Victoria Homecare Limited is a domiciliary care agency which provides personal care to people living in their own homes in the Doncaster area. At the time of our inspection it was predominantly supporting older people, including people living with dementia. Care and support was co-ordinated from the agency’s office, which is based in the centre of Doncaster. At the time of the inspection 62 people were receiving personal care from the service.

The inspection took place on 2 November 2017 with the registered provider being given short notice of the visit to the office, in line with our current methodology for inspecting domiciliary care agencies. At our previous inspection in October 2016 the service was given an overall rating of ‘Good’. However, we found improvements were required in the ‘Well Led’ domain, where a breach of Regulation was found in respect of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 [Governance]. We asked the registered provider to submit an action plan outlining how they were going to address the shortfalls we found, which they did.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Victoria Homecare Limited’ on our website at www.cqc.org.uk’

At this inspection we found improvements had been made regarding the governance of the service. A more robust auditing system had been introduced and action plans were in place to address any areas found to need improvement.

The service had a registered manager in post at the time of our inspection. 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.

People were happy with the quality of the care they received, and told us that staff treated them with respect and dignity, and cared for them in a way which met their needs.

There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to individual people. Staff had received appropriate training in relation to protecting people from the risk of abuse.

Recruitment processes were robust, which helped the employer make safer recruitment decisions when employing new staff. Staff had undertaken a range of training and support that aimed to meet people’s needs while developing staffs’ knowledge and skills. However, some staff felt additional training would be beneficial.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were encouraged to manage their own medication if they were able to, while other people were supported by their close family. However, when assistance was required appropriate support was provided by staff who had been trained to carry out this role.

People’s needs and any potential risks had been assessed before their care package started and where possible they or their relatives had been involved in formulating their care plans. The company was in the process of moving paper records onto a new electronic system. Although the new system told staff what ‘tasks’ they needed to carry out at each visit, information about peoples abilities and preferences had not always been fully transferred on to the new record. This had not had a negative impact on people, as they were usually supported by the same core team of care staff who knew them well.

The complaints policy was provided to people using the service. The people we spoke with told us they would feel comfortable speaking to any of the staff if they had any concerns. When concerns had been raised we saw the correct procedure had been used to record, investigate and resolve i

This inspection took place on 6 October 2016 and was un announced. We last inspected this service in November 2014 and found that the provider was meeting the legal requirements in the areas we looked at.

Victoria Homecare Limited is a community based service in Doncaster, providing care to people in their own homes. There were seventy people using the service at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff were trained in safeguarding and they knew how to keep people safe from avoidable harm. There was enough staff to safely meet people's needs. People had individualised risk assessments in place that gave guidance to staff on keeping them safe and their medicines were managed appropriately, where required. The provider had policies and procedures in place for the safe recruitment of new staff.

Staff were knowledgeable about people's care needs and were trained to meet these needs. The requirements of the Mental Capacity Act 2005 were met. People were able to express their views and be actively involved in making decisions about their care. Staff were caring, friendly and approachable. They were also respectful of people's dignity and privacy.

The service was responsive to people's needs which had been identified prior to them starting to use the service, and were reviewed regularly. People were supported in a personalised way and they all had individualised care plans in place.

There was a registered manager in post who supported staff. Quality assurance systems were used to monitor the quality of the service, however, in some cases there were no actions documented to address the shortfalls identified.

You can see what action we told the provider to take at the back of the full version of the report

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff received appropriate professional development. We saw that there were up to date policies for staff supervision, staff induction and a safe working practices policy.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had a quality policy and audits which covered areas such as missed calls, care plans, care plan notes, medication administration records (MAR), financial transactions and care plan reviews.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans were regularly reviewed to ensure that they remained valid. Audits and checks were in place but not completed regularly to assess the safety and quality of the service.

Is the service responsive?

Audits and checks were in place but not completed regularly to assess the safety and quality of the service. Staff supervisions did not take place.

Is the service effective?

Responses to service user questionnaires were predominantly positive. One response read,“All your carers are very kind.”

Is the service caring?

People’s records indicated that staff were following assessments and care plans in the way that they cared for each person.

Is the service well-led?

Periodic service user questionnaires were undertaken. Audits and checks were in place but not completed regularly to assess the safety and quality of the service.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People who used the service told us the care and treatment they received was good. Care plans and risk assessments were not robust. People did not consistently receive care and support at the time or frequency agreed.

Staff had received training in relation to safeguarding people who use the service. Most people who used the service told us they felt safe. However one person told us, “I don’t always know who is coming and it can be frightening to have strangers walk in.”

Is the service effective?

People's needs were not always thoroughly assessed. Care and treatment was not detailed consistently in the nine care plans we checked and care plans were not regularly reviewed. This meant staff did not have access to instructions that were clear to follow, up to date and detailed people's wishes.

Is the service caring?

People were treated with respect and dignity by the staff. People told us staff offered choices to them around their daily routines telling us that staff offered care in line with their care plans but also "ask if there's anything else I need". Staff were knowledgeable about how they offered choices according to people's individual needs.

Is the service well led?

Staff did not receive regular supervision or appraisal.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received. Audits for care plans and care plan notes did not identify missed calls and calls outside the agreed frequency and times.