The inspection took place on 5 December 2017 and was unannounced. Phone calls to people who used the service and their relatives were also carried out on 8 December 2017.

This was the first inspection for this service which was registered with the Care Quality Commission (CQC) in March 2017.

Total Care Norfolk is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection five people were using the service which provides care to people in the Downham Market area.

The service did not have a registered manager in post. A manager had previously been appointed but had left the service in October 2017 before they were registered with CQC. The provider had not yet appointed a new manager and was carrying out this role herself in the meantime. 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.

There were systems in place designed to help protect people from abuse. Staff understood their responsibilities and the service had raised concerns appropriately with the local authority and taken their advice.

Risks to people’s health and safety were assessed and managed well. Staff understood risk, including how to manage the risks relating to the spread of infection, and information about protecting people was clear.

Staff were recruited safely and there were enough staff to meet people’s needs. A small staff team provided consistent care to people.

The provider carried out a detailed assessment of people’s needs and encouraged people to be involved in decisions about their care and support. Staff received the training and support they needed to carry out their roles. Staff supported people to manage their healthcare needs and access the care they needed.

People consented to their care and their choices were respected. Staff worked in accordance with the Mental Capacity Act 2005 (MCA). The MCA ensures that people’s capacity to consent to their care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process.

Staff treated people with patience, warmth and kindness and relationships were good. Staff respected people’s privacy and maintained their dignity. People were encouraged to be as independent as possible.

People received flexible, person centred care which met their individual needs and preferences. Staff treated people as individuals and were committed to ensuring that people received their care in the way they chose.

A complaints procedure was in place but no formal complaints had been logged. People knew how to make a complaint and felt comfortable raising any informal issues with the provider.

There was no structured system of audits in place, although the provider was regularly on the shift rota and was monitoring the quality of the service by speaking with people directly.

The provider demonstrated that they needed a clearer understanding of some aspects of the role of regulation.

Staff felt supported and the provider promoted an open culture which welcomed constructive criticism.