Able Carers (York & Harrogate) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone who uses the service receives 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. The service supports older people, people living with dementia, mental health needs, physical disabilities, sensory impairments and younger adults. At the time of our inspection, the service was supporting 69 people with a regulated activity.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service is now rated Requires Improvement in one key question: ‘Is the service well-led?’. This is because the quality assurance checks and audits in place were not being used effectively, to identify record keeping issues and drive improvement. However, people expressed satisfaction with the care they received. There was a registered manager in post. People and staff spoke positively about the management of the service.

Risks to people were assessed and action taken to reduce them. The provider took prompt action to address anomalies we identified in some risk assessments. There was a system to record any accidents and incidents, and the provider took appropriate responsive action to learn from any incidents that occurred. Staff were aware of different types of abuse and knew what action they should take if they had any concerns. Where people required it, they were supported to receive their medicines in line with their prescription.

There was a system in place to organise care visits and people told us staff usually arrived on time. There was an electronic call monitoring system, which meant that the provider could identity if care staff had arrived to care visits on schedule. Appropriate recruitment checks were undertaken before staff started their employment, to ensure they were suitable to work with vulnerable people. Staff received an induction, training and on-going supervision to give them the skills and knowledge they needed to care for people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received support with preparing meals where required. There was information for staff about people’s nutritional and healthcare needs in care plans. Relatives gave us examples to show that staff had been proactive in identifying and responding to health concerns and changes in people's needs.

Staff treated people with dignity and respect. People told us care staff were kind and caring, and we observed positive interactions between staff and people who used the service. People told us they usually had consistent care staff, which enabled them to build relationships.

Care plans were in place to give staff the information they needed to support people in line with their preferences. This included information about people’s communication needs. The provider had a policy for responding to any concerns and complaints. We found issues raised had been responded to appropriately and people told us they would feel confident in reporting any concerns.

Our discussions with staff indicated there was a positive, person-centred culture within the service.

Further information is in the detailed findings below.

We undertook an announced comprehensive inspection on Wednesday 30 March 2016. We gave the provider 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service and we needed to be sure that someone would be at the agency office that could assist us with the inspection. This service was registered by CQC on 12 October 2015 and this was the first inspection for this location.

Able Carers York/Harrogate is registered to provide personal care for people with a range of varying needs including dementia, learning disabilities or autistic spectrum disorder, mental health, older people, physical disability, sensory impairment and younger people who live in their own homes.

At the time of our inspection, 76 people received a personal care service. The service provides domiciliary care and support services from the registered office location, on the outskirts of York.

The registered provider is required to have a registered manager in post and on the day of this inspection, there was a registered manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People who used the service told us they felt safe and we found that care workers knew how to protect people from avoidable harm. Risk assessments and risk management plans were in place and they were regularly reviewed and updated in line with the person’s needs.

Accidents and incidents were appropriately investigated and recorded with clear details of investigations and actions taken to help prevent re-occurrence.

The registered provider had a robust recruitment process in place including sufficient checks to help ensure that the care workers recruited were considered suitable to work with vulnerable people. We saw care workers underwent an induction programme followed by a supervised introduction to people. People told us they received consistent care from care workers who they knew.

Where people required support with their medication this was provided appropriately. Risk assessments were completed and training provided to care workers to help them ensure that they followed the agency’s policies and procedures. Care plans included protocols for medicines, which were prescribed for people with specific conditions.

Care workers told us they felt well supported and we saw good communication and relationships between care workers, management, people who used the service and outside agencies such as the local authority and health workers.

The registered provider had a training plan in place and we saw that this was managed and recorded electronically to ensure that they had the up to date skills they needed to carry out their duties effectively. Competencies were annually reviewed. Training included safeguarding, moving and handling, medicine management and health and safety. Person centred training was provided for care workers to meet people’s individual needs and included diabetes, dementia and Parkinson’s disease.

Training was available for care workers in the Mental Capacity Act 2005 and the registered provider had a policy in place. Care workers had a basic understanding of the MCA and they understood the importance of people being supported to make decisions for themselves.

The registered manager told us care workers do not receive training in the Mental Health Act. They told us they refer any concerns or changes in people’s behaviour to the Community Mental Health Team (CMHT). They told us they were looking at further training for care workers in mental health awareness.

People received support with eating and drinking. Support was varied dependent on their individual circumstances. Appro