ACS Care Services is a domiciliary care agency providing personal care, support and companionship to people in their own homes. At the time of our inspection the service was providing personal care to 131 people.

The service had a registered manager. The provider was also the 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 and associated Regulations about how the service is run.

At the last full comprehensive inspection of ACS Care Services on the 16 June 2016 the service was rated as requires improvement. We found that that the registered provider had failed to ensure systems or processes were in place to assess, monitor and improve the quality and safety of the services provide. In addition the registered provider had not consistently gained and acted upon feedback from people for the purposes of continually evaluating and improving services. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On 05 December 2016 we completed a focused inspection and found that the breach of regulation had been met. At this inspection we found the improvements that had been made had been sustained and ACS Care Services is now rated as good.

Sufficient travel time was not always factored into staff schedules, having the potential to jeopardise the safety of people using the service and the staff.

People felt safe when staff came to their homes. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were risk management plans in place to protect and promote people’s safety. Staffing numbers were appropriate to keep people safe. There were safe recruitment practices in place and these were being followed to ensure staff employed were suitable for their role. People’s medicines were managed safely and in line with best practice guidelines.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs. They were well supported by the management team and had regular one to one supervision and annual appraisals.

Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation. Where the service was responsible people were supported by staff to access food and drink of their choice to promote healthy eating. If required, staff supported people to access healthcare services.

People were treated with kindness and compassion by staff; and had established positive and caring relationships with them. People were able to express their views and to be involved in making decisions in relation to their care and support needs. Staff ensured people’s privacy and dignity was promoted.

People received care that was person centred and met their needs. Their needs were assessed prior to them receiving a service. This ensured the care provided would be appropriate and able to fully meet their needs. People’s care plans were updated when there was a change to their care needs. The service had a complaints procedure to enable people to raise a complaint if the need arose.

The service had quality assurance systems in place, which were used to good effect and to continuously improve on the quality of the care provided.

ACS Care Services provide personal and practical help that includes all aspects of personal care, meal preparation, domestic assistance including shopping, pension collection, accompanying people on appointments and other trips. ACS Care Services also provides a 'sitting service' keeping a person company whilst their main carer takes a break. There were 137 people using this service when we visited.

During our inspection in June 2016, we identified that the registered provider had failed to ensure that systems or processes were in place to assess, monitor and improve the quality and safety of the services provided and to mitigate the risks relating to the health, safety and welfare of people using the service. In addition the registered provider had not consistently gained and acted upon feedback from people for the purposes of continually evaluating and improving services.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stating that improvements would be achieved by November 2016.

We undertook this announced focused inspection on 5 December 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ACS Care Services Ltd on our website at www.cqc.org.uk.

A registered manager was 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.

We reviewed the quality assurance systems in place, and found that these had been strengthened. The processes in place were more robust and we saw that more regular quality assurance checks were taking place to ensure that people’s feedback was gathered and acted upon to make changes.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for well led at the next comprehensive inspection.

This inspection took place on 16 and 17 June 2016 and was announced.

This was the second comprehensive inspection carried out at ACS Care Services Limited.

ACS Care Services provide personal and practical help that includes all aspects of personal care, meal preparation, domestic assistance including shopping, pension collection, accompanying people on appointments and other trips. ACS Care Services also provides a 'sitting service' keeping a person company whilst their main carer takes a break. There were 151 people using this service when we visited.

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. We found the registered manager only visited the service on average once every two weeks which meant there was no consistent management oversight at the service.

Inconsistencies in the recruitment process meant that the service was not able to ensure staff were suitable to work with vulnerable people.

We found that although potential safeguarding concerns and incidents of concern were not sent to the Care Quality Commission (CQC).

The quality assurance systems needed to be improved to ensure that it is effective in all areas of the service including gaining feedback from people, relatives and staff.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to use the whistleblowing procedure. Staff were knowledgeable about the risks of abuse and reporting procedures. There were appropriate numbers of staff employed to meet people’s care needs. People had their medicines managed safely, and received their medicines in a way they chose and preferred.

Staff received appropriate support and training and were knowledgeable about their roles and responsibilities. They were provided with on-going training to update their skills and knowledge to support people with their care needs. People’s consent to care and treatment was sought in line with current legislation.

People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity. People were involved in making decisions about their own care and support.

People received personalised care that was responsive to their needs. The care plans met people’s needs and preferences and provided them with good support. The service had an effective complaints procedure in place.

We identified that the provider was not meeting regulatory requirements and was in breach of one 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 report.

The inspection was announced and took place on 3 March 2015.

During our inspection on 12 November 2013 we found that the service did not have adequate systems in place to monitor and review the service it provided. The provider did not always take appropriate action to respond to staff concerns. During this inspection we found improvements had been made to meet the legal requirement.

ACS Care Services provide personal and practical help that includes all aspects of personal care, meal preparation, domestic assistance including shopping, pension collection, accompanying people on appointments and other trips. ACS Care Services also provides a 'sitting service' keeping a person company whilst their main carer takes a break.

At the time of our visit there were 170 people receiving care and a team of 72 care staff, which included those working at the head office. 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 and associated Regulations about how the service is run.

People were protected from abuse and felt safe. Staff were knowledgeable about the risks of abuse and reporting procedures. There were appropriate numbers of staff employed to meet people’s care needs. Safe and effective recruitment practices were followed.

There were arrangements in place for people to receive their medicines safely. However, the provider did not maintain a record of medicines administered to people using the service. We have made a recommendation about the recording of medicines.

We found that consent had been obtained from people, in line with the Mental Capacity Act (MCA) 2005, before being supported by staff.

People’s care needs were met and we found that staff received regular training to ensure they were knowledgeable about their roles and responsibilities. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

People expressed dissatisfaction with the consistency of care staff and the timings of their visits, which meant they did not always receive care at a time that suited them and by staff who knew them.

We saw that people were encouraged to have their say about how the quality of services could be improved. We saw that a system of audits, surveys and reviews were used in monitoring performance and managing risks. However, these systems had not been effective in resolving issues about people’s dissatisfaction about call times and consistency of care staff visits.

We found there was a positive and open culture. The staff were positive in their desire to provide good quality care for people.

We spoke with five people and five relatives of people that used the service. We received mostly positive feedback. People told us that the carers were "very nice people" and that they completed the care in a way that people liked. One person told us that they liked all of the carers that provided their care and told us that they always asked if there was anything else the person wanted them to do before they left.

We found that the provider assessed people's needs and provided them with the care they required. We also found that the provider had taken suitable steps to ensure staff were aware of their safeguarding responsibilities and suitable checks were completed on new staff. We found that complaints were handled appropriately but we did identify concerns with the way the provider monitored the service that it provided.