We undertook an announced inspection of ARCH Care Services Limited on 28 November 2016. ARCH Care Services Limited provides personal care services to people in their own homes in and around Clevedon, Nailsea and Portishead. At the time of our inspection approximately 50 people were receiving a personal care service. This service was last inspected on 6 November 2013 and found to be compliant in all the areas we looked at. During this inspection we found no breaches of regulations and we found people received a good service.

People were kept safe and free from harm. People using the service, and staff, had access to a 24 hour ‘on-call’ service, which meant they could ask for guidance or additional support at any time.

The provider had a robust recruitment process which minimised the risks of abuse to people. Staff had received training and information on how to recognise and report any suspicions of abuse and they were confident any concerns would be acted on promptly.

There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Staff were able to accommodate last minute changes to appointments as requested by the person who used the service or their relatives. One person said, “I sometimes need help outside of my usual hours and they have always tried to get to me as soon as they can.” People were confident staff were never rushed and always stayed for the correct length of time.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. There were systems in place to ensure people received their medicines safely from staff who were trained and competent to carry out the task. Continuous observation and auditing ensured these systems were maintained and action taken to minimise the risk of errors, for example additional training for staff.

Staff knew the people they were supporting and provided a very personalised service. Care plans were in place detailing how people wished to be supported and people and/or their relatives were involved in making decisions about their care. People told us they liked the staff and found the care to be good. Peoples’ comments included, “ They [the staff] understand me and know about my needs. They make my life easier and take the pressure off me” and ““They cater to my every whim!”

People were supported to eat and drink if required. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. For example, they contacted social services and occupational therapists if people’s care needs increased and they required more time or equipment. Care plans were reviewed regularly which meant staff were able to continue to meet people’s needs as they changed. Effective communication systems ensured that this information was shared promptly with the person and the team supporting them, with the person’s consent.

Staff had received training and had an understanding of the requirements of the Mental Capacity Act (2005) (MCA), which meant people’s legal rights were protected. People who used the service and others involved in their care were fully involved and consulted. People were always asked for their consent before staff assisted them with any tasks. Staff respected people’s privacy and people were treated with respect and dignity. The service had developed a ‘Dignity Champion’ role and produced a Dignity in Care newsletter. People’s comments reflected a focus on personal care provided in a way that maintained their dignity. Comments had included how people receiving the service helped to make them feel ‘human’ and cared for.

Due to the commissioning process the service had recently lost the tender to provide care to some people. This meant that unless people were privately funded or used a direct payment scheme

People who used the service told us that they received the care and support that had been agreed. They spoke positively about the care workers, who were described for example as “excellent” and “very professional”. We also heard that the care workers were “proactive in identifying problems” and supported people to access other services that they may need.

People received support with medicines in ways that had been agreed and which promoted their independence. There were procedures in place so that support with medicines and personal care was provided in a safe way. Portable hoists for example were being checked to ensure that they were in a safe condition.

The office based staff we spoke with were clear about their roles and responsibilities. We saw that there was good communication between the people who used the service, the care workers and the office based staff. The agency had effective systems in place for monitoring the quality of service that people received. Overall, we found that people were receiving a well run service that met their needs.

During our inspection we spoke with seven people who used the service, five support workers, the provider and two other staff from the management team.

The people who used the service we spoke with told us staff treated them with respect and dignity. Staff gave us good examples of how they supported people to maintain their independence and dignity.

People said they received the care that they needed. One person told us, "the carers are very good and I am happy with the service”.

We found the provider reviewed people's needs and planed their care to ensure that people received safe care. For example, there was a risk assessment and care plan to support a person with a mobility need in order to reduce the risk of falling.

People told us that they felt safe with the support workers who visited them. We found that systems were in place to ensure people were safeguarded from abuse.

We found that staff were trained and supported to deliver care to an appropriate standard.

We found that the provider had an effective system in place to monitor the quality of the service, to ensure that people received safe care.

We saw the agency had effective complaints system in place and complaints people made were responded to.