This inspection took place on the 17 July 2018 and was announced. At the previous inspection of this service in September 2016 we found two breaches of regulations. This was because the registered manager had not undertaken training about safeguarding adults and risk assessments were of a poor standard in relation to the moving and handling of people. During this inspection we found both these issues had been addressed.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to people living with dementia, older people, people with learning disabilities and on the autistic spectrum, people with physical disabilities and sensory impairments. Fifty-five people were using the service at the time of our inspection.

The service had a registered manager in place. 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.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures had been implemented and staff understood how to respond to allegations of abuse. Risk assessments provided information about how to support people in a safe manner. Procedures were in place to reduce the risk of the spread of infection. The provider had taken steps to learn from issues of concern. Medicines were managed safely.

People’s needs were assessed before they started using the service to determine if those needs could be met. Staff received on-going training and supervision to support them in their role and undertook an induction programme upon commencing employment. People were able to make choices for themselves and the service operated within the principles of the Mental Capacity Act 2005. People were able to choose what they ate and drank. The service worked with other agencies to help ensure people’s needs were met.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity. Steps had been taken to promote people’s right to confidentiality. The service sought to meet people’s needs in relation to equality and diversity issues.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. The service had a complaints procedure in place and people knew how to make a complaint. Where people required support with end of life care this had been provided appropriately.

Staff and people spoke positively about the senior staff at the service. Systems were in place to monitor the quality and safety of support provided. Some of these included seeking the views of people who used the service.

This inspection took place on the 21 September 2016 and was announced. The service was last inspected in September 2015. During that inspection we found three breaches of legal requirements. This was because risk assessments about moving and handling were not sufficiently detailed, care plans were not personalised around the needs of individuals and the service did not have sufficiently robust quality assurance systems in place for seeking the views of people that used the service.

During this inspection we found that care plans were now personalised and the service had systems in place for seeking people’s views. However, risk assessments relating to moving and handling were still not of a satisfactory standard.

The service is registered with the Care Quality Commission to provide support with personal care to adults living in their own homes. At the time of our inspection 39 people were using the service. The service had a registered manager in place. 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 registered manager had not undertaken training about safeguarding adults and did not have a good understanding about his responsibility for reporting any allegations of abuse the relevant local authority.

We found two breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this

Report.

People told us they did not have any missed calls and that staff attended when required. The service had robust staff recruitment procedures in place. Medicines were managed in a safe manner.

Staff undertook an induction training programme on commencing work at the service and received on-going training after that. People were able to make choices for themselves where they had the capacity to do so and the service operated within the Mental Capacity Act 2005. Where people were supported with food preparation they were able to choose what they ate and drank. People were supported with medical appointments if required.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place for people which set out their needs and the support they required in a personalised manner about the individual person. The service had a complaints procedure in place and people told us they knew how to make a complaint if needed.

People and staff spoke positively of the management at the service. Various quality assurance and monitoring systems were in place, some of which included seeking the views of people that used the service.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with were happy with the care they received. One said "they do my leg and give me a lovely bath" and "I am quite happy with them. They don't make me feel embarrassed, they are very nice." We found that care plans were in place setting out how to meet people's assessed needs.

People told us they felt safe. One person replied "oh yes" when asked if they felt safe when staff were in their home. We found staff had a good understanding of their responsibility for reporting any suspicions of abuse.

People we spoke with said they were asked for their views about the service provided. One person said "they ask me if I am happy with what they are doing. If I want anything done differently." The service had a complaints procedure in place, although the provider told us no complaints had been made about the service. We found that not all staff who worked with vulnerable adults had undergone a robust recruitment procedure to help ensure they were suitable for the work. Therefore a compliance action has been made.

People told us that they were treated with dignity and respect, and that they were involved in discussions planning their care. A relative told us "they (staff) explain what they are doing." We found that care plans were in place which set out how to meet the needs of people. These had being drawn up with the involvement of the person receiving care as well as their relatives and social workers. People told us that care staff had a good understanding of how to meet their needs. We found that the provider understood their responsibilities with regard to safeguarding vulnerable adults, and that people felt safe. However, we found that care staff had not undertaken training in safeguarding vulnerable adults. People told us they were happy with the staff. One person said of them "they are perfect." We found that staff had to undergo various checks before being employed, including providing proof of ID and a Criminal Records Bureau check. However, we found that references had not being sought for all care staff working at the service. People told us they were asked abut the care they received, a relative said "they have phoned and asked if we are happy with them."

This inspection took place over two days on the 9 and 11 September 2015 and was announced. At the previous inspection of this service in September 2013 we found one breach of regulations because the provider did not have sufficiently robust staff recruitment procedures in place. During this inspection we found improvements had been made to the way staff were recruited.

The service is registered with the Care Quality Commission to provide support with personal care to adults living in their own homes. At the time of our inspection 40 people were using the service. The service had a registered manager in place. 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 at risk because the provider had not carried out adequate risk assessments relating to moving and handling. Care plans were in place but these did not contain detailed information about the individual person or how to support them in a personalised manner. The service did not have effective systems in place for monitoring the quality of care and support provided or for seeking feedback on the service from people.

People told us they felt safe using the service. Adequate arrangements were in place relating to safeguarding adults. Enough staff were employed to meet people’s needs.

Staff were supported by the service through the provision of training and supervision. However, staff had not undertaken training about the Mental Capacity Act 2005. The Mental Capacity Act 2005 is law designed to protect people’s rights to make decisions for themselves where they have the capacity and to make sure decisions are made in their best interests where they lack capacity. People were able to make choices about their care. Where the service supported people with meal preparation people were able to choose what they ate. The service worked with other agencies to promote people’s wellbeing.

People told us they were treated with respect and that staff behaved in a caring manner. Staff had a good understanding of how to promote people’s dignity.

The service had a complaints procedure in place and people were aware of how to make a complaint.

Staff told us they found the management of the service to be supportive and helpful.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.