A1 Quality Homecare Limited is a domiciliary care agency. At the time of our inspection they provided personal care to 75 people living in their own homes. It provided a service to older adults and some younger adults with a physical or learning disability.

Not everyone using A1 Quality Homecare Limited received the 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 our last inspection in April 2017, the service was rated 'Requires Improvement' in risk assessment, medicines management, care plans and quality assurance. At this inspection, we found the provider had made most of the required improvements. However, we also found different areas of practice that required improvement. This is the second inspection where the service has been rated Requires Improvement.

The service was not always well-led. Quality assurance processes had not identified the concerns people had raised around call times, lack of communication from office staff and staffing rotas. People had access to a complaints process, and said they would be happy to raise a complaint if they ever needed to. There had been some recent complaints about call times, and the registered manager had resolved these on an individual basis. However, other people continued to raise concerns regarding call times and rotas, as the registered manager had not taken action to resolve this issue for everyone who used the service. People’s views were sought but not always acted on to improve the service.

People were safe and had the support they needed. As far as possible, people were protected from harm and abuse. Staff knew how to recognise the signs of abuse and what they should do if they thought someone was a risk. People had risks to their safety properly assessed and managed. Medicines were safely managed. People were supported to eat and drink enough, and were supported to access the healthcare they needed to remain well.

People experienced care that met their needs, and were supported by kind and caring staff. People had their privacy and dignity respected, and staff knew what to do to make sure people’s independence was promoted. People experienced person centred care and were able to make their choices and preferences known.

Staff were supported with training, supervision and appraisals to make sure they had the skills they needed to provide good quality care. There were enough staff to support people to stay safe and meet their needs. Recruitment checks had been completed before staff began work, including disclosure and barring service (DBS) checks. Staff knew how to report incidents and accidents, and these were properly investigated.

People had their care needs assessed, and all of the relevant people were involved in care reviews. People experienced care and support that was in line with current guidance and standards.

People were asked for their consent before any care was given, and staff made sure they always acted in people’s best interests. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA).

The registered manager had notified the CQC of events that were reportable. The rating of ‘requires improvement’ was displayed at the service and on the provider’s website. However, the service has not met all the fundamental standards and we found one 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 this report.

This inspection took place on the 3 and the 6 April 2017 and it was announced.

A1 Quality Homecare Limited is a domiciliary care agency, which provides personal care to people living in their own houses or flats in the community.The registered office is in Worthing however the service provides personal care to people across West Sussex including Worthing, Pulbourough and Southwick. It provides a service to older people, people living with dementia, people with a physical disability and those with a sensory impairment. At the time of our visit, they were supporting 81 people with personal care in the community.

The service had a registered manager in post. They were registered in September 2016. 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.

There was a lack of robust and accurate risk assessments available for staff to refer to, to enable them to carry out consistent or safe care when supporting people. This was an area which required improvement. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not always managed safely. This included a lack of information and guidance for staff regarding prescribed medicine’s they administered to people. We made a recommendation to the provider to ensure care was reviewed for all people who were supported with their medicines. The provider was able to share the improvements they would make to how medicines were managed on behalf of people.

We found there were inconsistencies within care plans. Some care plans needed to be developed further to ensure they contained people’s preferences, likes and dislikes. We made a recommendation to the provider regarding this. The provider was able to share the action they were taking to ensure care records were accurate and reflected people’s current needs and wishes.

Mostly people spoke positively about the support they received from care staff and that there were sufficient staff to meet their needs. However, they also shared frustrations over staff not arriving at the preferred or agreed times, not knowing in advance which staff were attending and a lack of contact from the office when this happened.

The service had quality assurance monitoring tools in place which were not always effective in improving the service provided to people. We made a recommendation to the provider to ensure audits identified the areas we highlighted on our inspection regarding risk assessments, medicine management and care plans. The provider was able to share the action they were taking to improve their quality assurance systems.

Accidents and incidents were responded to by staff without delay and the appropriate medical professionals were contacted for advice and support when required. Staff were able to speak about what action they would take if they had a concern or felt a person was at risk of potential abuse or neglect. The service followed safe recruitment practices.

People's consent to care and treatment was considered. Staff understood the requirements under the Mental Capacity Act 2005 and about people's capacity to make decisions. Some people received support with food and drink and they made positive comments about staff and the way they met this need. Changes in people's health care needs and their support was reviewed when required. If people required input from other healthcare professionals, this was arranged.

We observed staff spoke kindly to people and had a caring approach. Staff involved people with their care provided and promoted their independence. People were treated with dignity and respect. People and their relatives knew who to approach when they had a concern or complaint about the