The Hydro Domiciliary Care Agency currently provides support for up to six people in flats owned by the provider and rented through a separate tenancy agreement. Four people were receiving care at the time of our inspection. A separately registered older person's home and two community houses for people with learning disabilities are located on the same site.

A manager was appointed in September 2013 for The Hydro and the community houses, and had applied for registration with the CQC. The care home is managed by another manager registered with the CQC.

As part of our inspection we spoke with three people receiving care, managers and staff working at the service. We also examined records and observed people receiving care.

Below is a summary of what we found.

Is the service safe?

People we spoke with receiving support told us they were happy with their care. One person said, “It’s the best place I’ve been to.” Systems were in place to monitor the safety and quality of care provided by the service. A plan was in place to help ensure people could continue to receive care if an emergency occurred. People’s needs were assessed but care planning did not always ensure their welfare and safety. Changes and updates were not always made to care plans and important information about reducing risks and specific care needs were not always included. People who had behaviours described as “challenging” did not have adequately detailed plans to ensure their care was safe and appropriate. Insufficient guidance was available for staff to help people who may need to be physically restrained. This meant there was a risk to people’s safety and welfare. Adequate numbers of suitable staff were provided in the daytime and evening but there were not enough staff to provide safe support for people at night, including if there was an emergency. Restrictions placed on some people at the service to keep them safe could mean they were at risk of having their liberty deprived. Appropriate procedures had not been followed to ensure people’s rights were not breached.

Is the service effective?

We found although consent was sometimes obtained for people's care, appropriate arrangements had not always been made if people could not consent for themselves due to their learning disability. We found people's needs were assessed and care files included some information about risks that could affect them. The care planning process had not always been used to effectively describe people’s needs and the support they needed. This meant people's welfare and safety was not always protected.

Is the service caring?

People told us they liked the staff and were happy with their care. One person told us, "The people are all nice and I like my flat too." We saw staff providing people’s care and that they were respectful and responsive to their needs. People’s preferences and lifestyle choices were included in their care records.

Is the service responsive?

People receiving care told us they were confident any concerns or complaints about the service would be properly responded to. Systems were in place for obtaining people's views about the service including regular meetings for people receiving care, team meetings for staff and surveys for people connected with the service. Records showed the manager made changes in response to any concerns. Care plans were not always updated to reflect changes in people’s care needs.

Is the service well-led?

A system of checks was in place regarding managing medicines, staff training and health and safety at the service. Professional advice was obtained to help plan people’s care and this was usually followed.

There were eight people using the service at the time of this inspection, including four people in the apartments attached to Lilybank Hamlet care home. We met three of the people using the service and spoke with two staff.

We found that the provider had taken action following our last inspection. This had resulted in changes and improvements to how care was planned and delivered. Medication was given safely and recorded correctly and there were systems to monitor this. People’s personal records were up to date and included full details of their needs and individual preferences. Staff were up to date with required training and had regular supervision to support them to meet the needs of people using the service.

The provider had taken some action to ensure that people were asked for their consent before they received care or treatment. However, we found that people were not always asked for consent to their care. Assessments of people’s capacity to consent were in place but were not in line with the relevant legislation. This meant that people’s rights may not be protected and upheld.

There were eight people using the service at the time of this inspection, including three people in the apartments attached to Lilybank Hamlet care home. We spoke with two relatives of people using the service and a social worker for one person using the service.

The relatives we spoke with told us they were mostly satisfied with the service provided. One said, “I’m impressed with the lengths they’ll go to to ensure the care meets her needs”. The other relative said, “Most of the time they understand what she needs. Just occasionally we need to explain”. A social worker for one person using the service told us they were happy with the care and support the person received.

We found that people were not always asked for their consent before they received care or treatment. If people lacked the capacity to consent, there were no suitable arrangements for acting in their best interests.

People’s needs were assessed, but their care and treatment was not always planned and delivered to meet their needs. This meant that people were at risk of receiving unsafe or inappropriate care or treatment.

We found that medicines were not always correctly recorded. There was insufficient guidance for staff about the administration of some medicines.

We found that staff did not always have the training and supervision to ensure they provided care and support to people safely and to an appropriate standard.

People’s personal records were not always accurate or up to date.

We did not speak with people using the service for this follow up review.

We found that the provider had taken some action following our previous inspection to ensure that people were protected against the risks of unsafe or inappropriate care. However, we found that one person’s needs had not been assessed or planned in relation to the support they needed with managing their medication.

We found that the provider had taken appropriate action following our last inspection to ensure that people could give their views about the quality of the service provided.

People told us they were involved in making decisions about their care and they understood the choices available to them. One person told us how the manager had visited them before the service started and had, “Asked me what I wanted doing and told me what they could and couldn't provide”.

People told us that their privacy and dignity were respected by staff. People were asked how they wanted to be addressed by staff and what gender of care worker they preferred.

People's needs were assessed and the planning and delivery of care usually ensured their welfare and safety. However, we found that one person's needs had not been fully assessed and their care plan lacked important details. This meant the person was at risk of receiving unsafe or inappropriate care.

People told us they felt safe with the staff who supported them. We found that people using the service were protected by the policies in place and by staff awareness.

People told us the staff had the right skills and experience to meet their needs. A relative told us the staff were, “Pleasant ladies. I overhear them talking with Mum and they always have a laugh and a joke with her”.

We found that the provider's systems for monitoring the quality of the service provided and for managing risks to people using the service were not always effective.