At the last comprehensive inspection of 20 May 2015, the service had an overall rating of ‘Good’. The responsive section of the report was rated as ‘Requires Improvement’. This was because the service could not provide at the time of the inspection a complaints log or sufficient information about raised complaints. The registered manager was on leave and the senior staff were unable to access the complaints log.

At this announced inspection on 20 June 2018, we found the service remained 'Good'. The complaints log we found to be up to date and senior staff were able to access information about complaints. The service was only sending one member of staff to provide care on occasions when two staff were required. Hence the management rating has deteriorated to requires improvement in the well-led section but this does not change the overall rating

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last comprehensive inspection.

The service provides support to people in their own home. At the time of our inspection the service was supporting 140 people.

People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. Staff had a good understanding of what safeguarding meant and the procedures for reporting any issues of harm to people. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by the registered manager. Staffing levels were sufficient to fulfil arranged visits to people and meet their needs other than possibly up to six people that were being reassessed regarding the number of staff needed to support them at each visit. No harm had come to people when one staff member came instead of two staff and we understood in some cases family members had assisted. The staff recruitment procedures ensured that appropriate pre-employment checks were completed to ensure only suitable staff worked at the service.

The processes in place for managing medicines ensured that the administration and handling of medicines was suitable for the people who used the service. Staff were trained in infection control, and supplied with appropriate personal protective equipment (PPE) to perform their roles safely. Arrangements were in place for the service to reflect and learn from complaints and incidents to improve safety across the service.

People’s needs were assessed and their care was provided by staff that had received training and were supported in their roles through supervision. Staff supported people with dietary choices when identified to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals and worked in partnership with other organisations to ensure that people received the required support.

People's consent was sought before any care was provided and the requirements of the Mental Capacity Act 2005 were met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice

Staff treated people with care and empathy, People were happy with the way that staff provided their care and support. People were listened to, their views were acknowledged and acted upon and care and support was delivered in accordance with their assessed needs and wishes. Records showed that people were involved in the assessment process and their on-going care reviews.

The service worked in partnership with other agencies to ensure quality of care across all levels. People, relatives and staff were encouraged to provide feedback about the service. The registered manager carried out a number of audits and acted upon the feedback to develop the service.

This inspection took place between 27 April and 20 May 2015. The initial visit to the service office was unannounced.

The service provides care to people who live in their own home.

There was a 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 provider had a safeguarding adults policy for staff that gave guidance on the identification and reporting of suspected abuse. Staff we spoke with were aware of how to report suspected abuse.

An assessment of people’s needs was carried out prior to the service providing care. This included risks to the individual receiving care and environmental risks. Risk reviews for people were carried out on a planned basis and in the light of any new information.

There were sufficient staff to support people safely and provide care. When the service staff were running late or in danger of missing calls to provide care to people, the service had back-up plans in place to deliver the care to people.

We saw that care plans had been reviewed on a systematic basis. A member of staff informed us of the procedure used which included the manager overseeing the review notes and updating information onto a computer generated care record. The service was providing support to a number of people that had received care from a previous provider. Confirming the support required and writing up the care plans was being attended to at the time of our inspection. The plan to update the individual care plans was to write up first those with the most changes as a result of the care reviews.

Staff had received training to provide medication safely and the service had medication policies and procedures. We saw gaps in the medication record of one person and this was explained to us that the matter was being resolved with the person and their family so all parties were clear about who and when medication was being administered. The service had a well-equipped training facility and staff had received training in mental capacity.

People and their relatives gave positive feedback about the care staff that provided care. The service provided both supervision and a yearly appraisal to the staff. Staff we spoke with considered they were well supported especially as they could raise matters as they happened with the service senior staff.

People and their relatives told us they were involved in the planning of their care and support. They felt that the service listened to their views. They told us that when they contacted the service their calls were always answered and staff tried to support and help them. At the time of our inspection the service informed us there were no outstanding complaints, although we found all of the senior staff did not have access to the service complaints log. This has been changed since our inspection and now all of the senior staff can access the log and record subsequent action taken.

The service had systems in place to monitor the quality of service.

We spoke with six people who use the service, they told us they were involved in developing their care plans and that their care records reflected their choices and preferences.

Everyone we spoke with told us they have regular care workers who stay the allocated time and that they were satisfied with the care and support they received.

One person told that the whole service was “Excellent." Another person told us their support staff were "Very caring, very helpful, they always stay their allotted time, sometimes they go over their time and can be late for the next person."

One person told us that overall they were satisfied with the support they got, and that they found the service fairly reliable, but that they had to remind them from time to time about matters otherwise the support they needed was not sustained.

People told us they felt safe and trusted their care workers. They also told us they knew how to report concerns and would contact the 'office' if they were worried. Everyone we spoke with told us they were treated with dignity and respect at all times.

One person told us that they had raised concerns about a staff member smelling of cigarettes and another person had long finger nails which were painful on occasions. These matters had been appropriately responded to and resolved by the agency.

People told us that they have been asked for their views about the care and support they receive. One person told us "Whenever I have had to call the office, staff are friendly and helpful." Another person told us, "We get a visit from a lady at Carewatch to see how we are finding the service."

We spoke with ten people who used the service when we visited them and also a further twenty people by telephone interview. People who used the service told us they were happy with the service, it was rare that staff did not attend on time and usually if there were problems the office staff informed them of the difficulty. One person said, “I was reluctant to receive care but the staff are good and I have no complaints.”

We spoke with seven staff to learn about how the service supported them and provided training and to see if they received supervision. We also inspected how the service ensured that it respected and involved people who used the service. We looked at records of care and saw they were reviewed six monthly and more frequently as required. There was a safeguarding policy and procedure in place to ensure the service was well lead and kept people safe. We inspected the quality monitoring of the service to understand it was responsive to people’s needs and to see how it responded to complaints.