This inspection took place on 12 November 2018 and was announced. This was to ensure someone would be available at the office to speak with us and show us records.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults with a variety of needs.

Not everyone using Ann Tuplin Care Services Limited receives the 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.

On the day of our inspection there were 45 people using the service.

At our last inspection 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.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

The service employed sufficient numbers of staff to support people with their individual needs. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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 were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care provided by Ann Tuplin Care Services.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

People were protected from social isolation.

The provider had a complaints procedure in place, and people who used the service and family members were aware of how to make a complaint.

There was an effective quality assurance process in place. Staff felt supported by the management team. People who used the service, family members and staff were regularly consulted about the quality of the service.

Ann Tuplin Care Services Limited is a Domiciliary Care Agency registered to provide personal care to people living in their own home. They primarily support people with a range of disabilities who want to retain their independence and continue living in the community. The service supports to people of all age ranges.

The service also provides personal care to people living in supported living arrangements. Individual support hours are provided depending on people’s needs, following an assessment by the local authority who commissions the service. The aim of the service is to provide people with the support they need to live as independently as possible.

The service was last inspected on 12 and 13 June 2014, when it was found to be compliant with the regulations inspected.

There was a registered manager in place who had recently, successfully had their competencies and skills assessed by the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People who used the service were protected by staff who knew how to recognise and report signs of potential abuse. Staff had been recruited safely to ensure they were suitable to work with vulnerable adults and children.

Staff completed an appropriate induction for the service and a range of training was provided to enable them to carry out their roles. Staff received regular supervision and appraisals of their skills to enable them to effectively support people and ensure their behaviours and attitudes were monitored.

People told us staff worked in partnership and involved them in decisions about their support and their written consent about this was obtained at the commencement of their use of the service. People and their relatives were unanimous in their praise of the quality of support that was provided by care staff who said treated them with kindness, dignity and respect at all times. People were supported and encouraged to eat a healthy balanced diet where this was required.

People who used the service were encouraged to provide feedback about the service to enable it to learn and develop and used ‘spot check’ visits to enable staff skills to be observed.

A complaints policy was in place to enable people’s concerns to be addressed and followed up if necessary. Some people told us communication with the office could sometimes be an issue over changes concerning their rotas; however the registered manager advised they were in the process of addressing this issue and were currently in the process of recruiting additional staff. The registered manager understood their responsibilities and reported accidents, incidents and other notifiable incidents as required.

People told us that care staff listened and involved them in decisions about their support People said that care staff were “Cheerful and respectful” and did a “Really good job.” One relative told us their member of family “Looked forward” to care staff arriving and that they went “Above the call of duty.” We were told that support was provided by a “Reliable” and “Consistent” set of carers, who knew people well and ensured their personal dignity was maintained.

People told us that care staff consulted them about their support, to ensure they were happy with the service delivered. A relative told us they felt “Reassured by the service”, whilst another said their member of family was “Treated like a gentlemen” and that care staff always ensured they were ”Clean and well looked after.”

People told us that support was provided by a consistent set of carers and who were “Flexible.” A relative told us that their member of family’s support package “Runs well” and that staff “Never rush” and provided them with “Stability.”

People told us they were” Comfortable” and “Very happy with service.” People told us they had trust in the provider and were “Confident” action would be taken to address any concerns if this was required. One relative told us the service enabled them to have “Peace of mind.”

People used the service told us that the provider listened to them and that their views were taken seriously.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency. This inspection was part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience, a person who has experience of using services and who can provide that perspective.

We spoke with seventeen people who used the services. We used telephone interviews and visited people who use the service at their home. We also spoke with their main carers (a relative or friend) to gain views about the service.

Everyone we spoke with was positive about the care and support they received. They told us that the care workers treated them with respect and they felt their dignity was protected. One person told us, ”I feel very comfortable with the personal care, they respect my privacy and dignity and encourage me to be independent.”

People told us their care and treatment was planned and delivered in line with their individual care plan. Comments included “I am happy with the care” and “I get all the care I need.”

People we spoke with told us that they felt safe when care workers visited them. They told us “I have felt safe so far when they come in, I rely on them” and ”I am happy with the staff, they speak nicely to me and I feel safe.”

People we spoke with said that they were asked for their views about their care and treatment and their feedback was listened to and acted upon. One person told us “I have seen people from the office; they have asked if I am happy with the service.”

People we spoke to as part of this review of compliance told us they were happy with the services they were being provided with and that staff were "patient" and "pleasant" to them. They told us that prior to accepting this provider to supply services to them they had been assessed and were able to contribute to their plan of care.

We visited the office of the domiciliary care agency together with the homes of two people who used the service as part of this inspection. We subsequently phoned five other people or their relatives, to ask them about their experience of the service and spoke to staff who supported them.

The inspection gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found:

Is the service safe?:-

We saw evidence in people’s care records that consent to their support was discussed and explored with them at the start of their use of the service. We saw people or their relatives had signed to confirm their agreement with the way support was provided. This helped ensure people’s dignity was respected and their human rights were protected.

People told us they felt safe and that staff were reliable. One person said, “The girls are marvellous, there is not one I would not employ.”

We found that safeguarding procedures were robust and staff understood how to protect vulnerable adults and children from harm.

We saw that systems were in place to ensure managers and staff learnt from events such as incidents and accidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Staff knew about risk management plans for people who used the service and we saw examples in people’s care records of how these were followed. We saw evidence that people were included and involved in decisions about their support to enable them to feel in control of their care and not put at unnecessary risk of harm.

Recruitment practices included checks to ensure new staff were safe to work with people who used the service. Policies and procedures were available to make sure unsafe care practices were identified and that people were protected from harm.

Is the service effective?:-

People told us they were involved in the development of their plans of support and were consulted during the assessment of their health and care needs. People told us their care plans were updated and reviewed to reflect changes in their needs.

Is the service caring?:-

We saw evidence that people’s preferences, interests and individual needs were recorded in their care records and that care and support was provided in accordance with their wishes and feelings.

People told us that the office staff were good at contacting them about possible changes to their routines of support. However one person said this could be improved at times such as holidays, or when staff were off sick and replacement staff were needed. Everyone we spoke with told us they had never experienced a ‘missed call’ (i.e. when staff fail to turn up) and that care staff were reliable.

When speaking with staff it was clear they knew about the needs of the people they supported. People who used the service and their relatives indicated they were regularly consulted about their views concerning the way support was delivered. We observed that unannounced visits or ‘spot-checks’ took place to people’s homes to ensure care staff support was correctly provided. People who used the service told us that where shortfalls or concerns were raised, these were taken on board and dealt with appropriately by the provider.

Is the service responsive?:-

People told us they knew how to contact the office and raise a complaint if this was required. They told us they were confident appropriate action would be taken to ensure any concerns they might have were followed up and appropriately addressed. This helped ensure complaints would be listened to and followed when needed.

Is the service well-led?:-

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

What people who used the service and those that matter to them said about the care and support they received:-

We spoke with seven people who used the service or their relatives about the support they received and asked them for their opinions about staff. Feedback from people was very positive overall. One person said care staff were, “Always polite and respectful.” They told us staff, “Listen and talk” to them to ensure they were involved in decisions about their support. People said that care staff did not rush and took their time and that they were, “Always punctual”. Whilst another person told us, “I can’t fault the care.”