The inspection took place on 13, 14 and 20 December 2016 and was announced. We gave the provider 48 hours’ notice of the inspection in order to ensure people we needed to speak with were available. The service provides personal care to people in their own homes.

The service has a registered manager. 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 knew how to protect people from potential abuse as they had attended training and were able to inform us what actions they would take should they suspect abuse. Staff had also learned from training how to support people appropriately and to facilitate their independence by providing them the support they needed. Staff used support plans and risk assessments to plan and record how they met people’s needs in a safe way.

People were supported by a sufficient number of suitably experienced and knowledgeable staff. The manager had ensured appropriate recruitment checks were carried out on staff before they started work. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place so that staff were trained to administer medicines and people were supported to take their prescribed medicines safely.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received training in mental capacity assessments, best interest and were competent to work with relevant professionals. This ensured that decisions were taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

The staff responded to people’s needs in a compassionate and caring manner. Positive and supportive relationships had been built up between the staff, people using the service and relatives. People were supported to make day to day decisions and were treated with dignity and respect. Choices about what people wanted to eat, where they intended spending Christmas and how to spend their lives were discussed, implemented and recorded in the persons support plan.

Staff were supported and supervised in their roles and all had an annual appraisal. People and when appropriate family members were involved in the planning and reviewing of the support provided. The service also worked with other professionals to support the people the using the service.

The health needs of people were overseen with input from relevant health care professionals. The service had worked with GP’s and Occupational Therapist to arrange appointments with these professionals and carry out support as instructed.. People were supported to maintain a nutritionally balanced diet and sufficient fluid intake to maintain good health.

People were supported to report any concerns or complaints and they felt they would be taken seriously. People who used the service, or their representatives, were encouraged to be involved in decisions about the service.

Support plans had been reviewed and we saw that they had been written with the individual and were person-centred. The management were supportive of its staff and promoted a person centred approach to the care and support it provided. The manager and senior staff were approachable to people using the service and staff and enabled people who used the service to express their views.

The provider had systems in place to check the quality of the service and take the views and concerns of people and thei

The provider had person centred care plans for people who used the service. We saw evidence that people who used the service understood their care and treatment and trusted the staff who looked after them. Appropriate risk assessments were carried out for people who used the service based on their individual needs and for the environment within which they lived. The provider had clear processes for decision making and service development. People who used the service and staff were involved in the on-going review of service provision and worked in collaboration to identify risks in relation to health, welfare and safety. Clear procedures were in place for emergencies. The provider had a clear recruitment process to ensure people who use the service are safe and have their needs met by appropriate staff. Staff and people who used the service were fully aware of issues around safeguarding and clear processes were in place to record and report abuse or suspected abuse.

We spoke with nine people who used the service, looked at five care records and spoke with the registered manager and four members of staff. We viewed the staff rota’s, service policies for the administration of medication, safeguarding and quality monitoring systems. We considered our inspection findings to answer 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;

Is the service safe?

When we arrived at the service administration centre the reception staff greeted us, noted our identification and asked us to sign in the visitor's book. We were invited to visit people in their own homes. We were introduced to people who used the service by members of staff and on each occasion our identification was checked. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We reviewed training records regarding the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) and saw that training had been delivered on 20 May 2014. The Care Quality Commission (CQC) monitors the operation of DoLS. While no applications have needed to be submitted, correct policies and procedures were in place.

Is the service effective?

There were systems in place to audit medication and care plans which ensured there were effective systems in place for the delivery of care.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that staff had signed records to show they had been reviewed and updated appropriately. One person told us, “The staff have helped me and I have learnt new things to be more independent.”

Is the service caring?

We saw that the staff interacted with people who used the service in a caring, respectful and professional manner.

Is the service responsive?

We spoke with one person who explained to us the support they had received from the staff regarding a medical condition. They said, “The staff responded so quickly when I was not well and have continued to help me with the support of my doctor.” The service had an effective complaints procedure in place which included a pictorial system to enable people to make a complaint.

The service has worked with three advocacy services to identify and respond to people’s needs.

Is the service well-led?

Staffs were provided with supervision and there were weekly staff meetings. The registered manager and senior staff had arrangements in place to be in 24 hour contact with staff to support them as required.