency.

Care workers protected people from avoidable harm. A relative told us, “They did a property assessment, we talked about what needed to be done to make the care safe and easier.”

Is the service effective?

We found the provider had effective systems to involve people in planning their care, and obtaining people’s consent for this to be provided. A person who used the service told us, “I can say what I want, and how, they listen to me.” The person also said, “They discuss my care plan with me.”

We found staff were effective at meeting the care and welfare needs of people who used the service. A person who used the service told us, “They always stay the full time, I never feel rushed and they leave everywhere tidy for me.”

We found the service had an effective quality assurance monitoring system. There were a number of comments made on survey forms which included, “We feel the service continues to improve”, and “The whole package offered by Silver Service Carers is a well thought out caring service.” Other comments referred to the service as being excellent and flexible.

Is the service caring?

We found the care and welfare needs of people who used the service were met in a sensitive and caring manner. A person who used the service told us, “I enjoy them coming and having a laugh and a joke with them. They are very kind.” A relative told us, “They have managed providing personal care very sensitively.”

Is the service responsive?

We found care workers responded appropriately when people had the capacity to make decisions about their care and welfare. We saw an entry in one person’s care plan stated the person had the mental capacity to be involved in planning their care, but chose to let a relative assume this responsibility. A relative told us, “They care for them as they would like them to, they can say what they want and when.”

We found the provider responded to the views of people who used the service. A person who used the service told us, “If I ask for some extra time they get back to me straight away, they never let me down.”

Is the service well-led

We found people’s care and support was planned and delivered in a way that ensured their safety and welfare. A relative told us, “Their whole approach is holistic, it is wonderful.”

We found the service was well led. Care workers told us that staff meetings took place and they could raise anything they wanted to with the manager at any time.

This inspection was carried out to follow up on our previous inspection in April 2013 where we found the provider had not been compliant with the outcome “Care and welfare of people who use services."

Prior to our visit we reviewed all the information we had received from the provider, including an action plan detailing how they would comply with the compliance action we set at the previous inspection. During the visit we spoke with the registered manager and looked at some of the records held in the service.

We found the provider had made the improvements we required to become complaint, so that people received care and support that met their needs.

We found Silver Service Carers Ltd was a new and developing service. The provider, who was also the manager, had identified plans and developments for the service, but these had not yet been implemented.

The provider told us they had been working as a care worker and employed two part time care workers. The provider told us they now had sufficient people using the service to employ another full time care worker and they were in the process of doing so. This would then give them time to put their plans and developments into place.

We found people were supported to make decisions about their care and they felt they were involved in this although some improvements could be made how these were recorded. A relative said, “When we ask them to do anything they get in there and do it.”

We found people received care and support that met their needs, but a full environmental assessment of people’s homes to identify any risks was not was not completed. A person told us, “I feel it (the care) is what is needed for me.” We found people were safeguarded from abuse. A relative told us their relation, “Trusts all the staff.”

We found the staff team were supported and appropriately trained. A person told us, “They (care workers) are very competent indeed.” We found the provider was implementing ways to assess and monitor the quality of the service. A person told us, “I feel I could make any comments I needed to. If something isn’t right I can say so.”