This inspection was carried out on 30 October 2018.

The provider registered this service with us to provide personal care and support for people within their own homes. At the time of our inspection 106 people in Herefordshire and 37 people living in Rose Gardens [a sheltered housing service supported by Agincare staff] received care and support from this service.

At our last inspection in August 2015 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

A registered manager was not in post at the time of our inspection, however, the provider was taking reasonable steps to address this. The manager had started the process of registration with the Care Quality Commission.

People continued to receive care, which protected them from avoidable harm and abuse. Care staff responded to and met people's needs safely. Risks to people’s safety were identified and measures were in place to help reduce these risks. Care staff continued to be recruited safely by the provider, and checks were completed on new staff to make sure they were suitable to support people in their own homes. There were sufficient numbers of staff to support people effectively. Medication administration continued to be safe.

People continued to receive care that was effective in meeting their needs, by care staff who had the knowledge and skills to support them. People's rights with regards to consent and making their own decisions continued to be respected by care staff.

People were supported by care staff who knew them well and had caring relationships with them. People felt involved in their own care and care staff and managers listened to what they wanted. Care staff respected people's privacy and dignity when they supported them and promoted their independence.

The provider and manager sought people's views and responded to the feedback about the service they received. Care staff spoke positively about feeling valued by management, who were always available to provide support and guidance. Systems were in place that continued to be effective in assessing and monitoring the quality of the service provided.

Care staff continued to assist people with care and support that was individual to them. People were encouraged to raise concerns and make complaints and were confident these would be dealt with. The provider was an inclusive service and promoted equality, diversity and human rights with people and care staff. People’s individual faiths were respected.

People were listened to when they gave feedback about the service they received. Care staff felt valued by management, who were always available to provide support and guidance. Systems were in place that continued to be effective in assessing and monitoring the quality of the service provided.

This inspection was carried out on 25 August 2015.

The provider registered this service with us to provide personal care and support for people within their own homes. At the time of our inspection 59 people in Herefordshire received care and support from this service.

There 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.

People told us that staff and management would listen to their views and any concerns.

People told that they had enough staff to meet their needs and this included support with their medicines. People told us that if staff were on holiday or sick, there were always staff on hand to cover any visits.

People told us that staff were caring and kind and able to support them as they would expect to be supported. People felt involved in their care and able to make choices regarding their care and treatment.

Staff were not recruited until appropriate checks had been made to make sure they were suitable to support people in their homes and keep them safe. Staff had a good understanding of how to protect people from abuse and how to report abuse.

The registered manager told us that they wanted a service that provided the best possible individualised care. Checks were completed regularly to ensure that good standards of care were maintained. Feedback from the people that used the service were sought on a regular basis and any areas identified for action were acted upon

People told us that nothing was done without their consent. Staff understood the importance of providing care that met people’s individual needs.

The people we spoke with told us that the service was good. They said the staff treated them with respect. People said, "The girls are very good indeed" and “They are extremely nice – always have a laugh.”

People told us they were regularly asked if their service was satisfactory. They told us that the senior staff assessed their needs. In the care plans we looked at we saw the instructions for staff minimised risks to people’s health and well-being.

Staff told us they had training in safeguarding people from abuse.

Staff also told us they felt supported to work effectively.

The provider had systems in place that enabled them to identify problems swiftly and act upon them to keep people safe at all times. This meant that the service was managed well.

People who use the service said that they were well looked after. They told us that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect. They said staff talked to them about how they liked their support to be provided.

We asked what they thought of their care and they replied with comments like, “The girls are good” and “Friendly”.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. Staff told us about the training that the service had arranged for them so that they would recognise abuse and how to report it.

People told us that staff were usually punctual and reliable. People’s relatives told us that staff were always friendly and professional when they visited. One person said, “No qualms with them; very pleased with them”.

People we spoke with said their comments were listened to. They said that they would not hesitate to talk to staff if something was wrong.

We carried out this review to check on the staffing arrangements for people who used this service. We did this because we had been made aware of two safeguarding alerts that included concerns about agreed staff support not being provided.

We visited the agency office and spoke with two carers and the registered manager. After the visit we spoke on the telephone with two other carers, two people who were using the service and the relative of another.

We looked at two safeguarding alerts we had received information about which included concerns about planned visits not taking place. The registered manager was confident that the correct staffing had been provided on both occasions. In one case the carer was late but the person using the service had no telephone so they could not be told about this. One of the carers involved spoke with us and confirmed they had visited the person but the person had refused to let them in. The registered manager was unable to provide records to evidence the actual timing of visits on these dates.

We talked to three people about their experience of the care and service they received from the agency. One person told us, “On the whole I find the agency very good. I have support from a team of five carers. They are all nice girls, pleasant and helpful. I have never been forgotten and they do tell me if they are running late, which is rare. If there are any problems I call the office where they are usually helpful. Occasionally only one carer comes instead of two but this does not cause a problem as on two of my calls I only have one carer anyway”.

Another person told us, “I have got new carers at the moment so they are learning what to do. I have not had any problem with carers’ attitudes. Most jobs are done well. I do not always get told of the changes to the times of visits. A new senior spoke to me recently and said she would make changes, but things have not improved yet”.

The relative of one person told us, “The timing of morning visits has improved in the last six months. In the past carers were quite often late which was no good as my son needs to be bathed and ready before his day centre bus comes. The current carers are nice. I do have to tell new carers to talk to my son as some are not used to helping people with a learning disability so they think he cannot understand them”.

The registered manager said she was interviewing candidates each week to keep staffing levels up. They explained there now had a robust office team to help run the service which comprised of an office manager, a care co-ordinator, an administrator and a supervisor.

Three carers told us that recently things had improved and they usually had enough care staff on their teams for the visits they covered. One said, “Two new carers joined our team recently and then left, which caused difficulties. A new carer has now started and team spirits are good. We are flexible and pick up extra shifts when colleagues are off sick”.

The registered manager showed us the surveys returned in December 2011 from over twenty people using the service. The feedback was all positive in areas such as the care provided. Some people felt the timing of carers’ visits were not always reliable. The registered manager had not summarised the feedback received and had not written back to people to show them how their feedback had been used to lead improvements in the service.