We inspected this service on 30 and 31 August 2016 and we gave short notice to the registered provider prior to our visit. This was to ensure that key people were available during the inspection.

Starcare Limited is a domiciliary care agency that provides a range of care services to people in their own homes. The offices are based in the city of Chester. There is limited car parking to the side of the building. The service covers the geographical areas of Chester, Ellesmere Port, Neston, Frodsham, Crewe, Middlewich, Winsford, Northwich and the surrounding areas. There are currently 350 people who use this service and who are supported by 168 staff.

The previous inspection was undertaken on 6 January 2014 and the service met the regulations we assessed at that time.

There was a registered manager in place, who was also the managing director and owner of the service. For the purposes of this report they will be referred to as the registered manager. They had been registered for eight years. 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 the staff were kind, caring and helpful. They said “The staff are trustworthy”, “The attitude of the staff is very good”, “The staff are nice”, “I like all the staff who come to me” and “I have got some good carers”.

People had mixed views about the punctuality of the staff and whether they were informed. We found that systems were in place to monitor this and that where issues occurred these were dealt with by the registered manager.

People said they were felt safe with the staff. Staff were aware of safeguarding policies and procedures and had undertaken safeguarding awareness training. The registered manager understood the principles of the Mental Capacity Act (MCA) 2005 and the implications of it on people who used the service. Staff had an awareness of the MCA through the induction process and safeguarding training.

Staff recruitment processes were in place which meant that people were protected from staff that were unsuitable to work with people who may be deemed vulnerable. Staff had undertaken an induction and had access to supervision sessions and training relevant to their job role.

Care plan documentation was person centred and gave good information about the individual needs of each person. A risk assessment was tailored to each person’s particular requirements. Some people were supported with their medications and these were well managed by the staff. All documentation seen was up to date.

Some people were supported with meal preparation and the purchase of food. A financial record was kept where food was purchased by staff and this was reviewed by senior staff during monitoring visits.

People had access to information about the service that included a service user’s guide. However most people telephoned the service and spoke to the registered manager to obtain verbal information about Starcare. An initial home visit was undertaken by senior staff prior to the service starting.

A complaints policy was available and each person had a copy within the service user’s guide which was within their care plan file. Processes were in place and complaints made had been dealt with in a timely manner.

Quality assurance processes were in place which included observations of staff to ensure that care and support standards were being maintained, reviews of people’s care and an annual questionnaire for people who used the service. There were also a range of audits undertaken in relation to the service provided that monitored its safety and effectiveness.

A range of policies and procedures were in place. We found that throughout some of these reference was made to past legislation

Some of the people using the service had communication difficulties and were unable to talk to us. We spoke to five relatives who were happy with the service provided. Comments included “Very happy” with the service”; “No worries at all about Starcare, quite happy with the service. They (the person using the service) look forward to them coming and a friendship has built. I’d be lost without them”; “It (the service) gives me tremendous peace of mind. Very happy with it, it’s a lifesaver”; “Everything has been really good, I can’t praise them enough”.

Care records were person centred with clear guidance to staff on the support required by each person. People's individual needs and preferences had been taken into account and people had been given a choice in how they wished to be cared for. Care plans were regularly reviewed and updated when a person's needs changed. Relatives confirmed that consent to any care plan changes or personal care was always sought by staff.

All necessary checks to safeguard people against abuse had been undertaken in the employment of staff and a regular training programme for all staff ensured they had the qualifications, skills and experience to undertake personal care. Staff were regularly supervised and appraised in their job role through spot checks and follow-up visits undertaken by team leaders.

The provider had systems in place to adequately assess and monitor people's individual risks such as care plan audits, care reviews and regular contact with the person and/or their relatives. An annual survey and quality monitoring visits were undertaken to collect people's/relatives views on the service provided. The survey results for 2013 showed people who used the service and/or their relatives were satisfied with the service provided.

We spoke with people who used the services in their own homes and asked them to share with us their views and experience of the care support they received.

One person’s relative told us “My relative really enjoys the company of the staff. They (their relative) only had wonderful things to say about the Starcare staff.” Another person told us “I have just had a review with the senior, they (the staff) are very good it is a very well run place and the staff are very kind and respectful.”

In the office the service had a methodical management procedure for the referral process. The manager told us they had daily meetings to review all aspects of the business which included the step by step management of new and existing people who used the service.

We viewed care files and found them to be person centred. A process was in place to support scheduled reviews every three months.

We spoke with staff who told us they felt well supported by both the management and their peers. They said they worked well as a team. The manager told us that they had their own training facilities where training was delivered to the staff to keep them updated on care delivery courses and mandatory training. This was supported by our discussions with staff who told us that training was encouraged.

We spoke to a selection of eight people and we received 2 emails from people who use the service. We asked their views about how they are involved in making decisions about their support and how the service was run.

People told us they had information about the service which they kept in their home. Most of the people we spoke to said they didn’t really look at their care plan file but they knew it had a lot of information if they needed it.

People told us they felt well supported by the staff. Everyone we spoke with was very positive about the care provided and felt that the standard of care was very good. Most people told us they were familiar with the staff that supported them and knew their names

Most people felt they usually received the same staff to provide their support.

Three people felt they didn’t always know what staff were turning up. They suggested that if they had a rota supplied that this would help them to identify who was due to call to see them.

Some comments made included, for example:

“I have had the most wonderful care and experience, I have the highest opinion for all the staff”: “The staff cant do enough for me”; “ On the whole very good service”: “Staff are kind cant fault them”; “I’ve had visits from the senior staff to review the care package”; “ The staff are very kind”; “The staff advised me I can ring anytime and let them know if I have a problem”: “I have a number to ring if I have any problems”; “I know if I complain they respond and sort it out, they respond very quickly”.

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the service. They had no issues of concern to report.