Westminster Homecare Limited (Cheltenham) provides personal care to people living in their own homes in Gloucestershire. They provide personal care to a wide range of people and specialise in supporting people living with dementia. They were providing personal care to 48 people at the time of our inspection, 12 of whom were living with dementia.

At the last inspection in July 2015, the service was rated Good. At this inspection we found the service remained Good.

The registered manager had been absent due to illness. 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. The operations manager had been working closely with the quality assurance co-ordinator to manage the service. A new manager had recently been appointed and was applying with CQC to become jointly registered to manage the service. They shared with us their visions and values for the service.

People’s care was individualised and reflected their personal preferences, routines and wishes about how they wished to be supported. People and those important to them discussed their care needs and were involved in reviews of their care and support. Their health and well-being was promoted by highlighting any changes in their needs and liaising closely with health care professionals. When changes were made their care records were updated and staff were informed. Information was provided to people about the service they could expect to receive. Accessible formats, such as audio or easy to read, could be provided if needed.

People were supported by staff who understood their needs well. Staff were kind and caring. They had positive relationships with people and enjoyed the time they had together. Relatives commented how important the social aspect of their visits were as well as attending to people’s care needs. People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice. People were offered choices; staff did not make assumptions and involved people in aspects of their support whenever they could. People’s rights were upheld and staff knew how to recognise and report suspected abuse. Any hazards had been assessed and risks were minimised.

People benefited from staff who had been through a recruitment process which made sure they had the aptitude and skills to support them. Staff had access to a range of training and support to help them develop in their roles. Care was taken to make sure wherever possible people had the same staff supporting them. Their visits were scheduled to fit in with people's lifestyles as far as possible. If staff were late they were informed about this and people knew how to contact the management team if they had a query.

People’s views were sought to help drive through improvements to the service. A range of quality assurance audits monitored the standard of the service provided. Actions identified where improvements were needed and these were monitored to ensure they had been completed. People said, “We really are delighted with the service and are so grateful” and “They are excellent. Very caring. It seems to have got better. They know what they are doing.”

Further information is in the detailed findings below.

This inspection took place on 21, 23 and 27 July 2015 and was announced. Care in the Home provides personal care to people living in their own homes in Gloucestershire. They were providing personal care to 109 people at the time of our inspection.

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 and associated Regulations about how the service is run.

People’s care records were not being updated to reflect changes to their health or well-being and to reflect the care staff were actually providing to them. Some people’s care records were not being reviewed each year. The absence of accurate, complete and contemporaneous records for people could potentially lead to inappropriate or poor care being provided.

People’s care records provided an individualised account of how they would like their personal care to be delivered and by whom. Their preferences, routines and levels of independence had been discussed and agreed with them or their legal representatives and were documented for reference by staff. Staff had a good understanding of people’s backgrounds and people important to them. They took account of people’s disabilities or sensory needs when delivering their care. People had a positive relationship with the staff supporting them and said it was really important to have the same staff attending to their needs. They recognised at times this was not always possible and were informed if new staff would be visiting them. When staff were running late, people said they were mostly informed of this. The registered manager closely monitored if any visits had been missed and took action to prevent this happening again. People knew how to make a complaint and were asked for their feedback about the service they received as part of the quality assurance auditing system.

Staff were supported to develop the skills they needed to support people. The recruitment process made sure all checks had been carried out before they started working with people. During their induction they attended training, shadowed staff and completed open learning. Their knowledge was tested through questionnaires and observation of them supporting people confirmed whether or not they were competent to carry out their duties. A training programme made sure staff kept their skills and knowledge up to date and could develop professionally with national qualifications. Staff received individual support through meetings with seniors and said the registered manager was open and accessible to them for support and discussion. Systems were in place for advice or support out of working hours or in emergencies. Staff had a good understanding of how to keep people safe and to report suspected abuse. Staff achievements were recognised with a carer of the month award.

The registered manager was supported by senior carers and office staff to arrange, schedule and monitor visits to people and to support staff. Lessons were learnt from missed visits, complaints and feedback from people to improve the service. The registered manager recognised the challenges of keeping a consistent staff team and had plans to improve their working conditions and so the service provided to people. Westminster Homecare monitored the quality of service provided through their quality assurance audits and the registered manager was addressing their improvement plan. The registered manager worked closely with social and health care professionals and local providers to deliver a service which reflected current best practice and legislation requirements.

We found a breach 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 version of the report.

At the time of our inspection the provider did not have a registered manager in post. The provider was supporting over 100 people in their homes around Gloucestershire.

People we spoke with said staff treated them respectfully and politely. People told us, "staff are very good, lovely" and "they treat me respectfully, always cheerful". We found that people were given information about the service to help them make choices about the care and support provided.

People's needs were reflected in their care records promoting their wishes and preferences for the way in which they wanted to be supported. One person said, "they are very flexible. I can't fault them at all, an excellent service". Another person told us, "I am so lucky, it's handy if I get regular carers, they get into my routine".

People were protected from the risk of abuse. The provider had taken steps to identify the possibility of abuse and to prevent it occurring. One person told us, "you feel safe with the carers, I am comfortable with them".

People said that staff had a good understanding of their needs. Effective recruitment and selection checks were in place to make sure that staff had the skills, aptitude and competency to support people.

Quality assurance processes provided the opportunity for people and staff to express their views about the service. People told us “excellent, couldn’t ask for better” and “I am very satisfied, they have been a great help to me, marvellous”.