People received safe support because staff knew how to protect them from harm. One person told us, “I feel safe and well supported.” Another person said, “They [the staff] are obliging and anything I ask them to do they will do as long as it’s safe for them to do so.”

Staff we spoke with knew how to keep people safe and what to do if they had concerns about a person’s safety. Staff told us they had received training to protect people from abuse and were able to share examples of different types of abuse to demonstrate their understanding. Staff were confident to recognise and report concerns about people’s safety. They were confident that the registered manager would then take appropriate action.

Staff promoted health and safety and safe working practices. Staff told us that they were confident to recognise hazards in people’s homes. They developed plans to reduce risks and remove hazards if possible. For example, one staff member told us, “We look for hazards such as rugs and other obstacles that prevent us using equipment or place the person at risk of falling.” Staff told us that they had received training to help them to identify hazards in people’s home environment. When risks could not be removed they were managed safely.

One person had behaviour that challenged staff. Staff told us that they had received training that enabled them to offer safe support. One staff member said, “We have been taught to manage the behaviour safely. We redirect them if necessary. We speak with them and offer reassurance. This works.”

People were supported by staff who had sufficient time to carry out tasks required of them safely. People told us that staff had time to meet their needs. Staff said that they would never leave a person until they had done everything they needed. They said that if that meant they were late to their next call they would contact the office to inform them of this. Staff working at the office had lists of people who wanted to be informed if calls were going to be late. Staff also had a list of ‘high risk’ people who could not miss calls or had to have calls at set times. Staff had the resources to ensure that these calls were covered.

People we spoke with told us they had not experienced a missed call. The provider’s audits identified that there had been a decreasing number of missed calls over the last six months. Processes to manage this had been reviewed and undated. For example staff were given new rotas when changes were made as previous arrangements were not considered to be as effective.

People were supported by staff who had been recruited safely. Staff told us they were subject to pre-employment checks which included references from previous employers and checks with the Disclosure and Barring Service (DBS). The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with people.

People’s medicines were given to them in a safe way. People required varying levels of support to take their medicines. Some people told us they managed their own medicines. One person told us, “The managers assessed me and I can self-medicate. Carers still help me out to put cream and ointment on due to my lack of mobility when sitting.” Another person told us, “My husband does my medicines, although staff apply my eye drops.” Staff were able to offer flexible support depending on people’s needs. Staff encouraged people to be as independent as possible. One staff member told us, “We follow medication assessments. One person can manage if we just pour out the liquid medicine. We encourage people to be independent.” When staff supported people they completed records to show that the person had taken their medicines.

Staff told us that they had received training before they administered medicines and this gave them confidence to do it safely. One staff member told us, “The training was really good.”

We saw that staff had been observed to ensure they were competent to administer m

The people we spoke with told us that the service was good. They said the staff treated them with respect. People said, "They’re brilliant. I can’t fault my care" and “I’d be lost without them.”

People told us they were regularly asked if their service was satisfactory. They told us that the senior staff assessed their needs. In the care plans we looked at we saw the instructions for staff that minimised risks to people’s health and well-being.

Staff told us they had training in safeguarding people from abuse.

Staff also told us they felt supported to work effectively.

The provider had systems in place that enabled them to identify problems swiftly and act upon them to keep people safe at all times. This meant that the service was managed well.

People who use the service said that they were well looked after. They told us that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect. They said staff talked to them about how they liked their support to be provided.

People said that they were treated with respect and their privacy was maintained. They said that the staff were always polite and helpful.

We asked what they thought of their care and they replied with comments like “They’re brilliant” and “Absolutely brilliant”.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. Staff told us about the training that the service had arranged for them so that they would recognise abuse and how to report it.

People told us that staff were punctual and reliable. People’s relatives told us that staff were always friendly and professional when they visited. One person said “They are very good. Very punctual” and another said “Can’t grumble about the staff”.

People we spoke with said their comments were listened to. A relative said that they would not hesitate to talk to staff if something was wrong.

The inspection was announced and took place across three days from 11 January 2016. The provider had short notice that an inspection would take place. This was because the organisation provides a domiciliary care and we needed to ensure that the registered manager would be available to assist with the inspection. At the time of this inspection 154 people were receiving a service from the provider. At the last inspection in December 2013, we found the provider was meeting all of the requirements of the regulations we reviewed.

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 2008 and associated Regulations about how the service is run.

Feedback we received from people who used the service and their representatives was mixed. Some people considered that staff sickness and changes of staff over the last few months had impacted on the delivery of care and support they or their relatives received from the agency. Some people indicated that their calls were not always at the preferred time or with their regular carers, but most people acknowledged they were informed prior to any change. The management team acknowledged there had been an acute period of staff sickness. As a separate issue, staff recruitment and retention was also acknowledged as being historically challenging, but recruitment had now improved.

People told us they felt safe when being supported by their carers. Staff had received training in safeguarding and were aware of their responsibilities to report safeguarding concerns or poor practice. They were confident any safeguarding concerns raised were acted on. Risks to people were identified, assessed and reviewed to ensure their on-going safety. Staff recruitment processes were in place to ensure only staff suitable to support people living in their own homes were employed.

Most people we spoke with considered their carers had the skills and knowledge to meet their individual needs. 88% of people we surveyed considered their carers had the skills and knowledge to give them care and support they needed. Six people considered their or their relatives’ carers required more training or supervision. Staff were able to share examples of how they offered people choices, gained their consent, respected people’s rights and how they involved them in decisions about their care. Staff ensured people had sufficient amounts to eat and drink and supported people with accessing healthcare services where required.

Most people considered they were always supported by staff that were kind and compassionate. Staff were able to share good examples of how they treated people with dignity and respect and promoted their independence. People were involved in their assessments and planning and reviewing their care with other key people in their lives. People knew how to complain about their service although some people felt the agency did not respond well to complaints they raised. Some people felt new staff did not consistently understand their care needs and preferences.

Most people considered the agency was managed well. Some people and staff felt that communication could be improved. We saw there were systems in place to gain people’s views and to monitor the service. The management team completed regular quality checks. These included checks on staff working with people in the community in addition to a range of audits carried out. Managers reported they had recently been through a challenging period with acute staff sickness and that they had recently made some changes to management arrangements. These were part of the provider’s ongoing efforts to improve people’s experiences.