We undertook an inspection of Alliance Living Care Portishead on the 3, 4, 6 and 10 December 2018.

The inspection was announced, which meant that the registered manager knew we would be visiting. This was to ensure the registered manager or someone who could act on their behalf, would be available to support the inspection.

The service registered to provide a regulated activity with the Care Quality Commission in June 2014. The service was rated requires improvement at the last inspection in September 2017. In Safe and Well-led it was rated requires improvement. At this inspection we found the service had improved to a rating of Good in all domains and overall.

Alliance Living Care – Portishead is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people. Not everyone using Alliance Living Care – Portishead receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; for example help with tasks related to personal hygiene and eating. At the time of our inspection there were 44 people receiving personal care and support from the service.

A registered manager was in post at the time of our inspection. 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.

At our last inspection we found records relating to how people received their medicines needed improving. Audits were also failing to identify shortfalls found. At this inspection we found improvements had been made to audits that were effective however, records relating to cream charts still needed action.

People received their medicines safely and records relating to the recording of tablets had improved.

People received their visits from staff who were kind and helpful. However, at times people’s visits were later than scheduled.

The provider had audits that identified shortfalls relating to people’s medicines. Feedback was sought so improvements could be made to people’s care.

People were supported by staff who had checks in place to ensure they were suitable to work with vulnerable adults.

Staff received training and supervision and all felt well supported and able to raise any concerns should they need to.

Staff were familiar with people’s needs and care plans were reviewed and personalised.

People felt safe and care plans contained environmental and individual risk assessments.

Staff gave examples of how they gave people choice and staff demonstrated compassion.

People felt able to complain, and when they had problems had been resolved satisfactorily.

We undertook an inspection of Alliance Living Care - Portishead on 19 October 2017. The inspection was announced, which meant that the provider knew we would be visiting. This is because we wanted to ensure that the provider, or someone who could act on their behalf, would be available to support the inspection. The service registered to provide a regulated activity with the Care Quality Commission in September 2015. This was the service’s first inspection since registering and had not been previously rated.

Alliance Living Care - Portishead provides personal care and support to older people in their own homes in the North Somerset and Bristol area. At the time of our inspection there were 107 people receiving personal care and support from the service.

A registered manager was in post at the time of our inspection. 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 was not consistently safe as medicines records were not always sufficiently detailed. Audits were not fully effective in monitoring and improving the quality of the service provided. Not all areas of care and support were included and the audits in place were not detailed.

The service had safe staff recruitment procedures in place. People spoke highly of the staff at the service. Risk assessments were in place to keep people safe. Staff were knowledgeable about identifying and reporting and safeguarding concerns.

Staff were supported and developed in their role by an induction to the service, supervision and regular training. People’s health needs were met. Staff supported people as directed in meeting people’s nutritional and hydration requirements.

People spoke positively about the kind and caring staff at the service. Care and support was delivered to people as they preferred. Care and support was received as scheduled and people were informed of any changes.

Care plans were person centred. Care plans were reviewed regularly, with people and changes made as necessary. New care plans being introduced identified areas where people’s capacity to consent to care and treatment may need assessing. Staff had training in the Mental Capacity Act 2005 and could apply their knowledge within their roles.

People and staff felt comfortable in raising any issues of concerns and these were listened to and responses given. Different systems were in place to effectively communicate and gain feedback from people and staff through meetings, surveys and newsletters.

The provider ensured information was effectively communicated to people and staff through newsletters,

We found one breach 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 this report.