About the service:

• 4Life Healthcare Services is registered as a domiciliary care service and a supported living service. At the time of our inspection the service was only operating as a domiciliary care service. It provides a service to older people, people living with dementia, people with mental health conditions and people with learning and/or physical adaptive needs. At the time of this inspection the service was providing care calls to 30 people.

• For more details, please read the full report which is on the CQC website at www.cqc.org.uk

People's experience of using the service:

• People received safe care and treatment with their care calls being reliably completed by care staff who knew how to provide the right care.

• People were safeguarded from the risk of abuse and received person-centred care that promoted their dignity.

• People were supported to safely take medicines.

• People were consulted about and consented to the care they received.

• Complaints were managed in the right way and people had been invited to suggest improvements to the service.

• People who used the service and their relatives were consistently positive in the feedback. One relative said, "This is the best care at home service we've tried by a mile. The care staff arrive on time, know what they're doing and can be relied upon."

Rating at last inspection:

The service was rated as ‘Requires Improvement' at the inspection on 5 February 2018. At this inspection in March 2019 the overall rating of the service has improved to Good.

Why we inspected:

• At the inspection in February 2018 there were two breaches of the regulations. This was because the service did not operate safe recruitment practices. Also, the service did not have robust quality checks in place to ensure that people consistently received care that met their needs and expectations. This had led to shortfalls in the management of medicines and in learning lessons when things had gone wrong. We told the registered persons to send us an action plan stating what improvements they had made and intended to make to address our concerns. The registered persons complied with this requirement and at this inspection both the breaches of regulations had been addressed.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

4Life Healthcare service is a domiciliary care agency registered to provide personal care to adults with physical disabilities, learning disabilities, dementia and those with mental health conditions. It provides care to people living in their own houses and flats. Not everyone using 4Life Healthcare receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 4Life Healthcare provided a service to 17 people.

The inspection took place on 10 and 11 January 2018 and was announced. It was the first inspection since the service was registered with us on 6 March 2017. The service had a registered manager. 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. However, the registered manager of 4Life Healthcare was no longer directly involved in the day-to-day running of the service. That responsibility had been passed to the service manager, who at the time of the inspection was in the process of registering with CQC. The service manager was present throughout the inspection.

People were not always recruited safely. When assessing whether an applicant was of good character, pre-employment checks were not always made in line with the service’s recruitment policy or other guidance. Accidents and incidents were not always being reviewed and analysed by the service manager in a robust manner. There was a sufficient number of staff on duty to meet the needs of the people using the service. Staffing levels were planned around the needs of people and rotas showed these were consistent. People were kept safe from the risk of abuse. Staff had a good understanding of safeguarding procedures and the action they needed to take if they were concerned about any potential abuse. Risks to people were assessed and minimised. People received their medicines safely. People were protected by the prevention and control of infection where possible.

People’s needs were assessed before the service commenced. People, their relatives and external advocates were involved in assessments. Staff received training which ensured they had the skills and knowledge to deliver effective care. People’s rights had been protected and staff were acting in accordance with the Mental Capacity Act 2005. Staff demonstrated a good understanding of the MCA. Staff worked together across organisations to help deliver effective care when people moved between services. People’s care records showed many health and social care professionals were involved in their care.

Staff were encouraged to develop positive, caring relationships with the people they supported. Staff were able to describe people’s likes, dislikes and routines. Staff supported people to express their views and be actively involved in making decisions about their care. People were involved in reviewing their care. People’s dignity and independence was respected at all times.

Some people’s care plans did not always reflect their physical, mental, emotional and social needs. People and their families were encouraged and supported to raise any issues or concerns with the service manager. Although staff had not provided care to anyone at the end of their life, the service manager was able to describe how they would support people to have a comfortable and dignified death

Quality Assurance audits were not carried out in line with the provider’s policy and procedures. The service manager ensured the service was managed in a way that was transparent, honest and person focused. People and staff had the opportunity to feedback to t