We undertook an inspection of Alliance Living Care – Weston Super-Mare on the 25, 28 January and finished on the 1 February 2019. An Expert by experience made phone calls to people on the 25 January 2019.

The inspection was announced, which meant that the manager knew we would be visiting. This was to ensure someone 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 Safe, effective 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 – Weston Super Mare 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 – Weston Super Mare 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 239 people were 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 as well as audits. At this inspection we found improvements had been made to the recording of medicines and audits.

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

People received their visits from staff who they were familiar with and who they described as kind and caring. People felt safe and care plans contained environmental risk assessments.

Staff had checks undertaken prior to starting work. Staff received training and supervision and all felt able to raise any concerns should they need to. New staff received an induction and people were supported by staff who received additional training to ensure they were competent and skilled in their roles.

People were supported by staff who were kind and caring and who were able to demonstrate examples of privacy and respect. Staff had a good understanding of equality and diversity and how they promoted people’s independence and choice.

People felt able to complain should they need to however all people and relatives were happy and had no reason to complain.

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

The provider had audits that identified shortfalls and the performance of the service was monitored by the nominated individual.

People’s views were sought so improvements could be made. Staff felt the service was a nice place to work with a good staff team.

The provider was submitting notifications when required and displaying their rating.

We undertook an inspection of Alliance Living Care – Weston Super Mare on 19 and 21 December 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 June 2014. This was the service’s first inspection since registering and had not been previously rated.

Alliance Living Care – Weston Super Mare 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 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 227 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. For example, medicines and care and support audits were not in place to monitor the service effectivity.

The provider was not always ensuring safe staff recruitment procedures were in place when new staff were introduced through the ‘Care Academy’. Staff were not always following the provider’s dress code policy as some staff had painted nails that can impede hand washing.

People felt safe and were supported by staff who were able to identify abuse and knew who to go to should they have concerns. Risk assessments identified concerns, however guidelines were not always in place where staff supported people with daily exercises.

Staff had access to personal protective equipment and an ID badge, alarm, torch and ruck sack to keep items safe.

People were not always supported by staff who had received training to ensure they were competent in their role.

Where people lacked capacity, the provider was not always ensuring the principles of The Mental Capacity Act 2005 were being followed.

Staff received an induction and regular supervision and people were supported by staff with their nutrition and hydration.

People felt supported by staff who were kind and caring and staff demonstrated a good understanding of equality and diversity.

People felt respected and confirmed they felt they had choice in their care.

People felt able to complain, and where complaints had been raised records confirmed actions taken. Care plans were person centred and reviewed every six months.

Staff felt the provider and management were supportive and accessible and they had regular staff meetings. Newsletters were an opportunity to share updates with staff and customers about feedback and new initiatives.

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.