4u Support Limited is a domiciliary care service registered to provide personal care and support to people living in either their own homes or with family members within the Plymouth area. Some people using the service were supported but did not receive personal care. Our inspection only looked at people who received personal care. 123 people were receiving the service at the time of this inspection.

There was a registered manager, who was also the registered provider. 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 registered manager/provider was unavailable to attend this inspection and so we worked with their representatives. We received information from the registered manager following the inspection visits.

At the last comprehensive inspection in January 2016 the service was rated Good overall. At this inspection we found the evidence could no longer support that rating and now the overall rating is Requires Improvement.

Why the service now has the rating of Requires Improvement.

Staff recruitment was not robust because staff were employed before it was confirmed they were fit employees to work with vulnerable people. Staff did not work alone at this time, but were already getting to know people, including how to access their home.

Staffing arrangements did not ensure people received the amount of visit time they required, in accordance with their care plan. Some staff said they did not have the travel time they needed, and the registered manager said this would be increased. However, the registered manager did not expect staff to stay the full time agreed, in accordance with the person’s care plan.

Opinion about continuity of the care workers visiting varied widely. The provider representatives said they worked continually to improve visits, and care workers confirmed visits were never missed. An ‘app’ monitoring device meant the office was fully aware of the times care workers arrived at a person’s house and when they left. One person told us, “There used to be different carers every day, in the last 4-5 months its got much better.”

Some risks were assessed and action to protect people were in place, but not all risk management was clear, such as who was at risk from cleaning chemicals in a person’s home. There was no evidence that this had led to a poor outcome for people but we have recommended that risk assessment is reviewed.

People told us they felt safe when receiving care and support. They said care workers were skilled and competent when assisting them, and this is what we observed.

People said they received their medicines on time and as expected and care workers said they were clear in how to provide medicines safely. However, the information about medicine assistance in people’s care plans was not always clear or complete, and this was not being checked by team leaders. This was corrected following our feedback. Care workers were very clear on how to report any medicine errors and few errors had occurred.

Care workers confirmed they had all the necessary protective clothing to promote hygiene and infection control. The use of protective clothing was monitored by senior agency staff.

People were protected through the agency’s safeguarding arrangements. Staff knew what action to take if they suspected someone was being abused, mistreated or neglected. Where care workers handled people’s money there were checks in place to ensure this was done in a safe way. There were arrangements for reporting accidents and incidents. There had been very few.

Staff spoke positively about the training they received and people said the care workers were skilled. Staff received supervision of their work although this was a f

We carried out an announced comprehensive inspection of this service on 27 and 29 January 2016. At the last inspection, the service was rated Good overall.

After that inspection we received concerns in relation to shortages of staff, staff missing appointments and cancelling visits at short notice due to shortages of staff.

The concerns went on to say that staff were not being recruited safely and there were no risk assessments in place for people to help protect them and the staff providing care. Concerns suggested that manual handling risk assessments showed that two staff members where needed to move people safely but only one staff member had been sent and that one person’s equipment was not suitable to keep them safe. Also, it was alleged that there were no risk assessments to show staff what care was needed for people they visited for the first time including environmental risk assessment and any behavioural issues with people living with a mental illness.

It was also alleged that staff where not provided with suitable identification to show people when they visited for the first time. The concerns received also stated that people’s medicines where not always managed appropriately and safely. For example people did not have recording sheets, MAR (Medicine Administration Records) for staff to complete after they had administered medicines to people, no list of what medicines people where prescribed and that staff had not always received medicines training to help keep people safe. Other information about medicines stated that people prescribed and receiving eye drops did not have a date recorded on when these had been opened or a “to be used by” date.

Another concern raised was that staff did not leave people’s houses hygienically clean and that staff where not being informed of infection control issues when they visited people’s houses. For example if people had an infectious skin condition.

There were concerns raised that people did not have expenditure forms for any money they were asked to use to purchase items with and nowhere to record receipts of items purchased.

Though there was a lone working policy in place the concerns raised stated that staff did not always have on call advice made available to them particularly when the registered manager was on holiday.

As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 4USupport Limited on our website at www.cqc.org.uk.

4USupport Limited is registered to provide personal care service to people living in their own home. On the day of the inspection 4USupport were providing care to over 100 people.

The service had a registered manager in post. 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’. The registered manager is also the registered provider. 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’s needs were met by sufficient numbers of staff. Rotas recorded there were sufficient staff employed to provide two staff when required. Staff were knowledgeable about people's needs and received training, for example manual handling training, to help keep people safe. One person said of the agency; “Absolutely marvellous!”

The registered manager followed safe recruitment practices to help ensure staff were suitable to work with vulnerable adults. Staff received identification badges to provide people receiving a service reassurance and the security of knowing staff worked for this agency when entering their home.

People’s care records held information about how people wished to be supported and what level of support was re

The inspection took place on 27 and 29 January 2016 and was announced. The provider was given notice because the location was a domiciliary care agency (DCA) and we needed to be sure that someone would be in. We also gave notice to enable the agency to arrange home visits with people’s consent.

4uSupport DCA provides a personal care service to people living in their own home. On the day of the inspection 58 people were being supported by 4uSupport with their personal care needs.

The service had 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 protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable adults. There were sufficient numbers of staff employed to support people safely. Staff received an induction programme. Staff had completed training and had the right skills and knowledge to meet people’s needs. Staff described the management as very open, supportive and approachable. Staff talked positively about their jobs and felt motivated to provide quality care.

Care records contained information that described what staff needed to do to provide individual care and support at each visit. Staff responded quickly to people’s change in needs. Where appropriate, friends, relatives and health and social care professionals were involved in identifying and supporting people’s needs. People’s preferences, disabilities and abilities were taken into account, communicated and recorded.

People’s risks were managed well and monitored. The service had policies and procedures in place and these were understood by staff to help protect people and keep them safe.

People who required it were encouraged and supported to maintain a healthy balanced diet.

People’s medicines were managed safely and people and staff told us people received their medicines as prescribed.

People, their relatives and staff were encouraged to be involved and help drive continuous improvements. This helped ensure positive progress was made in the delivery of care and support provided by the service.

The service sought verbal feedback from people, relatives, and staff. People were encouraged to share their concerns and complaints. The registered manager investigated any complaints or concerns thoroughly and used the outcome as an opportunity for learning to take place.

The registered manager and staff had completed training in the Mental Capacity Act. The registered manager displayed a good understanding of the requirements of the act, which had been followed in practice.

People were kept safe and protected from discrimination. All staff had undertaken training on safeguarding from abuse and equality and diversity. Staff understood the principles, had a good knowledge on how to report any concerns and described what action they would take to protect people against harm.

There were effective quality assurance systems in place to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.