The inspection took place on 30 March 2017 and was announced. The last inspection was undertaken in February 2016 when the service was rated as Requires Improvement overall. Your Care is a domiciliary care agency based in Bolton. At the time of the inspection there were 38 people using the service.

There was a registered manager at the 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.

The recruitment system was robust and helped ensure people employed at the service were suitable to work with vulnerable people.

Safeguarding policies and procedures were in place and staff were aware of the importance of reporting any concerns. Medicines systems were safe and an appropriate policy was in place.

Accidents and incidents were recorded correctly and followed up appropriately.

The induction programme was thorough and included all relevant mandatory training. Further training and development for staff was on-going. The service worked closely with other agencies and referrals were made appropriately when required.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA).

Staff were caring and polite and treated people with kindness. People’s confidentiality, dignity and privacy was respected.

There was information given to people who used the service. We saw that changes and updates were communicated clearly to people who used the service and their families.

People’s opinions and suggestions were regularly sought via questionnaires and contact from the registered manager.

Care plans included a range of health and personal information. People’s likes, dislikes, interests and preferences were respected.

There was an appropriate complaints policy in place and complaints had been followed up in a timely manner. The service had received a number of compliments.

People who used the service and their relatives told us the management were accessible and approachable. Staff also felt supported by the management team.

Staff supervisions and appraisals were undertaken regularly. Team meetings took place on a regular basis. A number of checks and audits were undertaken to help ensure continual improvement in the delivery of care and support.

The inspection took place on 04 and 25 February 2016 and we gave the provider 48 hours’ notice to ensure there would be a member of the management team in the office. The last inspection was carried out on 02 February 2014, when all areas reviewed were meeting requirements.

Your Care is a domiciliary care agency based in Bolton. At the time of our inspection the agency was supporting 38, mainly older Asian people in the Bolton areas. The vast majority of these were receiving personal care support from the service

At the time of the inspection there was no registered manager in place. 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. An acting manager was in place during the first day of the inspection and a new manager had been recruited and had started in their post on the second day of the inspection.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities)

Regulations 2014. This breach related to the provider not setting up systems to assess, monitor and improve the quality and safety of the services or to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity.

We found that some care records in an individual’s home had been completed prior to visits being made. We brought this matter to the attention of the provider who dealt with the staff member responsible immediately. Spot checks carried out at all households confirmed that this was an isolated incident and not the usual practice of the service.

The service had an effective recruitment system in place, which helped ensure staff were suitable to work with vulnerable people. There were sufficient staff to ensure people’s needs were met and rotas demonstrated that staff were given travelling time between visits to ensure they spent the required amount of time with people they were supporting.

Appropriate risk assessments were in place within care plans and accidents and incidents were recorded and reported as required.

Staff had undertaken training in safeguarding vulnerable adults and were confident they could recognise and report any concerns in this area. Staff had undertaken training in administering medicines, but there was presently no one who used the service who required more than prompts for their medicines.

We saw evidence that staff had undertaken a thorough induction programme prior to commencing work. There was an on-going programme of training staff.

Supervision sessions were undertaken regularly and these were recorded appropriately.

Care plans included a range of health and personal information and copies were kept in the office and in people’s houses.

Staff had an awareness of Mental Capacity Act (2005) (MCA) but their level of understanding was inconsistent. The new manager booked all staff on MCA training to address this.

People who used the service, their families and professionals involved with the service all told us staff were kind and caring. We observed good, relaxed and friendly interactions between staff and people they supported.

People told us they had been involved with their care planning and in reviews. However, the recording of their involvement was not consistent.

Information was produced in English and Asian languages to help make it accessible to the people who used the service and their families.

Staff were aware of the need for confidentiality and there was an appropriate policy in place regarding this.

People who used the service and their families, with whom we spoke told us the service was flexible and responsive to their needs and requirements.

Complaints and concerns were

What people told us and what we found.

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at care, staffing numbers, quality assurance and records. We also visited some people who used the service to gather their views.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and looking at records:

Is the service safe?

Staff were given training in a number of areas, including moving and handling, in order to enable them to deliver care safely. Training and staff development was a priority at the agency and staff were well equipped to carry out their caring duties.

There were enough staff to cover for holidays and sickness and contingency plans were in place to ensure that shifts would be covered in case of an emergency. The manager was available to staff and people who used the service throughout the day and there was a member of the management team on call at all times.

Risk assessments were in place for each person who used the service. There was clear guidance for staff on how to manage each individual risk as well as what equipment to use and techniques to be followed.

Checks were carried out regularly to ensure that staff were following people’s care plans and guidance around issues such as moving and handling. The manager visited people who used the service on a regular basis to ascertain their satisfaction with the care provided.

Is the service effective?

A thorough assessment of people’s needs was carried out prior to commencing a service, to ensure their particular needs could be met. Care was taken to ensure carers were matched with people who used the service so that needs such as ethnicity, culture and language were taken into account. Care plans contained enough information about people’s health conditions and personal requirements.

People with whom we spoke were very happy with the care provided. One person said, “Your Care accommodate me very well, they always put my needs first”. Another commented, “They help as much as they can and ask what I want. They are very understanding and caring”.

Is the service caring?

People told us staff were caring and kind. One person told us, “I have been with the company for 10 years and wouldn’t change them for anything. They have become like family”. Another described the carers as “Very understanding and very caring”.

We saw evidence within people’s care records that their personal preferences, family situations, cultural needs and personalities were taken into consideration when care was being arranged and delivered. The agency took great care to ensure people were introduced to prospective carers prior to commencement of a care package and that they were happy with the carers.

Is the service responsive?

We saw evidence within the care files of reviews taking place, not only on an annual basis, but as and when changes occurred. It was clear that the agency responded in a timely way to any changes in a person’s needs or requirements.

Each person who used the service was discussed with their carer at every staff supervision session to look at all aspects of their care delivery and any issues arising. Staff were encouraged to speak to the manager at any time if they identified any difficulties or changes which may need to be addressed.

People were aware of how to make a complaint, but were confident any issues would be addressed by speaking to the care staff or the manager. None of the people we spoke with had felt the need to make a complaint.

Is the service well-led?

There were a number of quality assurance systems in place to ensure care delivery was kept at a high standard. The manager carried out regular random staff checks as well as visiting people who used the service. This ensured she was able to oversee the work of the agency and address any issues in a timely way.

The manager demonstrated a good knowledge of the staff employed by the agency and the people who used the service. We spoke with one member of staff who had a good understanding of their role and responsibilities.

We visited Your Care on 1 July 2013. We looked at documentation and found that all appropriate policies and procedures were in place. We looked at three files for people who used the service and they included relevant, factual information. We saw that consent forms were signed where appropriate by the person who used the service or their representative.

Many people who used the service were Asian and the service endeavoured to match them up with appropriate carers.This gave them some choice around gender of carers, religious beliefs, culture and language.

We spoke with four people who used the service. All were complimentary about the service. One person said “We have a good laugh and they are good at what they do”.

We were told that people who used the service were given a rota of times of their visits and which carer would be visiting and those with whom we spoke found this very reassuring. One person said “I have my rota and I know who is coming and when they are coming.” Another person said ”The carers are all nice and the care is very good.”

We saw that appropriate safeguarding policies were in place and that staff were aware of procedures and confident of following these.

Staff were recruited robustly and were suitably trained and qualified to carry out their roles within the service.

There was a complaints procedure in place and quality checks were regularly undertaken to ensure that the service being delivering was of an appropriate standard.

As part of our inspection we went to visit three people who were using the service in their own homes with the assistance of the care co-ordinator who translated for us.

People told us that they had used the agency for a long time and were “very happy” with the service that they received from staff. We talked about how the service supported their religious and cultural needs for example ensuring that they had a carer was of the gender, religion and could speak the same language. A person told us about how they and their carer’s respected each others religion and gave examples of how they worked around this.

People we spoke with during our visit said that the “carer’s that come at the moment help me very well. I can ring office if I am concerned and whatever I ask them they never say no to the changes.” Another person said that care staff were, “always on time and always smiling.”

People told us that if they had any problems they could ring the office. They felt they would be listened to and any problems would be sorted out. If not they would ask a relative to contact the manager. They said they “felt safe” and that care staff members checked that there property was secure before they left them. One person said “I don’t have any problems or concerns, I am happy.”

People told us that they had had the same care staff members caring for them for many years and that they liked the continuity. One person said “I don’t like change” and “I like to know who is coming.” They said that care staff members were flexible to any changes in the times of their care and support.

People we spoke with confirmed that the manager visited them to check that the paperwork was right and if they were happy with the service. People also completed a service user satisfaction form that contained the following quotes “everything is alright, no complaints from me, staff are punctual and happy to come to me” and it is a “very good company, always on time and keeps me informed of all rotas. No need to improve doing well already”