This was an announced inspection that took place on 20 December 2016.

St. Michael Care Limited t/a Home instead Senior Care provides personal care support to people in their own homes. They also provide other services that are not registered or regulated by the Care Quality Commission, such as offering companionship and preparing meals.

There was 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 and associated Regulations about how the service is run.

This is the first inspection under the new methodology. In February 2014, our inspection found that the service met the regulation we inspected against.

People said they were pleased with the service provided and were notified of any changes to staff and the timing of their care. The designated tasks were carried out to their satisfaction and the staff team really cared. They thought the service provided was safe, effective, caring, responsive and well led.

People’s, staff and other records were kept up to date and covered all aspects of the care and support people received, their choices and identified and met their needs. They contained clearly recorded, fully completed, and regularly reviewed information that enabled staff to perform their duties well.

Staff where knowledgeable about the people they gave support to and the way people liked to be supported. They also worked well as a team when required, such as calls that may require two staff members. Staff provided care and support in a professional, friendly and supportive way that was focussed on the individual and they had appropriate skills to do so. Staff were well trained, knowledgeable and accessible to people using the service and their relatives. Staff said the organisation was a good one to work for and they enjoyed their work. They had access to good training, support and there were opportunities for career advancement.

People and their relatives were encouraged to discuss health and other needs with staff and had agreed information shared with GP’s and other community based health professionals, as appropriate. Staff protected people from nutrition and hydration associated risks by giving advice about healthy food options and balanced diets whilst still making sure people’s meal likes, dislikes and preferences were met.

The agency staff knew about the Mental Capacity Act and their responsibilities regarding it.

People told us the office, management team and organisation were approachable, responsive, encouraged feedback and frequently monitored and assessed the quality of the service provided.

At the last inspection which took place on 28 October 2013 we found that the service was not meeting essential standards of quality and safety. We found that people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The provider told us they would make the necessary improvements in the management of medicines by 31 January 2014.

At this inspection we found improvements in the recording and monitoring of people’s medicines. We viewed the revised medicines policy and procedure dated January 2014. This outlined the roles and responsibilities of the staff who supported people using the service. We looked at the care records for three people using the service. We found detailed information recorded about people’s support needs in relation to the medicines they were prescribed. We saw that identified risks in relation to medicines had been assessed and there was clear guidance for staff in relation to managing these risks. For example, in one person’s records we read that they sometimes forgot to take their morning medicines. There was an expectation that staff monitored this and recorded and reported if the person had not taken their medicines.

Furthermore the manager told us that she had started completing medicine audits to ensure that staff were following the revised medicine policy and procedures for the service. We saw two audits that had been completed in January 2014. We saw that any gaps in the records had been identified and addressed with staff.

We met with the manager and two other members of staff . We also spoke with two people who use the service and one relative. There were eight people receiving various levels of personal care support at the time of our inspection including people needing assistance with taking their medicines.

People were involved in the support and help they required from the service. Where possible they were asked and encouraged to give consent about how they wanted to be cared for. Relatives were also involved and included in planning the support needed. One relative confirmed they had seen and signed their family member’s care plan.

People were supported effectively and had visits from a regular member of staff. People who use the service confirmed they knew who was coming to their home and that they had developed positive relationships with staff. One person told us “I am clear what I want” and said the service responded quickly if they had a concern or wanted a different member of staff to visit them.

Staff received training on medicines management. However we found there were shortfalls in this area. There was limited information in people’s care plans regarding the support people needed, such as prompting to take their prescribed medicines or if staff had to administer the medicine to the person. There were no records to show that any risks had been assessed with regard to medicines and if so how these would be managed. Therefore people using the service could be placed at risk of unsafe help and support.

There were systems in place to monitor the service. The manager and care manager contacted people on a regular basis and visited them to ensure they were happy with the service they received. Those people we spoke with confirmed they received phone calls and visits and were able to talk about any issues they might have with the service.

The service had a complaints procedure in place and responded to any comments or complaints made. People and the relative we talked with said they would be happy to talk to the service if they had a complaint.

We were able to talk with two people who use the service. People said they received information about the agency and had information in a folder provided by the agency. People said that the carer treated them with dignity and respect. We were told that the carer and manager listed, were responsive and flexible and met people's preferences. Comments made were "they are excellent and very friendly" and "marvellous."

People said they were satisfied with the care provided. We were informed that carer's monitored the person they were caring for and if there were any concerns or changes required communication was good.

Information was available on the services being offered by St. Michael Home Instead to assist people in making a decision about their care. The agency assessed people's personal care and social needs and aimed to provide a care worker who would understand their preferences and lifestyle.

People have a care plan which reflects their physical, emotional and social needs and ensures care is delivered safely.

The agency had policies and procedures in place to protect people from the risk of abuse.

The agency had a robust recruitment procedure in place for the selection of care staff. Staff received appropriate training, and regular planned supervision with their manager.

The agency had a system in place for auditing standards and asking people for their views on the service.