The inspection took place on 30 and 31 January 2018. The inspection was unannounced. This meant the service didn’t know we were arriving to carry out the inspection.

We last inspected Ascot Homecare in February 2016, at which time it was rated good. At this inspection we rated the service as good.

Ascot home care is a domiciliary care agency. It provides personal care to people living in their own houses. It provides a service to 18 older people.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 confident in the ability of staff to keep them safe. No concerns were raised from people and their relatives.

Care plans were detailed and person-centred. Each contained a one page profile that gave staff relevant information when providing care to people who used the service. ‘Person centred’ means the person receiving care is central in developing their care and their preferences are respected.

Support plans contained person centred risk assessments. These identified risks and described the measures to be taken to ensure people would be protected from the risk of harm. This supported people to do the things they wanted to live their life fully.

Staff were trained in safeguarding and were able to describe types of abuse and what they could do to protect people.

There were sufficient staff to meet people’s needs safely. Spot checks were carried out by the registered manager to ensure quality and competency of staff.

The registered manager displayed a sound understanding of capacity and the need for consent on a decision specific basis. Consent was documented in people’s care files and people we spoke with confirmed staff asked for their consent on a day to day basis.

People were supported to maintain their independence on a daily basis with living skills and with personal care where appropriate. They had choice and control over their own life from being supported by person centred care approaches. Person centred care is when the person is central to their support and their preferences are respected.

People were always respected by staff and treated with kindness. We saw staff being respectful, considerate and communicating exceptionally well with people.

People’s support plans were personcentred. They included a ‘one page profile’ that referenced people’s history, preferences and described their individual support needs. These were regularly reviewed.

People were supported to maintain good health and had access to healthcare professionals and services.

We saw people were supported to prepare meals, eat and drink sufficient amounts to meet their needs.

Infection control measures were in place for staff to protect people from the risk of infection through, training, cleanliness and protective clothing where required.

Support staff told us they felt supported to carry out their role and to develop further and that the registered manager was supportive and always approachable.

Medicines were managed and administered safely. We looked at how records were kept and spoke with the registered manager about how staff were trained to administer medicines and how this was monitored.

We found an effective quality assurance survey took place regularly and we looked at the results. The service delivered had been regularly reviewed through a range of internal and external audits.

We found people who used the service and their representatives were regularly asked for their views about the support through questionnaire and feedback forms.

People and their relatives were able to complain if they wished and were knowledgeable of how to complain or raise minor

The inspection team was made up of one inspector. During the inspection we spoke with the owner, four staff members out of 10, three people who used the service out of 15 and one relative.

We set out to answer our five 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. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

Is the service safe?

Care plans and risk assessments were in place and were updated as people's needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe and we saw a section in their care file stating ‘what I need to stay safe’ and to say whether they wanted to interview staff prior to commencing. Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

We looked at the recruitment of new staff. This showed that appropriate checks were carried out on staff before they commenced work. This helped to ensure the safety of people who used the service. We looked at the files for two people who had just completed their induction, there was no evidence in the files to show how the induction process went, if they were doing well or needed extra training or support.

There was additional information in each person’s care file such as how to access their property and locations of stop cock, gas and electric points and fuse boxes. The service did have a key holding and entry code policy, the policy said the key safe number would not be written down next to the service user’s address and would be held separately from the service user’s personal file. We saw evidence of the key code in a personal file which also contained their address.

Is the service effective?

People's health and care needs were assessed and where possible people and their relatives were involved in writing the plan of care. Care and support plans were reviewed and updated every six months. Daily records were left in people’s homes for three months before being collected and returned to the office. Therefore they could not monitor the record keeping on a timely basis and evidence that it was being completed correctly.

Is the service caring?

People told us that they were supported by kind and friendly staff. People who used the service and their relatives were asked for their views on the care and service provided via a questionnaire, we saw evidence of this at the office. Unfortunately the questionnaires were not dated so we could not be sure of when these had been sent out or received back. Where people had stated they had issues or ticked I disagree, there was no evidence of any action being taken.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. The care files included 'what is important to me' and 'who will help me make important decisions in my life.'

Is the service responsive?

We did see evidence of consent being obtained at assessment and then annually, following a review of care. The form for recording consent was not clear. There was also no consent to people accessing their property or using the key safe.

People were provided with information on how to make a complaint in the ‘service user’s guide’, one person we spoke with had made a complaint about six weeks ago to say no one had turned up, we could not see any evidence of this complaint. We looked at the complaints record and only one complaint was documented which was about the office phone not being answered, it stated what action had been taken but not an outcome as to whether the complainant was happy with the action. Verbal complaints were not recorded and the daily phone log did not have any information other than a phone number.

Is the service well led?

The service had a quality assurance policy which stated that they would complete quality audits and quality assurance checks with staff and clients. No quality assurance checks had taken place since 2013, spot checks on staff had been carried out but these were not dated so we could not evidence when they had taken place. During the spot checks it was ticked to say one carer was wearing a very strong and heavy perfume, there was nothing documented regarding this. The owner told us that another director had done some anonymous spot checks to see if staff turned up on time, stayed the correct amount of time and looked presentable, we asked to see these records but they were not documented. We were told the manager at the office rang the clients monthly to check if everything was fine, there were no records of these conversations.

There were no records of missed or late calls, therefore the service could not learn from events. Abacus did have a missed/late calls policy which stated ‘Abacus Care have an electronic call monitoring system in place whereby all staff are requested to log in upon arrive at a service user’s home and log out upon exit. This enables us to monitor and audit the provision of care and support to all service users’. We asked to see this but we were told this was something they were thinking of doing in the future. The policy also stated that missed calls are logged in our in house ‘agency system’ whereby any trends or patterns of missed calls and late calls can be followed up, we could not see any evidence of an in house ‘agency system’.

What people told us

During the inspection we spoke with three people who used the service, one relative of a person who used the service and four members of staff. People told us that they were very happy with the care and service received, one person said “They are very good and caring,” another said “The staff are very respectful and friendly, I feel happy in their presence and look forward to them coming,” and “They do a really good job, would be nice to have a male each day, to support with the lifting,” another person said “Everything is fine and rolling along alright.”

People also said “We get no contact from Abacus unless I call them,” and “Sometimes they are late, about 20 minutes, no one informs me,” and “I rang the office about six weeks ago as no one turned up,” and “Now and again I have a long wait but this could be due to an emergency.”

The relative we spoke with said “I am very happy with Abacus, they do their very best,” and “I have not complaints.”

Staff we spoke with said “I enjoy working here,” and “It is alright for now, everything is fine, they are a nice company to work for,” another said “I always get consent, it is natural to ask for it,” and “We get enough time to do the job, sometimes we may be there three quarters of an hour instead of half an hour, the travelling time is sometimes difficult, this is our own time and we do not get paid for this,” and “I sometimes do about 60 mile a week and get no petrol paid.”

One person said “I feel we need a supervisor, they are too far away in the office and no one is in charge, they do not see the client for six months.”

We spoke to three people who received care from the agency by telephone. All of those we spoke with were happy with the care they received. One person said the staff were “jolly and helpful”, they found the service “alright” and they confirmed they had no missed calls. We spoke with a relative of a person using the service who said that they were “very happy” they also said the staff were “reliable and polite”. They went on to say “it doesn’t matter what it is they are helpful and marvellous”.

We found people were given care, treatment and support that met their needs. People who used the service were also protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider could demonstrate that appropriate checks were in place regarding the recruitment and vetting of staff. There was an effective system in place to assess and monitor the quality of service.

The inspection took place on 7, 8 December 2015. The inspection was announced. This was because the service was small we needed to be sure that someone would be available so we could carry out our inspection.

Ascot Care is a Domiciliary Care service that provides personal care and support to older people who live in their own home. The service covers the Darlington area and currently provides supportfor 16 people.

The service had 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.

We spoke with a range of different staff members; the registered manager, care co-ordinator and care staff who told us that the registered manager was always available and approachable. Throughout the day we spoke with the people who used the service and staff were comfortable and relaxed with the registered manager and each other. The atmosphere was relaxed and we saw that staff interacted with each other and the people who used the service in a person centred way and were encouraging, friendly, positive and respectful.

From looking at people’s care plans we saw they were written in plain English and described individuals care, treatment, wellbeing and support needs. These were regularly reviewed and updated by the care staff and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: their GP, district nurse team and care managers.

Speaking to people who used the service and their relatives during our inspection showed us that people were supported in a person centred way by sufficient numbers of staff to meet their individual needs and wishes. The recruitment process that we looked into was safe and inclusive and people were matched to their own support staff.

When we looked at the staff training records we could see staff were supported to maintain and develop their skills through training and development opportunities. The staff we spoke with confirmed they attended a range of learning opportunities. They told us they had regular supervisions with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs.

We were unable to observe how the service administered medicines on the day of our inspection but we were able to establish how people stored and managed them safely in their own home. We looked at how records were kept and spoke with the registered manager about how staff were trained to administer medicines and we found that the medicines administering process was safe.

From speaking to people who used the service and their relatives during the inspection it was evident that the staff had a good rapport with the people who used the service. People give us positive feedback that showed us that the staff were caring, positive, encouraging and attentive when communicating and supporting people in their own home with daily life tasks, care and support.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Any DoLS applications must be made to the Court of Protection.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. We checked to see if the service had procedures in place to manage. At the time of our inspection no applications had been made to the Court of Protection. We found that the staff had not received any MCA or DoLS training and this was highlighted to the registered manager to action.

We saw a complaints procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had access to advocacy services and safeguarding contact details if they needed it.

We found that the service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service and their representatives were regularly asked for their views via an annual quality survey to collect feedback about the service.