This inspection took place on 21, 22, 23 and 24 November 2018. We visited the office on the 21 November and between 22 to 24 we made calls to people, relatives and staff. At the last inspection in July and August 2017 there was two breaches, we had concerns around inaccurate care records and the lack of information relating to the mental capacity act, and analysis on incidents to look for patterns and trends of the service. At this inspection we found the provider had improved in all areas and were no longer in breach.

Welcome Independent Living provides personal care for older people and people living with dementia. At the time of our inspection Welcome Independent Living provided personal care for 73 people.

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 were asked for consent before care was provided to them. Where people lacked capacity to make certain decisions for themselves, their care records contained evidence that decisions had been made in their best interests. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The service worked closely with community health professionals to support people with their health needs. People’s care records evidenced they received medical attention when they needed it, to promote their health.

People told us they felt safe. There were mixed views from people and their relatives around if there was enough staff available to meet there needs and if they arrived on time and stayed for the duration of the visit. We spoke to the registered manager about this who told us they had employed more staff and used a tool to show how long staff stayed at each visit. This was evident in the documentation we saw.

Staff understood what it meant to protect people from abuse. They told us they were confident the management team would take any concerns they raised seriously. The registered manager made appropriate referrals to the local safeguarding authority when this was necessary.

Medicines were recorded appropriately and procedures were in place to ensure people received their medicines as prescribed. However, we spoke to the registered manager about the reporting on the medication administration records (MAR) chart and how to ensure this was robust. This was implemented on the first day of inspection.

Procedures for recruiting new staff had recently been improved to help make sure the staff employed at the service were of suitable character.

Staff received a range of training which was effective. Staff told us they were happy with the training they received and felt it supported them to do their roles.

People told us the staff were kind and caring. We saw staff had spot checks and this showed evidence staff were compassionate and caring to people.

Staff were overall supervised by the management team; an appraisal had been completed for some staff, others were booked in for December to ensure all staff had received one this year.

People, their relatives and the staff all spoke kindly of the registered manager. Staff told us they could always approach the registered manager if they needed support or if they had any concerns. The registered manager, the deputy managers and the provider completed regular audits of the service to make sure action was taken and lessons learned when things went wrong. This meant systems were in place to support the continuous improvement of the service.

Further information is in the detailed findings below.

This inspection took place on 31 July 2017 and 2 August 2017 and was announced. At the last inspection we had concerns about the number of calls the agency had missed and found that on at least two occasions only one member of staff had provided people with care and support when two staff should have attended. This potentially put people at risk of not receiving safe care and treatment and was found to be a breach of Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made in this area and the provider was no longer in breach of this regulation.

Welcome Independent Living provides personal care for a variety of people including older people living with dementia. At the time of our inspection Welcome Independent Living provided personal care for 112 people. 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.

A new electronic call monitoring system had been introduced which enabled call times to be monitored. Staff logged their visit by swiping their phone camera against a QR code (barcode) in the customer file. This registered the time staff spent on the call. A new rota system had been implemented which now took into account travel time. People who required two care workers told us they always had two care workers.

The provider had a recruitment process in place to ensure staff were of good character and that all checks were complete and satisfactory prior to letting staff deliver care.

The provider had sufficient staff to meet people’s needs.

Staff were supported in their role and most staff received regular supervision. Staff told us they received training. We saw evidence which confirmed this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. We found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People's privacy and dignity were respected. People's independence was promoted and they were involved about matters relating to their care and support. People were provided with service user handbooks which gave information on the care offered to people, how to make complaints/compliments, including the mobile number of the provider.

Most people told us they were involved with their care and had reviews. However, two people and one relative said this had not happened. All staff told us care records were kept up to date and were easy to follow. Staff explained how they would identify a person’s needs had changed.

There were systems in place to respond to complaints. Complaints were responded to appropriately.

Staff told us they felt supported by the management team.

Statutory notifications had been submitted to the CQC, however the registered manager had on occasion not done this. We saw the local authority had been informed and appropriate action had been taken. The registered manager gave assurances they would look into this oversight immediately and ensure they sent all statutory notifications to us. We recommend the provider reviews their systems to ensure the CQC is notified of relevant matters.

The provider did not operate effective systems and processes to make sure they assessed and monitored the service. The provider did not ensure care records were accurate and complete in respect of service users. We found this to be a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Welcome Independent Living provides home care services in the Calderdale area of West Yorkshire from spacious office premises in Hebden Bridge. At the time of the inspection the service was providing care and support to fifty five people and employed approximately eighty members of staff.

We initially inspected the main office premises on the 18 March 2015. However, we made a second visit to the service on the 31 July 2015 as the provider had moved to new office premises. The provider was given 48 hours’ notice because the location provides a domiciliary care service.

Our last inspection of the service took place on the 14 August  2014 and at that time we found the agency was not meeting four out of the five regulations we looked at. These related to staff recruitment and training, record keeping and quality assurance monitoring. We asked the provider to make improvements and following the inspection they sent us an action plan outlining how they intended to address the breaches in regulations.

During this inspection we found significant steps had been taken to improve service delivery although some areas requiring further improvement were identified.

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.

We found the organisation’s staff recruitment and selection procedures were now robust which helped to ensure people were supported by staff suitable to work in the caring profession. We also saw all staff had received mandatory training and that one to one supervision meetings took place which helped staff to carry out their roles effectively. However, we found the staff disciplinary procedures designed to protect people who used the service from poor work practices were not always being followed.

The care/support plans we looked at were person centred and were reviewed on a regular basis to make sure they provided accurate and up to date information and were fit for purpose.

The staff we spoke with were able to describe how individual people preferred their care and support to be delivered and the importance of treating people with respect in their own homes. People who used the service and their relatives told us staff were very caring and always provided care and support in line with their agreed support plan.

However, we were concerned about the number of calls the agency had missed. We were also concerned that on at least two occasion’s only one member of staff had provided people with care and support when two staff should have attended. This potentially put people at risk of not receiving safe care and treatment.

The provider had policies and procedures relating to the safe administration of medication in people's own homes which gave guidance to staff on their roles and responsibilities.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or treatment they received. The majority of people we spoke with told us they were aware of the complaints procedure and would have no hesitation in making a formal complaint if they had any concerns about the standard of care provided.

We saw the management of the service was more structured and the provider had started to introduce a more robust quality assurance monitoring system that continually monitored and identified shortfalls in service provision. However, the provider and registered manager were aware that more work was required before the systems in place were fully operational and consistently applied.

We found one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 come into force on 1 April 2015. They replace the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.