The inspection of the service took place between 20 June 2018 and 19 July 2018 and was unannounced. During the inspection we visited the offices to speak with management and review records, carried out visits to people in their own homes and spoke with people, their relatives and staff over the telephone.

The service is managed from offices in Kirkham, Lancashire. Services are provided to support people to live independently in the community. At the time of our inspection, 147 people used the service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing.

Not everyone using the service received a 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.

There was a registered manager at the service. 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.

The service had systems to protect people from abuse or the risk of abuse. Staff had received training to safeguard people and were aware of how to report any concerns.

The service had systems to ensure the safe and proper management of medicines. Staff received training and their competency was assessed before they provided people with support with their medicines.

Robust recruitment processes ensured only suitable candidates were employed by the service. Staff received a comprehensive induction, ongoing training and support in order for them to provide effective care and support to people who used the service.

Staff assessed risks to people and measures were put in place to lessen risks. Accidents and incidents were reported and recorded. These were analysed by the registered manager so lessens could be learned and the risk of repeat occurrences reduced.

No one we spoke with raised any concerns about staffing. We saw the service used an electronic system to organise staff rotas. However, some people we spoke with and staff, told us some changes to rotas were not always communicated effectively. The registered manager confirmed they would address this issue following the inspection.

We found people were supported with nutrition and hydration. Staff carried out thorough assessments to ensure the service could meet the needs of people. We saw written plans of care were reviewed regularly to ensure they met people’s current needs.

People we spoke with and their relatives gave us consistently positive feedback about how the service was delivered and the approach of staff. We observed a good rapport between staff and people they supported. Staff had a good understanding of protecting people’s rights and treated each person as a unique individual.

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 told us they were encouraged to raise any concerns or complaints and felt they would be taken seriously. The service had a complaints policy and we saw complaints had been investigated and responded to appropriately.

We found staff and management were open and honest and spoke of a positive culture within the service. Everyone we spoke with told us there had been improvements to the service since our last inspection. The registered manager was keen to continue to drive improvements.

We saw the registered manager used a range of methods to assess, monitor and improve the service. Regular audits and checks were carried out. Feedback was sought from people who used the servic

Advanced Homecare is a domiciliary care agency, which provides support with daily living and personal care to 234 people who live in the Fylde and Wyre areas. The service operates out of offices in the centre of Kirkham. The offices are easily accessible for clients.

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. We were informed by the Provider that the manager who is registered with CQC no longer carried out this role. A new manager had taken over the service and was in the process of registering with CQC at the time of our inspection.

Prior to our inspection concerns had been raised with us about nutrition, hydration, medicines, inconsistencies in care records and instability in management. We used the opportunity to ensure the provider had taken action to ensure people who used the service received safe, effective, compassionate, high-quality care.

There had been instability among the management team which had led to communication issues prior to our inspection. The manager was confident they now had the right people in place. Staff and people we spoke with told us the service had improved recently.

The provider had introduced monitoring systems to protect people against the risks of poor nutrition and hydration. People told us staff supported them to make sure they ate and drank enough to keep them well.

We found inconsistencies in the level of detail recorded in people’s written plans of care. The manager was introducing a new care planning system to address this, which contained more detail to guide staff.

The provider had safe systems to ensure people received the right medicines at the right time when supported by staff. The systems were newly introduced and good practice needs to be shown to be sustained in this area.

We last inspected the service in August and September 2015, when we found the provider was meeting the requirements of the regulations. Following that inspection, we made two recommendations.

The first was for the provider to ensure people’s risk assessments were kept up to date in line with any changes in circumstances. The second, for the provider to ensure staff competency with regard to medicines administration recording. We found improvements had been made in both these areas. However, we found there had been recent issues regarding risk assessments including nutrition, hydration and medicines. These were highlighted as part of safeguarding investigations by the local authority. We saw the manager had introduced new systems to try to ensure people received safe care and support.

People had signed their care plans to say they consented to their package of care. However, we found assessments of people’s capacity to consent and decisions made during best interests processes were not clearly recorded. We have made a recommendation about this.

People and their relatives told us they felt safe with staff. Staff had received safeguarding from abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were being met.

New systems to manage risks and plan care and support for individuals h

The inspection took place on 13 August 2015. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure there would be someone available to provide us with the necessary information. We also carried out visits to people in their own homes on 16 & 17 September 2015.

The service is a domiciliary care agency, which provides support with daily living and personal care to 130 people who live in the Fylde and Wyre areas. The service operates out of well-equipped offices in the centre of Kirkham. The offices are easily accessible for clients.

The service has a registered manager in place. 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 spoke with people who used the service, some relatives and staff during the inspection. The feedback we received from people was positive. People expressed satisfaction with all aspects of the service provided and spoke highly of staff and managers. People who used the service told us they were treated with compassion and kindness and that their privacy and dignity were respected.

There were effective systems in place to assess and manage risks to people’s health, safety and wellbeing. Staff were fully aware of personal risks people’s faced for instance, in relation to their health or mobility, and the measures they should take to support people safely. However, we found that assessments for two people we spoke with had not been reviewed and updated for some time. We have made a recommendation about this.

Staff were fully aware of their responsibilities to safeguard people they supported from abuse. Staff were able to speak confidently about their role in safeguarding people and told us they were confident managers would support them if they raised any concerns.

The service worked well to help ensure people received effective health care support from other agencies. People who required assistance to take their medicines were provided with safe support. However, we found the provider did not routinely record checks on staff competence with medicines. They assured us they would address this following our inspection. We have made a recommendation about this.

People’s care plans reflected their individual needs and personal wishes. People told us they were involved in the development of their care plans and were enabled to express their views on an on-going basis.

Staffing levels were carefully assessed and regularly reviewed. This helped to ensure people received a consistent and reliable service.

Staff at the service were carefully recruited and were required to undergo a number of background checks prior to starting their employment. This helped to ensure only people with the correct skills and of suitable character were employed.

Staff received training in a number of topics, which helped to enable them to have the skills and knowledge required to meet people's needs effectively. The provider was reviewing staff training at the time of our inspection and hoped to increase the variety of training for staff.

There were systems in place which enabled the registered manager and provider to monitor the quality and safety of the service on an on-going basis so that any areas for improvement could be promptly identified and addressed.