ACAH Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and young people with disabilities.

The Care Quality Commission (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 our inspection, 21 people were receiving personal care.

At our last inspection we rated the service as requires improvement. At this inspection we found that although some improvements had been made these had not always been consistently maintained and embedded; we identified other areas that required improving. The service has been rated overall as requires improvement.

The systems in place to monitor the quality, safety and performance of the service were not always effective and were not consistently maintained.

Risks to people were identified but there were no detailed risk management plans in place. 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 place support this practice. However, it was not always clear which decisions people may not have the mental capacity to make for themselves.

We have made a recommendation in relation to seeking further guidance around the Mental Capacity Act.

Staff did not all regularly receive formal supervision and there was limited opportunity for them to come together and share their experience and good practice.

People continued to be treated with empathy and kindness and their individuality was respected. The staff were friendly, caring and compassionate and go the ‘extra mile’ to help people. Positive relationships had been developed between people and staff; people were happy with the service they received.

Care plans were in place, which enabled staff to provide consistent care and support in line with people's personal preferences and choices. People were supported to maintain good health and nutrition.

People received safe care from a staff team who were experienced and undertook regular training. Staff were appropriately recruited and there were sufficient staff to meet people's needs. People were protected from the risk of harm and received the support they needed to take their prescribed medicines safely.

The service had a positive ethos and an open culture. Development of staff knowledge and skills was encouraged.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they received.

At this inspection, we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The action we have taken is detailed at the end of this report.

This announced inspection took place on 8 and 14 November 2017. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection there were 19 people using the service.

There was 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.

Improvements were required to ensure that people’s risk assessment procedures were fully documented and were updated when changes had occurred. The registered manager also needed to document the action they had taken to ensure that safe recruitment practices had been adhered to and that staff were given adequate feedback about their performance and development needs.

Improvements were also required to the understanding of the Mental Capacity Act and the documentation that this requires when considering if people who use the service have the capacity to make particular decisions about their care. The registered manager showed competence at delivering good quality care but improvements were required to their knowledge of the regulations with which they must comply.

Further improvements were required to ensure that policies and procedures reflected the current practices adopted by the service and that effective quality assurance systems were in place to review the quality of care that people received.

People felt safe using the service and felt that they were treated well by staff. Systems were in place to help protect people from harm and people received their care from consistent members of staff in a timely way.

People were supported to have their medicines as they needed them and people were suitably protected by the prevention and control of infection. Systems were in place to identify if lessons could be learned if anything within the service went wrong and this was quickly shared amongst staff if improvements had been identified.

The registered manager had good systems in place to complete a detailed assessment of people’s needs, and they worked to match staff and people together with common interests or backgrounds if this would be beneficial. People were happy that staff had appropriate skills and competencies to provide the care they required, even in challenging circumstances.

People’s nutritional needs were met and monitored by staff if people required this support, and people’s healthcare needs were well supported with good liaison between services if necessary.

People spoke highly of the staff and the caring approach they took with them. People commented that the staff often went above and beyond expectations and they were thankful to have found ACAH. People were treated with kindness and respect and staff had developed positive relationships with people that helped to empower them.

People’s care needs were met in a personalised manner and staff were responsive and considerate in their approach. Staff provided flexibility when it was required and people were able to rely on the service. People’s care plans were person centred and each one was individualised to meet the specific needs of each person.

The registered manager was approachable and took an open approach to improving the service and providing the best care for people. The culture of the service promoted people’s independence and encouraged and empowered people. People were able to provide feedback to the service and this was very complimentary.

This is the first inspection of the service, and the first time it has been rated as Requires Improvement. We have made a recommendation about increasing knowledge and understanding of the regulations which govern this service.