Ascot Care was inspected on 16 October 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because we wanted to make sure key staff would be available to speak with us.

Ascot Care is a domiciliary care service situated in Horsham, West Sussex. It provides personal care to adults living in their own houses and flats in the community. At the time of the inspection, they were providing a service to 46 people. Not everyone using Ascot Care receives the regulated activity of personal care; 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 consider any wider social care provided.

The service had two registered managers. One registered manager was present at the inspection. The other registered manager was also the owner of the service. 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 the last inspection on 19 October 2016 the service was rated good. At this inspection there had been a decline to requires improvement. People were not consistently safeguarded from abuse. The registered managers had not identified two allegations of potential abuse from complaints made by people who use the service.

The provider’s quality assurance systems did not always identify areas of practice that require improvement. People’s care records did not always contain person centred detail and identified risks were not always reflected in people’s care plans. Several of the provider’s policies and procedures were not effective in providing staff with suitable guidance.

Risks to people were assessed and mitigated. Staff had a good understanding of infection control and had been provided with appropriate equipment to support people safely. There were safe systems in place to manage, administer, store and dispose of medicines. A relative told us, “They are very good about any changes that the doctor makes or additions to the medicines and they keep me informed.”

People's needs were assessed before they used the service and regularly thereafter. 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. Staff understood people's needs and preferences. Staff received training to support the needs of people using the service. People were assisted to eat healthy and balanced diets.

People told us they felt well cared for. People received kind and compassionate care and support. One person told us, “They are caring, kind and approachable making the visits a social occasion.” People and their relatives were encouraged to share their views of the service. People's privacy and dignity were respected.

Staff were responsive to people's needs. Staff knew people well and spoke about their routines and preferences in detail. Care was delivered with a person-centred approach. One person told us, “They are engaging and very person centred.” People received dignified end of life care.

People and staff were involved in the running of the service and staff worked well with other healthcare professionals to meet people’s needs. A health care professional told us they felt the service was well managed through the conversations they have with staff.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 and one of the Care Quality Commission Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 19 October 2016 and was announced. The provider was given 48 hour’s notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us.

Ascot Care is a domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people and people living with dementia. At the time of our inspection 46 people were receiving a care service, with an age range between 36 to 99 years old.

The service had two registered managers. 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 last inspected on 28 October 2015. We found areas of practice which required improvement. This was in relation to concerns around care staff had not received training on the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). There was not a robust quality assurance framework in place. The provider was unable to demonstrate how they internally monitored, reviewed and assessed the quality of the agency. The provider drew up an action plan as to how they would address these issues. We looked at the improvements made as part of this inspection. At this inspection we found the provider had followed their action plan, improvements had been made and issues identified had been rectified.

People told us they felt safe, that staff were kind and the care they received was good. One person told us “Absolutely feel safe. From the beginning they are really good. I consider (staff names) to be someone I can thoroughly trust. They both are”.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff at all times to meet people’s needs.

The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. People were supported to maintain good health and had assistance to access health care services when needed. One person told us “If I need to go to the dentist or the optician they will take me”.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.

Staff felt fully supported by the registered managers to undertake their roles. They were given training updates, supervision and development opportunities. One member of staff told us “We have regular training and updates. One of the managers holds training sessions in our team meetings. We recently went over medication again”.

People’s needs were assessed and regularly reviewed and they received care based upon their needs and preferences. Staff were proactive in recognising and supporting changes in people’s needs. We found the care plans to be person centred and details recorded were consistent.

People and relatives told us that staff were kind and caring. Comments included “They are intelligent, nice caring people and very conscientious” and “I’m absolutely delighted with them, they really are first class”. People confirmed staff respected their privacy and dignity. Staff had an understanding of respecting people within their own home and providing them with choice and control. People were suppor

We inspected Ascot Care on the 28 October 2015 and it was an announced inspection. Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available. Ascot Care is a domiciliary care agency providing personal care and live in care workers for a range of people living in their own homes. These included people living with dementia, older people, people with a physical disability and people with a learning disability. At the time of our inspection, the service was supporting up to 47 people and employed 39 members of staff.

A registered manager was in post. 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, relatives and staff spoke highly of the service. Relatives confirmed they would recommend the agency and people felt confident in the skills and ability of their care workers. One relative told us, “Absolutely, we can’t fault them they are so kind and helpful.” Another relative told us, “I don’t think we would manage without Ascot Care. They are very worthwhile.”

Training schedules confirmed care workers had not received training on Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider also failed to have policies and procedures in place regarding these pieces of legislation. Where people had bed rails in place, bed rail risk assessments had not been completed and the provider was unable to demonstrate if the person had consented to their freedom being restricted or not. We have identified this as an area of practice that needs improvement.

A robust quality assurance framework was not in place. The provider was completing quarterly audits for the local authority but was not undertaking their own internal audits to demonstrate how they assessed, reviewed and monitored the quality of the agency and identified where standards were falling. We have made a recommendation for improvement in this area.

There were sufficient numbers of care workers available to make sure people’s needs were met. Care workers had permanent regular schedules of calls so that people received care from a consistent team. Each week, people were sent a rota informing them who would be visiting next week and the times of their care calls.

Systems were in place to protect people from abuse and harm and care workers knew how to use them. Care workers understood the needs of the people they were supporting and had received training on safeguarding adults. People commented they felt safe with care workers entering their home. One person told uh, “I know I feel safe because my carers will do anything for me, they all have good training.”

People were protected by robust recruitment procedures and new care workers had induction training which included shadowing more experienced care workers, until they were competent to work on their own. Care workers had core training and more specialist training, so they had the skills and knowledge to meet people’s needs.

Placing people first was at the core of Ascot Care. The provider demonstrated outstanding flexibility and ability to deliver person centred care. There was a real focus on improving the quality of lives for people. Risks of social isolation was minimised and the provider had strived to create strong links with the local community. Care workers supported people on social outings, to tea dances and to the local RAFA (Royal Airforce Association) club.

The culture within the service was transparent, personalised and open. The registered manager led by example and care workers spoke highly of their leadership style. Two care workers were up for the South Coast carer of the year award and the registered manager understood the importance of recognising care workers achievements.

People confirmed care workers respected their privacy and dignity. Care workers had a firm understanding of respecting people within their own home and providing them with choice and control. The agency had identified people’s needs and preferences in order to plan and deliver their care. Mechanisms were in place to review people’s packages of care and care plans to ensure the level of support was still meeting their care needs. One person told us, “ One of the carers especially is very initiative, they go that bit extra with their job.”

On this occasion we did not speak with people the agency provided a service to.

We spoke with the manager and general manager. They described the new quality assurance and monitoring process for incidents and complaints that had been put in place since our last inspection.

We looked at three months of incident and complaint records, starting from September 2013. We found that a monitoring and auditing system was in place. This was underpinned by a new policy.

The manager and general manager told us that the process helped them to be more robust. They told us, “The process enables us to capture things clearly and to take action”.

As part of this inspection we carried out telephone interviews with people who used the service and their family members. We spoke with two people who used the service and two relatives of people who were unable to speak to us directly. They all spoke positively about the service they received.

All of the people we spoke with told us that they felt they were treated with respect. People told us the care and support was consistent and delivered in a manner that met their expectations. One person said, “They are very good in comparison to other care agencies I have used”.

We looked at the care records of four people who used the service and found their needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A family member told us that the care staff provided, "Go the extra mile".

Care staff told us they were supported to understand their role through induction training and shadowing colleagues on visits. Three of the people that we spoke with told us that care staff were, “Always on time”. A family member told us the agency, “Have never let me down”.

We saw that any concerns raised by people or their relatives were addressed by the manager in a timely manner and people and their families were invited to discuss comments further.