This announced inspection took place on 23 November 2017. The inspection was announced because the service provides a domiciliary care service and we needed to make sure the registered manager would be available to facilitate the inspection.

Aegis Care is a Domiciliary Care service which provides support to people, mainly with mental health difficulties, in their own homes. The head office is located in the Swinton area of Greater Manchester and support is provided to people who are aged 18 and above.

We last inspected Aegis Care in September 2015 and rated the service as Good, however the well-led key question was rated as Requires Improvement due to limited quality assurance systems being in place at that time to monitor the quality of service being provided to people. At this inspection, we found the service has improved in this area, although we have made a recommendation about how these could be expanded further.

At the time of the inspection there were approximately 130 people using the service, however only five were in receipt of a regulated activity which was personal care. As such we only focussed on people in receipt of a regulated activity during the inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

At this this inspection we found the service remained Good.

Why was the service rated as Good?

People told us they felt safe as result of the care and support they received and staff understood their responsibility with regards to safeguarding and how to report concerns.

Staff continued to be recruited safely, with appropriate checks undertaken before staff commenced employment. The people we spoke with told us staff always turned up on time, had never experienced any missed visits and that staff stayed for the correct length of time for each call.

People had individual risk assessments in their care plans and the service maintained and log of any accidents and incidents which had occurred, which detailed any follow up actions taken.

At the time of our visit, the service did not currently take the responsibility for administering medication for people who used the service and as such, we have not covered this area as part of our inspection.

Staff told us they received enough training and said they felt well supported to undertake their roles. Although there was a training matrix in place, it indicated that some courses were due for renewal and were out of date. The manager told us these would be undertaken following the inspection and the training matrix updated accordingly. We have made a recommendation about this in the detailed findings of the report.

Staff received regular supervision as part of their ongoing development. Appraisals were being held, although as part of supervision sessions. We discussed with the manager about ensuring these sessions were kept separate so that staff were being given the opportunity to discuss their performance over the year.

People told us they received enough to eat and drink. The support people required was detailed in their care plans so that staff had relevant information to follow.

The people we spoke with told us they were happy with the care and support they received and described staff as kind and caring.

People were supported by staff to be independent where possible and be involved with tasks to keep up their skills. The service also took people’s equality, diversity and human rights needs into account when delivering care and support to ensure care was person centred.

Each person who used the service had a care plan in place, detailing the care and support they required. Although the registered manager told us the co

Aegis Care is owned by Care and Support Ltd. It is a domiciliary care service that provides care and support to people in their own homes who are living with a mental health illness. Some of the services provided include assistance with shopping, budgeting and domestic tasks within peoples own home. The head office is situated in the Swinton area of Salford, Greater Manchester.

We carried out this announced inspection of Aegis Care on 28 August 2015. At the previous inspection in July 2013, we found the service was meeting each of the standards assessed.

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 spoke with four people who used the service who all told us they felt safe as a result of the support they received. One person said; “I definitely feel safe. It is re-assuring to know I have a regular support worker who I can rely on. It gives me an extra sense of security”.

The manager told us they had limited involvement with people’s medication and at the time of the inspection, as it did not form part of peoples support requirements.

We looked at how the service managed risk. We found individual risk assessments had been completed for each person and recorded in their support plan. We saw there was information about prevention measures available, to provide staff with guidance on how to safely any risks identified.

People were protected against some of the risks of abuse because the service had a robust recruitment procedure in place. Appropriate checks were carried out before staff began work at the service to ensure they were fit to work with vulnerable adults. During the inspection we looked at three staff personnel files. Each file contained job application forms, a minimum of two references and evidence of either a CRB or DBS (Criminal Records Bureau or Disclosure Barring Service) check being undertaken.

We looked at the staff rotas to ensure there were sufficient staffs available to meet people’s needs. The manager told us that any staff shortages were covered by two supervisors who had worked for the service for several years and had a good understanding of people’s needs.

All staff were given the training and support they needed to help them support people properly. We found staff had received training in areas such as Safeguarding, Break Away Techniques, Risk Awareness, Suicide Awareness and Mental Health Awareness. The staff we spoke with told us they were happy with the training available to them.

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. From our discussions with managers and staff and from looking at records we found staff had a good understanding in this area.

The manager told us they had limited involvement with people’s nutritional needs and that each person who used the service could prepare their own meals. The staff we spoke with told us that they prompted people to eat meals when providing support but that in the main, it was not always required. The manager said that where some people may be overweight, that staff offered healthier food options and prompted people to exercise.

People told us they were treated with respect and that staff allowed them to retain their independence.

Each person who used the service had a support plan in place, which provided staff with an overview of their support needs and what they needed to do. Copies of these were located at the head office and also in people’s own homes.

There was a complaints procedure in place. The service user guide also referred specifically to complaints and explained the process people could follow if they were unhappy with any aspects of the service.

The staff we spoke with spoke positively about the management and leadership of the service. Staff felt the manager was approachable and supported them to carry out their work to a high standard.

We found that there were limited systems in place to monitor the quality of service provided to people. The manager told us that there was no formal auditing process used which would cover areas such as support plans, peoples home environment, staff training, staff personnel files and infection control. The manager told us they did keep on top of these checks but did not document any of it to show what was found as a result. Additionally, the manager said that there was no documentary evidence of staff competency checks, to ensure they were able to undertake their role to the required standard. This is a breach of regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Good Governance.

As part of our inspection we spoke with three people who used the service who currently received support from Aegis Care. Comments from people included; “The support has been very helpful indeed” and “The staff are good on the whole. I would recommend them to other people” and “The staff help me with things I don’t expect which is nice” and “They are extremely supportive. They are a great team”.

We looked at how people who used the service provided consent to their support and found that there were appropriate arrangements in place. One person said to us; “I’m fully in agreement with my support package and for the reasoning behind it”.

We looked at four staff files to ensure that the provider had recruited staff safely and had conducted the appropriate checks on new staff prior to them commencing in their job role.

We found that Aegis Care had appropriate systems in place to monitor the quality of service provision and to handle complaints effectively, although we felt that recording of the audits and staff meetings could be improved.

We visited the agency on 20 December 2012. We looked at the care records for six people who used the service. The records were factual and contained relevant information to inform their care delivery. We saw that care records were individual and contained information about people’s personal preferences and demonstrated their involvement with the way that their care needs were met.

We spoke with three people who used the service. One person told us “They are very efficient, very friendly and nice with me. My family like them”. Another person said “I am absolutely satisfied” and a third told us “they are lovely, everyone is really nice”.

We saw that all relevant policies and procedures were in place. We saw that safeguarding people who used the service from the risk of abuse was taken seriously and followed up appropriately and that mental capacity was considered as a matter of course. We spoke with three staff members who all demonstrated an awareness of safeguarding issues and reporting procedures.

We observed that appropriate recruitment procedures were in place, supervision was given to staff on a regular basis and ongoing training and development was offered. We spoke with three staff members, all of whom felt very well supported by the company.

We saw that there was an appropriate complaints policy and complaints were dealt with efficiently. Systems were in place to allow the continual monitoring and improvement of the service delivery.