The inspection took place on 4 and 6 April 2017 and was announced. The provider was given 48 hours’ notice as they provide a service to people in their own homes and we needed to be sure managers would be available to speak with us. The service was last inspected in June 2016 when it was found to be in breach of four regulations and was rated requires improvement. At this inspection the service had made the required improvements and is now rated good.

AQT Home Care Services is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection they were providing care to approximately 20 people.

The service is required to have a registered manager. 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 manager of the service was successful in their application to register the day after the inspection was completed.

People and their relatives were confident they were safe with their care workers. The provider had robust systems in place to respond to incidents and staff were knowledgeable about safeguarding adults from harm. Care files contained a range of risk assessments to mitigate risks faced by people during care.

People were supported to take medicines by care workers, and were confident in staff ability to do this safely. There were detailed plans in place to ensure staff had the information they needed to administer medicines and records were clear. Staff had received appropriate training and support in administering medicines and in other areas required to enable them to perform their roles.

Staff were recruited in a safe way that ensured they were suitable to work in a care setting. People told us they had regular care workers who did not have to rush their visits. People and relatives told us this had enabled them to develop positive, caring relationships with their care workers. The provider ensured they had enough staff to meet people’s needs.

Care plans were highly personalised and very detailed. People were involved in the assessment, review and care planning processes. Care plans contained details of how people wished to receive their care, their nutritional and hydration needs and preferences and support required with maintaining their health. Records showed people were supported in line with their care plans. The service included information about people’s cultural background, personal histories and significant relationships into people’s care plans. Dignity in care was embedded in care plans with specific instructions for care workers on how to promote people’s dignity during care.

Many of the people receiving a service were at the end of their lives. The service ensured they had good links with relevant healthcare services to ensure people were supported to be as comfortable and pain free as possible at the end of their lives.

People told us they could ask for changes in their care easily by contacting the office. Care workers told us they could raise any concerns they had about people’s needs and the office would respond promptly to ensure people’s needs were met.

People and their relatives told us they had not needed to make any complaints, but knew how to should the need arise. The service had a robust complaints policy in place. The service sought and acted upon feedback from people and their staff through annual surveys and spot checks on staff.

The service completed various audits and quality checks to monitor the quality and safety of the service. Any issues identified by these checks were addressed by the provider. The provider had a clear plan to continue to improve the service.

The inspection took place on 16 and 20 June 2016 and was announced. The provider was given 24 hours’ notice as we needed to be sure the manager would be available to talk to us. The service was last inspected in August 2014 when it was found to be compliant with the outcomes inspected.

AQT Home Care Services is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection they were providing support to 22 people.

The service had a manager in place. However, they were not registered with the Care Quality Commission. The manager had started the application process to become registered. 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 they felt safe using the service, and care workers were knowledgeable about their responsibilities to safeguard people from harm. However, the processes for escalating concerns were not operating effectively to ensure that concerns and allegations were investigated appropriately.

People were at risk of harm and poor support because care plans and risk assessments did not contain the information staff required to provide good quality safe care. Care workers relied on feedback from people, their relatives and more experienced colleagues to know what support to provide. Care plans were not kept up to date when people’s needs changed.

The service did not always have enough staff to ensure that people’s needs were met. We have made a recommendation about staffing levels.

People and their relatives told us they were supported to take their medicines as prescribed. However, records were not well maintained. We have made a recommendation about recording medicines administration.

People and their relatives told us they thought that staff were good at their jobs. Staff told us they received regular training, although this was not always reflected in the records of training received. Staff did not receive regular supervision. We have made a recommendation about supporting staff.

The service provided support to people at the end of their lives. End of life care plans did not contain the information required to ensure that people were supported at the end of their lives to have a dignified and pain free death. We have made a recommendation about end of life care.

The systems for monitoring the quality of the service were not operating effectively. Management audits of care plans and records of care delivered had not identified that more information was required to ensure high quality care was delivered.

Where the service was responsible for supporting people with eating and drinking this was recorded in the care plan. People were supported to eat and drink enough and to maintain a balanced diet. The service supported people to access healthcare services as appropriate, but did not update care plans to reflect current advice from health professionals.

The service sought consent from people and their legal representatives in line with legislation and guidance.

People and their relatives told us they thought the staff had a caring attitude. Regular care workers had developed positive relationships with the people they supported. People told us they felt they were treated with dignity and that care staff were respectful to them.

People and their relatives knew how to make complaints and records showed these were responded to in line with the provider’s complaints policy. People and their relatives told us the service responded well to any concerns they raised and made changes as requested. The provider completed annual surveys of staff and people who used the service to obtain feedback about the service.

We found five breaches of the Regulations. You

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw the service had infection control procedures. Staff were aware of the policy and understood their roles in relation to infection control.

We saw the service carried out Disclosure and Barring Service (DBS) checks on people who worked in the service to ensure they were not barred from working in the care sector.

There were arrangements in place to deal with foreseeable emergencies. This included emergency contact numbers, and first aid training for staff.

The service had a safeguarding policy in place which explained how the provider would protect people from abuse. Staff understood their role and responsibility in safeguarding people.

The registered manager was able to explain how the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) related to their service.

Is the service effective?

People’s social, health and support needs were assessed with them, and they were involved in reviewing their care plans. People told us the service met their identified needs. One person we spoke with said, “I told them when I wanted them to come, they wrote it in the care plan and stuck to what they had said.”

Is the service caring?

People were supported by kind and attentive staff. Staff were able to explain how they supported people to maintain their dignity and deliver services in a caring way. Care plans included details of how people liked to be supported. People told us the staff were “caring” and “always very polite.”

Is the service responsive?

People’s needs were assessed before they were signed up to the service. We saw checks had been made to ensure people had not changed their minds about what they liked to do. People told us staff would make changes to the service at their request. One person told us, “If I want to change the time the worker comes I just ring X, she will sort it out.” We saw the service had a system in place to respond to complaints and comments. Staff regularly asked people’s view of the service and responded to what people told them.

Is the service well-led?

The registered manager was clear about the aims and objectives of the service. We saw quality assurance processes in place to check what people thought about the service. We saw the service had sent feedback forms to people who used the service and their relatives. A report on the findings from the feedback form had been produced and this report explained what management intended to do to address issues identified from the feedback forms.

We were not able to speak to people who used the service. We spoke to four relatives of people who used the service and three members of staff. Relatives told us, “the carer makes my relative smile. That means a lot to me” and "I'm a satisfied customer."

Relatives told us the service took their views and the views of their family members into account when planning and delivering care. One relative said, “they ask my opinion about the care and they listen to me.” We found that people's cultural and religious backgrounds were considered.

We found that people's needs were assessed and people had individual care plans and risk assessments, which were updated regularly. Staff were aware of these and daily notes showed care was delivered in line with care plans. One relative told us the care plan was thorough and "they know my relative well." Staff received training in emergency first aid.

Staff were trained in management of medicines. Each person's care plan contained information about the medicines they took and what they were prescribed for. However, we found staff did not consistently record when they had prompted people to take medicines or checked whether people had taken medicines themselves.

People's personal records were fit for purpose. Staff recorded the times of their visits and the care that was delivered. Staff files contained personal information and supervision records. The service recorded informal conversations about people's care.

People's consent was obtained before care and treatment began and throughout their care. We saw the provider had a number of methods in obtaining consent and involved family members where people were unable to give valid consent.

People had their needs thoroughly assessed and risk was assessed and reviewed properly. On the day of the inspection we viewed eight care plans and found that people and their families were involved in care planning. A relative told us "The agency is great we are really happy."

We viewed eight staff files and saw that staff had been through a thorough recruitment process and the provider carried out Criminal Records Bureau and Protection of Vulnerable Adult checks. The provider was committed to employing staff who had the skills and experience to do the job and provided support to ensure staff met the required standard.

There were sufficient staff employed to carry out the role and the provider ensured they had two staff for each person to ensure continuity of care and that there was always cover for people who received care. One member of staff said "There are enough staff, I will provide cover when somebody has called in sick if needed."

The provider had a clear and effective complaints procedure and we saw that people had their complaints dealt with promptly and to their satisfaction.

People were generally pleased with the service provided by AQT Home Care Services, describing the care as good and the staff well trained and caring. There was one person describing the service as “poor”. External feedback was positive about the agency and staff told us that they received good training and support.