The inspection took place on 26 September 2017 and was announced. At the previous inspection in September 2016, the registered provider was in breach of the regulations around the need for consent, safe care and treatment and good governance. We asked the provider to take action to make improvements in their systems and processes, how they sought consent from people, risk assessment and the management of medicines. This action has been completed.

This service is a domiciliary care agency and provides personal care to people living in their own homes in the community. At the time of this inspection they were providing a service to approximately 190 people over the age of 18 in the Calderdale and Kirklees area. It is a condition of registration with the Care Quality Commission that the service has a registered manager in place and 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.

Our inspection confirmed staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents, which included contacting their line manager in the first instance and other statutory organisations if required.

The service practised safe recruitment to ensure people were cared for by staff who had undergone the necessary checks including obtaining evidence of conduct in previous employment, their full employment history, together with a satisfactory written explanation of any gaps in employment and checks with the Disclosure and Barring Service (DBS).

Environmental risks had been assessed to ensure a safe working environment for staff. The service had assessed the risks to people supported, but some of the measures put in place to mitigate risk were very general. The registered provider had recognised this and was in the process of improving these to make them more person-centred.

At our previous inspection we found moving and handling care plans lacked detail. At this inspection, we found improvements had been made in the assessment and records. These detailed the method staff were to follow when moving and positioning people.

We found the management of medicines was not in line with good practice at our previous inspections. We found improvements had been made at this inspection. Improvements were on-going and actions put in place when medicines audits highlighted gaps in medicines administration records.

At our previous inspection, the service was not meeting its responsibilities under the Mental Capacity Act 2005. Improvements had been made and mental capacity assessments and best interest decisions had been recorded. The registered provider was improving how it was recording Lasting Power of Attorney to ensure they had a record of who they needed to consult if the need arose.

Staff received regular training to ensure they developed skills and knowledge to perform their role and received regular on-going supervision and an appraisal to support their development. New staff completed the Care Certificate which included observations in their role and competency checks.

People were cared for by staff who were caring and compassionate and who respected their dignity and privacy. Staff could describe how they ensured they maintained people’s privacy. Equality and diversity was respected by the registered provider in relation to the workforce, and when providing the service.

Care records were person-centred and recorded people’s preferences, views and how they wanted their care to be delivered. Staff had received additional training in record keeping and this was an o

The inspection took place on 8 and 27 September 2016 and was announced. The service was previously inspected on 15 May 2014 and met all the requirements in place at that time.

Town and Local Care provides a domiciliary care service for approximately 195 people in the Calderdale and Kirklees area. They are registered to provide the regulated activity of personal care. It is a condition of registration with the Care Quality Commission that the service has a registered manager in place and 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.

Our inspection confirmed staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

The service practised safe recruitment to ensure people were cared for by staff who had undergone the necessary checks.

Environmental risks had been assessed to ensure a safe working environment for staff. The service had assessed the risks to people supported, but we found the identification of risk and measures put in place to mitigate risk were not specific to the person. As a result not all risks had been identified to ensure they were reduced.

We found people had assistive equipment in place which was not referenced in their moving and handling care plans and there was insufficient detail in the method staff were to follow when moving and positioning people.

We found the management of medicines was not in line with good practice and there were incorrect dosages recorded in care plans when referenced against the medicines administration records, not all medicines recorded in the care plans and gaps in the medicine administration records.

The service was not meeting its responsibilities under the Mental Capacity Act 2005. No capacity assessments or best interest decisions had been recorded and staff did not have a good understanding of the principles of the Act although they could describe how they supported people to make decisions.

Staff received regular training to ensure they developed skills and knowledge to perform in their role and received regular ongoing supervision and an appraisal to support their development. Staff competency was checked through two direct care observations each year.

People were cared for by staff who were caring and compassionate and who respected their dignity and privacy.

Care records were person centred and recorded people’s preferences, views and how they wanted their care to be delivered. However, care plans contained contradictory information and there were gaps in essential information which meant unfamiliar staff might not have sufficient recorded information to care for people appropriately.

The service had a complaints policy in place and complaints were handled appropriately to ensure a satisfactory outcome for people using the service. A record was kept of all compliments received and when these related to staff, these were published in the company newsletter to acknowledge staff achievements.

Staff spoke highly of the registered manager and the organisation and told us they were supported in their role. They enjoyed their caring role and showed great pride in their work and the feedback they received from the people they cared for.

The registered provider had a clear vision in place to develop the service. There was robust monitoring in place in areas such as people management and staff training. However, we found audits to monitor the quality of service provision around for example, the safe administration of medicines, and care plan audits had not been

The inspection visit was carried out by one inspector. During the inspection, we spoke with the deputy manager. We looked at the care records of five people who used the service and other records relevant to the management of the service. Following the inspection we spoke with seven people who used the service, one person's relative and seven members of staff. We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People received care which met their needs.

There were enough staff on duty to meet the needs of the people who used the service. Staff we spoke with told us they were given enough time during visits to people to provide care as planned.

Is the service effective?

We looked at five people’s care records and saw their individual needs were assessed thoroughly. We also saw care plans had been developed which were clear and provided staff with clear guidance on how to meet people’s needs.

Is the service caring?

We spoke with eight staff members and it was clear they cared for the people they supported.

Staff told us their rounds of calls to people were planned in such a way which ensured they visited the same people as much as possible. This meant people were supported by staff who knew them well. All of the staff we spoke with told us that each person’s care plans were person centred. This showed people’s care planning was individually tailored to meet their needs.

Is the service responsive?

We saw in all five care records that people’s needs had been assessed before they began using the service. Two people we spoke with told us they had required changes to the way care was provided. They had been able to talk to their carer about this and their care plan had been changed to reflect this.

Is the service well-led?

We spoke with the deputy manager of the service. We looked at the systems in place for monitoring the quality of the service provided to people. We found there were systems in place which ensured the service gathered feedback from people who used the service. We saw evidence of where action had been taken in response to feedback received.

We spoke with six people who used the service and the relatives of two people. The majority of comments about the quality of care provided by the care workers were good. Comments included, "Care workers are friendly; they know what they are doing" and "Absolutely brilliant girls". However nearly everyone we spoke with spoke negatively about the management of the service and most people told us they would not recommend it. Comments included, "I've been disappointed, information never gets through to the carer," "Too many people to see and not enough time," It's awful; times have been moved without letting us know".

We spoke with a selection of office staff and care workers. The office staff told us they had been going through a period of change as the registered manager had recognised there was a problem with the co-ordination of care. One office worker told us, "There's light at the end of the tunnel, we are getting the support we need".

We looked at the recruitment and training files of four care workers and saw they had received sufficient training for their role. However, two care workers we spoke with told us they had new staff shadowing them and they felt they did not have the relevant experience to support them.

We looked at the changes the registered manager was in the process of implementing in order to rectify concerns raised. We saw that progress was being made towards achieving the action plan.