We carried out this inspection on 21 September 2018. The inspection was announced. We gave notice because this is a small service and we needed to ensure the registered manager would be available to speak with us.

This service was last inspected in March 2016 and was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to adults who have a learning disability. The service is provided in Chester, Cheshire.

There were 15 people receiving regulated activity at the time we carried out our inspection.

There was an experienced registered manager responsible for the day-to-day management of the service. 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 this was a good service and said they would recommend it.

The staff knew people well and treated them in a kind and caring way. People valued the service they received. There were enough staff to support people. People received support from a small team of staff who they knew. Safe systems were used when new staff were employed to check they were suitable to work in people’s homes.

The staff were well trained and skilled to care for people. They knew how to provide people’s care safely and to protect people from abuse and harm. 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 supported this practice. People consented to the care they received and their rights were respected. People’s needs were assessed and care was planned and provided to meet their needs.

People knew the registered manager and how they could contact her. The registered manager set high standards and checked the service to ensure these were met.

The registered provider had a procedure for receiving and responding to complaints about the service. They prided themselves on being response to any concerns raised before they became complaints.

This was an announced inspection, carried out on the 8 and 9 March 2016.

Bank House is a domiciliary care agency registered to provider personal care to people who live in their own homes. The agency is based in Chester and provides support to people with a diagnosis of autism and/or learning disability in the Chester area. The service currently supports fourteen people who live in shared rented accommodation.

The service has a registered manager. 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 last inspection of Bank House was carried out in April 2014 and we found that the service was meeting all the regulations that were assessed.

People and their relatives told us that they felt safe. The service had processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency's whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider or the registered manager and that they would be addressed appropriately.

Staff carried out risk assessments and identified people's specific health and support needs. Care was planned and agreed between the service and the individual person concerned.

There were safe systems in place for the management of medicines. People were supported to independently manage their medication and individual signed medication support agreements were in place.

The service had robust recruitment practices in place. Applicants for posts were assessed as suitable for their job roles. All staff received training to enable them to fulfil their roles which included essential subjects such as moving and handling, safeguarding people and medication training. Staff were well supported through regular supervisions, appraisals and team meetings.

Staff were trained in the Mental Capacity Act 2005 (MCA) and showed a good understanding of the importance of involving people in decision making and seeking consent in their day to day support. The registered manager informed us following the inspection that they were resourcing a policy and procedure on the MCA and this would be implemented in the near future.

People were treated with dignity and respect and staff respected individual’s decisions regarding their lifestyle choices. Staff had received training on equality and diversity and were able to describe how this influenced their work practice.

People were involved in the development and reviewing of their care plans. Information was personalised and focused on promoting people’s choice, independence and preferred methods of communication. People signed their own care plans to confirm they were happy with the information that was written about them.

The service sought feedback from people and their relatives. People were encouraged to share their concerns and complaints. The registered manager investigated any complaints or concerns thoroughly in line with their own policy and procedures.

The service was well- managed by a person described as “approachable”. Quality assurance audits were undertaken by the registered provider to ensure that they service provided was effective and meeting people’s needs. The registered provider planned to review the audit process in the near future to further develop the service. Accidents and incidents were reviewed to ensure that any risks to people were minimised and we were notified as required about incidents and events which had occurred at the service.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe and their rights were respected. They were protected from unsafe or inappropriate care arising from a lack of proper information about them because the service maintained accurate information about their care and support needs.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, complaints and investigations. This reduced the risks to people and helped the service to continually improve.

Staff knew about risk management plans and we saw examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Recruitment practice was safe and thorough.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. People said that their care plans were up to date and reflected their current needs.

Is the service caring?

We spoke with three people being supported by the service. We asked them for their opinions about the support they received. Feedback from people was positive and they were keen to tell us how staff supported them to improve their independence and be involved in the local community.

When speaking with staff it was clear that they genuinely cared for the people they supported.

Is the service responsive?

The service worked well with other agencies and services to make sure people received care and support in a coherent way.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well-led?

People using the service or their relatives completed an annual satisfaction survey and this was used to identify areas for improvement. The service had also achieved Investors in People accreditation. This demonstrated that the service was aiming to continuously improve.

We visited one of the properties where people were supported and spoke to three people who used the service. They said that they were getting the support they needed. They said they were happy living in their home, liked the people they lived with and liked the staff.

Two relatives spoken with said that they were happy with the service and that a good standard of care was provided. They said that they were involved in the plans of care and support and were kept well informed by the staff team.

Our observations indicated that the people who used the service appeared relaxed and happy with the staff supporting them. Staff were observed to be respectful and caring towards the people who used the service.

Records showed that the people who used the service had a support plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

Staff were supported in their role and they were aware of the action to be taken to safeguard vulnerable adults from abuse.

There were systems in place to monitor the quality of the service. This included having a number of ways in which the people who used the service and their relatives could make their views known about how the service operated.

We spoke to six people who used the service who told us they were happy with the support they received. They described the staff positively and said that they listened to them and gave them the support they needed. They told us about a range of things they did with the support of staff, which indicated that staff were supporting people to make choices and to use and develop their independent living skills. Some comments made were:-

“I like it.”

“I get the help I need. I get on with the staff. I’m happy.”

“We are like a family here. I like the staff, they give me the help I need.”

We spoke to four relatives who said they were happy with the service and that a good standard of care was provided.

Records showed that the people who used the service had a support plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

People’s nutritional needs were appropriately supported.

There were systems in place to respond to complaints and to take appropriate action when necessary.

Improvements were needed to the recruitment process to ensure that people were supported by staff suitable for their role.