This was an announced inspection that took place on 13, 14, 15 and , 16 June 2017. Time2Care (BSE) Ltd provides domiciliary care services to people in their own homes. At the time of the inspection, the service provided care and support to 118 people.

There was a registered manager working at 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 and associated Regulations about how the service is run. The registered manager was on leave during our visit. We met with one of the directors of the company and the care manager.

People received a very responsive and person centred service. People’s care and support was planned in partnership with them and was flexible to change as required.

There was a strong ethos within the provider company of responding to people as individuals and with respect. Information was available to people about how to raise any concerns they may have and where concerns were raised these were encouraged and dealt with speedily.

There were systems in place to minimise risks to people and to help keep them safe from harm. People felt safe. Appropriate plans were in place to guide staff in how to minimise risks to keep people safe. Staff knew what action to take to ensure people were protected if they suspected they were at risk of harm. There was a consistent staff team and there were recruitment practices in place, which meant staff had been recruited safely.

Medicines were managed in a safe way and support was offered to people to manage their medicines when needed.

People received care in a manner which was in accordance with the principles of the Mental Capacity Act. People were given the information needed to make informed choices, and their choices were respected.

When needed, people were offered support to eat and drink in accordance with their preferences. Staff supported people to make and attend health appointments where requested.

Staff received training which was relevant to the needs of the people they were supporting. Staff were supported through supervision and the managers’ ‘open door’ policy. People who used the service and the staff thought highly of the care staff and the provider.

Staff were knowledgeable about people and their preferences and routines and provided person centred care.

People’s privacy and dignity was respected by staff. Staff were enthusiastic about working with the people who used the service and developed positive relationships with them.

There was a quality assurance system in place to ensure the service was routinely audited and checked. The registered manager and directors used these checks to assess and review the quality of service people experienced. There was information available if people or their relatives wanted to complain.

The inspection took place on the 18 January 2016. We gave the provider 62 hours’ notice of our intention to inspect to give them time to arrange visits to people using the service. The agency gained consent ahead of our visits and we visited 15 people to ascertain their views of the service.

The service is registered to provide personal care to people and currently supports about 150 people with domestic, social and personal care support.

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.

People’s views of the service were positive and staff enjoyed working for the agency. Senior staff knew people well and care calls appeared to be well coordinated with most care staff having regular rounds with minimal travelling. However there had been some missed calls, the last being the day before our inspection. This potentially putting people at increased risk of harm.

People were supported to take their medicines [where required] by staff who were trained to do so. However we identified a number of issues and did not feel the auditing of medicines was sufficiently robust.

Staff were given sufficient training and induction into their role to enable them to deliver care effectively. Staff understood their responsibilities and their performance was monitored to ensure they had the competencies and skills for their role.

Risks to people’s safety were not always fully assessed and we found record keeping required improvement as it did not always accurately reflect people’s needs or take into account changes which had occurred. This meant staff were not always sufficiently knowledgeable about people’s needs and we found they did not always have sufficient time to deliver the care the person needed.

Staff understood how to promote people’s safety and independence. Staff had been provided with training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS) and understood the principles of consent and best interests. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions were made in their best interests according to a structured process. However, people’s preferences were not always recorded. Staff had a good knowledge about how to safeguard people in their care and report any changes or where they had concerns about people’s well-being.

The service was well led with staff working together as a team and having a clear understanding of theirs and others roles. There were clear lines of accountability and staff were well supported. There were sufficiently robust quality audit systems which took into account people’s views and experiences which were used to change and improve the service as required.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in one regulation. You can see what action we told the provider to take at the back of the full version of this report.