What life is like for people using this service:

People told us that they felt safe using the service and staff were confident that any concerns would be dealt with appropriately. The provider had an electronic call monitoring system where staff logged in and out of their calls, which enabled care staff visits and punctuality to be monitored. Staff followed infection control guidance and had access to personal protective equipment. Improvements were needed in how the provider assessed risks to people as there were inconsistences across the records we reviewed.

People who used the service told us that staff were kind and caring and treated them with dignity and respect. People had regular care staff who knew how they liked to be supported. We saw the provider had contacted the necessary health and social care professionals when people's health deteriorated.

The provider had a system in place for responding to complaints. People knew who to contact if they had any concerns.

The provider continued to promote an open and honest culture and people told us they were happy with the management of the service. Staff spoke positively about the support they received.

Although people told us that they did not have any concerns with how they were supported with their medicines, we continued to see that improvement was needed to ensure practice was in line with the National Institute for Health and Care Excellence guidance.

The governance systems in place to monitor the quality and safety of care provided had not been effective leaving people at risk of receiving unsafe care. Some improvements were needed around the auditing and reviewing of people's care documents as issues that we found had not always been picked up.

We found a breach of regulation in relation to the systems in place to monitor and improve the quality of the service. You can see what action we told the provider to take at the end of the full version of this report.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 9 August 2017).

About the service: South Birmingham Home Care is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger adults. Some people receive an ‘enablement’ package of up to six weeks. At the time of the inspection they were supporting 84 people.

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

Follow up: We will ask the provider following this report being published to tell us how they will make changes to ensure they improve the rating of the service to at least Good. We will revisit the service in the future to check if improvements have been made.

This inspection took place on 23 May 2017 and was announced. We previously inspected the service in August 2014 and identified no concerns. South Birmingham Home Care provides a short term enablement service of care and support to people in their own homes. The service also provides support to people living in an extra care scheme. At the time of our inspection, there were 199 people receiving the enablement service and 15 people receiving support through the extra care scheme.

There was a registered manager in place who was present throughout 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 told us that they were supported to feel safe and comfortable using the service. Staff we spoke with were aware of their responsibilities to promptly raise any safeguarding concerns they identified to help protect people using the service.

Systems were not robust for monitoring and reflecting how people received support that met their needs. Records were not robust in relation to the support people required and received however to help manage their risks. This posed a risk that people would not be supported in line with their needs. People described how staff helped them to manage their risks and staff demonstrated a general understanding in such areas.

People were satisfied that they received their calls on time and suitable action was taken to prevent late and missed calls. The registered provider continued to undertake safe recruitment practices to ensure that people were supported by staff who were suitable.

Staff told us that they felt confident providing support to people with their medicines. We found however that people were not supported with this task in line with current good practice guidance. This did not ensure that people always received safe support with their medicines.

People spoke positively about the support they received from staff and how this met their needs. Staff told us that they felt supported and equipped for their roles, although aspects of training had been delayed.

People confirmed that staff followed their choices and wishes. Staff had not received training in relation to the Mental Capacity Act (2005), the registered manager assured us that guidance would be provided in this area to address any shortfalls in staff knowledge. People were satisfied with the support they received with meal preparation, although records did not always reflect this positive practice. People were supported to access further healthcare support to promote their health.

People told us that they were treated with respect by staff who were kind and caring. People were involved in planning their care and described the positive outcomes and experience of using the service.

The registered provider had a formal complaints process. People told us that they had no reason to submit a formal complaint about the service, although they would feel comfortable doing so if necessary.

People and staff described the service positively. Records and systems were not always robust, and information available to the service was not always used to ensure and drive the quality and safety of the service.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an announced inspection. This meant the service was given short notice that we would be visiting the office from where the care was organised.

This is a large domiciliary care service that provides an enablement service for approximately 200 people. This is a six week service that is provided to enable people to receive support following discharge from hospital. The service also provides a long term service to approximately 50 people who live in extra care accommodation.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

All the people we spoke with said they received a safe service. We saw that safe systems were in place to ensure that people received a service that was safe, protected them from harm and ensured their rights were protected. The risk of harm to people receiving a service was assessed and managed appropriately; this ensured that people received care and support in a safe way.

The provider had procedures in place to ensure that there were sufficient numbers of staff recruited to meet the needs of people and keep them safe. Everyone that used the service felt the staff that supported them was trained and competent. We saw that staff received the training development and support needed to ensure they did their job well and provided an effective service.

People told us that where required staff supported them with their nutrition and health care needs. All the people spoken with told us they had a good relationship with the staff that supported them. People said they were able to make decisions about their care and were actively involved in how their care was planned and delivered. People were able to raise their concerns or complaints and these were thoroughly investigated and responded to, so people were confident they were listened to and their concerns taken seriously.

Everyone spoken with said they received a good quality service. The management of the service was stable, with robust processes in place to monitor the quality of the service. People were asked to comment on the quality of service they received and the information was used to improve the service.

Hall Green / Selly Oak Home Care Service provided short term enablement care. People were being helped on a time limited basis to regain skills and abilities to become as independent as they could. People that required long term support with personal care were being assisted to get services from other providers.

People's needs were assessed before they received a service. Information about people's needs and support required was available to care staff before they provided assistance. This helped to keep people safe.

We spoke with seven people or their relatives about the service. Amongst their comments were: "They do everything to help you”, "They are very respectful and patient”, "I got on the mend faster that I would have without them."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Care staff had supervision, training and support whilst providing a service and this helped to keep people safe. The provider had appropriate systems in place to ensure that the quality of the service could be measured.

When we visited Hall Green / Selly Oak Home Care Service we looked at the care records for people who started receiving this service over a two week period in August 2012. We looked at the care records for 16 out of 40 people who started the service during this time weeks. We spoke with 12 of these people or their relatives. We spoke with 14 care staff that supplied help to these people.

Information had been collected from people about their needs before receiving a service. However all the people we spoke with said that they had received no written information about the service before it started. Home care organisers told them about the service after it had started.

We found that people received appropriate care from care staff that understood their needs. However, people experienced a large number of different carers providing their care. This meant that people did not receive the continuity of care they wanted. A new computer scheduling and monitoring system had started to be used when we visited. We were advised that this system should improve the scheduling care in the future.

There was appropriate information recorded about people's nutrition and hydration. People we spoke with felt safe with how the care was provided. There was appropriate written information about people's care and this was kept securely.