This inspection took place on 21 June 2017 and was announced. At our last inspection completed in September 2015, we found the provider was meeting all of the requirements of the law we looked at. At this inspection we found the provider needed to make some improvements within the service.

Twilight Homecare Services is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection the service supported 74 people; most of whom were older people and some of these people were living with dementia.

The provider was registered for the regulated activities of personal care and treatment of disease disorder or injury. The provider was not providing any services under the regulated activity of treatment of disease, disorder or injury and therefore it was not inspected. The provider confirmed to us they would be cancelling this part of their registration.

A registered manager was 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 did not always receive their care visits on time which increased risks to their health and well-being. People were however protected by a staff team who understood how to protect them from potential abuse. Staff also understood how to minimise the risk of harm such as injury or accidents to people. People were supported by a staff team who had been recruited safely for their roles.

People were happy with the support they received with their medicines. Records relating to the administration of medicines were not always accurately completed. This meant the registered manager was not always able to demonstrate that people had received their medicines as needed and as prescribed.

People without capacity to make their own decisions or consent to their own care were not always supported in line with the requirements of the Mental Capacity Act 2005. People were supported by staff who mostly had the skills required to support them effectively. People’s day to day health needs were supported and staff knew how to support people with their nutritional needs.

People were supported by a staff team who were kind and caring towards them. People were encouraged to make choices about their care. People’s dignity was protected and their independence promoted.

People received care and support from care staff that met their needs and preferences. Care plans were in place and were regularly reviewed. People felt able to raise complaints about their care if necessary. We saw the registered manager took complaints seriously and provided a response.

People felt the service was well-led and their views and opinions were sought. People were cared for by a staff team who felt supported by the management team. We saw the registered manager had systems in place to identify areas for improvement within the service and action was taken to make improvements. However some improvements were required to ensure system’s identified issues with individual people’s care records and the accuracy of records held within the service.

We found the provider was not meeting the regulations regarding the display of their last CQC inspection rating and the submission of statutory notifications to CQC. You can see what action we told the provider to take at the back of the full version of the report.

We gave short notice of our inspection. At the time of our inspection the service was providing personal care and support to 43 people. We spoke with five people who used the service and five relatives. We visited the offices where the care was managed from. We spoke with four staff and the registered manager. We observed a senior member of staff and visited three people living in their own homes, who used the service.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, telephone discussions with relatives and by looking at records. This helped us to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective and, Is the service well led?

Below is a summary of what we found.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

One person told us, “I have regular staff and I am very pleased with everything”. A relative told us, “I am happy with the service provided”.

All the staff we spoke with told us that they felt that the people who used the service were well cared for, their needs were met and that people were safe. Staff told us about the on call procedures that were in place to provide advice and support to staff when needed, so that they felt supported and safe in their role.

The care records showed how people wanted to be supported and provided most of the information that staff needed to ensure people’s wellbeing and safety.

Staff we spoke with had only a basic knowledge of Deprivation of Liberty Safeguards (DoLS) process. DoLS is a legal framework that may need to be applied to people who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. The registered manager told us that all staff had received the training and that some training updates would be provided to ensure that staff understood the importance of the legislation.

We determined that the management of medication administration needed greater diligence. This included assessing any risks to people and ensuring that documentation recorded the support people needed so people received their medication safely.

Overall, we found that some improvements were needed to meet the requirements of the law to ensure the service was safe.

Is the service effective?

One person told us, “The staff are very good I am happy with the care staff”.

We observed that people who used the service looked comfortable and relaxed around the care staff that were supporting them.

Staff told us if people were unwell or needed more time to carry out their care then they would ensure that this was provided, and that they would inform their managers.

People had their needs assessed and care records generally showed how they wanted to be supported.

Systems were in place to identify changes in people’s needs so that people continued to receive the care they needed.

We found that auditing and monitoring systems had improved. However further improvements were needed to ensure medication systems were effective.

Overall, we found that some improvements were needed to meet the requirements of the law to ensure the service was effective.

Is the service caring?

One person told us, “The staff are very good and kind”. A relative told us, “Most of the care staff seem very good”.

We observed a senior staff member visiting people to monitor their care. We saw that interactions between staff and the people who used the service was relaxed and staff were generally caring.

All staff that we spoke with knew the care and support needs of people well enough to ensure personal care was provided in a way that the person preferred.

Overall, we found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was caring.

Is the service responsive?

We found that review meetings had taken place and questionnaires had been sent out to people to ask their views about the service. This meant that people had the opportunity to raise issues. This showed that the provider was willing to listen to the views of the people that used the service to improve the overall provision.

When people had become unwell or their care needs had changed staff had noticed this and taken action.

We found that the provider had taken note of the findings from our previous inspection and had taken some action to address issues to improve, for example, improving written information about people’s care so that care was delivered as needed.

Overall, we found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was responsive.

Is the service well lead?

There was a registered manager in place who was aware of their legal responsibilities.

All the staff we spoke with told us that they could raise any concern about poor practice in the service and these would be addressed to ensure people were protected from the risk of harm.

Arrangements were in place to ensure that staff knew how to act in the event of an emergency so that people were safe.

Arrangements were in place to listen to people and to deal with complaints.

Overall, we found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was well lead.

People who used Twilight Homecare Services had complex care needs. We spoke to relatives of three people with dementia. One relative told us “The care workers are very good with him. They treat him like a member of their own family. The manager makes sure everything is done properly”.

Another relative said: “We have a regular care worker. She does whatever she needs to do to care for him through the night, so that I can have a good night’s sleep. She is gentle; she gets on well with him. Her time-keeping has been excellent”.

A third relative described the service as “excellent; reliable and responsive. On an occasion when the family had been particularly concerned, the care provided was outstanding”.

This inspection took place on 09 and 17 September 2015 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because the service provides domiciliary care and we wanted to be sure that staff would be available.

We last inspected Twilight Home Care Services on 09 June 2014. At that inspection we found the provider was not meeting two regulations. Systems in place to ensure people received their medicine safely and monitoring of the service had not been effective. The provider sent us an action plan and told us what improvements they had made. 

Twilight Homecare Services limited is a privately owned service, which provides a personal care service to people living in their own home.

There was a registered manager in post at the time of our inspection. A registered manager is required to manage this 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 were supported by staff who were able to recognise the signs and symptoms of abuse and knew how to raise these concerns. There were sufficient numbers of trained staff that had the appropriate recruitment checks to ensure that they received safe care.

All the people we spoke with said they had received a safe service. The risk of harm to people was assessed so that risks were minimised. People who received support with how their medicines were managed were satisfied. 

People told us that the staff supporting them were caring and trained and competent in their role. Arrangements were in place to ensure that staff received the training and support they needed to carry out their role.

Most people told us that they received support from a consistent team of staff. Systems were in place to ask people their views about their care. However, some people told us that their views had not been sought.

Systems were in place to monitor the quality of the service provided and to learn and make improvements to the service. Some records needed to be more detailed to ensure robust systems were in place.