Advanced Care and Support provides support including personal care for people in their own homes. At the time of our inspection 75 people were using the service.

This inspection took place on 11 and 18 April 2017 and was announced. We gave the registered manager 48 hours’ notice as we needed to be sure they would be available for the inspection. At our previous inspection of the service on 12 December 2014 the service was rated good. At this inspection they remained rated Good.

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 2008 and associated Regulations about how the service is run.

Medicines were handled and administered safely. People received their medicines as required because staff understood and followed the organisation’s medicines policy. Risk assessments were in place and detailed actions to manage identified risks and to keep people safe. Recruitment procedures were robust and safe. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse.

Staff understood their responsibilities within the Mental Capacity Act 2005. Staff were supported through effective induction, supervision, appraisal and training to provide effective service to people. People were supported to eat and drink appropriately and to meet their dietary and nutritional requirements.

The service worked with social care and health care professionals. People were supported to arrange appointments to ensure their health needs were met. Relevant professionals were involved to ensure people received appropriate support and care that met their needs.

People told us staff treated them with kindness, compassion and respect. Staff provided support to people the way they wanted to be cared for. People and their relatives were involved in their care planning and these were reviewed and updated regularly to reflect people’s changing needs.

People and their relatives were given opportunity to feedback about the service provided. The registered manager investigated and responded to complaints and concerns appropriately to improve the service.

The registered manager checked the quality of service delivered. Regular spot checks and audits were carried out to identify shortfall in the service.

This inspection took place on 12 December 2014 and was announced. We gave the registered manager 48 hours’ notice as we needed to be sure they would be available for the inspection.

When we last visited the service on 20 December 2013, the service was meeting the regulations we looked at.

Advanced Care and Support provides support including personal care for people in their own homes. At the time of the inspection 80 people were using the service.

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 2008 and associated Regulations about how the service is run.

Medicines were not always handled and managed safely. There were unexplained gaps on the medicine administration record (MAR) and people did not always get the support they required to take their prescribed medicines.

Risk assessments did not always include detail of how to manage the risks associated with people’s health conditions.

Recruitment procedures were robust and safe. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse. People, their relatives and staff were encouraged to provide feedback and to raise concerns. The registered manager investigated and responded to complaints and concerns appropriately to improve the service.

The service worked with social care and health care professionals. People were supported to arrange appointments to ensure their health needs were met. Relevant professionals were involved to ensure people received appropriate support and care that met their needs.

Staff understood their responsibilities within the Mental Capacity Act 2005. Staff were supported through effective induction, supervision, appraisal and training to provide effective service to people.

People said staff treated them with kindness, compassion and respect. People were supported to eat and drink appropriately. Staff provided support to people the way they wanted to be cared for. Care plans were reviewed and updated to reflect people’s changing needs.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.

We found that people were involved in the planning and the delivery of their care. People's needs were assessed by external healthcare professionals and the management team. One person told us, "I am involved in everything the carers do" another told us, "I am very happy with my carers, they listen to me and are very respectful."

We looked at people's care records which showed care planning and risk assessments were thorough and ensured people were kept safe whilst maintaining their independence. People told us they were, "happy with the care" they received and "felt safe and supported."

We saw staff were trained in safeguarding. We noted staff followed safeguarding procedures when incidents took place and knew who to contact in the event of a safeguarding issue. Staff we spoke to were able to recognise different types of abuse. This meant their safeguarding training had been effective.

We found evidence that effective recruitment procedures were followed and people were cared for by staff who were fit and appropriately qualified to deliver safe and effective care. Staff told us they were, "Happy with the training they received."

We saw evidence that the provider regularly monitored the quality of the service provided. We noted that risk and needs assessments were updated and reviewed regulary. Staff told us that home visits were undertaken by care management staff to observe care delivery. This meant that people received safe and effective care.

We spoke with eight people using the service and / or their relatives. They spoke well of the care staff and managers in the service.

Suitable arrangements were in place to support people to manage their medicines safely.

Our inspection of 14 February 2012 found that staff did not always receive sufficient support in terms of supervision, staff meetings and appraisal. When we inspected the service on 17 January 2013, we found that suitable staff support arrangements had now been put in place. We spoke with the manager, two team leaders and four care workers. Staff told us that they felt supported in their work and had developmental opportunities through training sessions, one to one supervision and annual appraisals meetings.

The provider had improved their quality management system since our last inspection by scheduling monitoring visits and purchasing a rostering system that would support them to plan these visits and monitor calls. The provider took account of comments, compliments and complaints, and sought the views of people using the service to make improvements. Records of incidents were maintained and appropriate actions taken in response to incidents.

People said that their needs and preferences were taken into account. They said that they had access to and knew what was in their care plans. People felt that staff respected their privacy and dignity.

People said that they felt well cared for by staff. They said that staff stayed for the allotted time and provided them with the care that they needed. People said that care staff usually turned up on time, although there were some exceptions to this. They said that they were usually notified if staff were going to be late, although staff being late sometimes caused them anxiety.

People felt safe and able to raise any concerns with the agency.

People said that staff were kind and caring. They said that staff did what they were supposed to do when they visited them.

However, there was other evidence that people experienced care from staff who were not always appropriately supported and the care being provided to them was not always monitored effectively.