We carried out an announced inspection of Ashcroft Homecare Limited on 24 and 25 July 2018.

Ashcroft Homecare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using Ashcroft Homecare Limited receives a regulated activity. The Care Quality Commission (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.

At the time of our inspection the agency was providing personal care to 38 people.

At the last inspection on 26 and 27 September 2017, we found a breach of the regulations relating to the provider’s failure to manage people’s medicines safely, a failure to recruit staff safely and a failure to effectively monitor the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service.

During this inspection, we found the necessary improvements had been made and the service was meeting all the current regulations.

At the time of our inspection, there was a registered manager 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 were happy with the care and support they received and made positive comments about the staff. They told us they felt safe and staff were patient, caring and respectful. People had developed positive trusting relationships with staff. Staff understood how to protect people from abuse.

People told us that they received support that reflected their individual needs and preferences. The information in people's support plans was sufficiently detailed and risks to their health and safety had been identified and managed safely. We spoke with the registered manager about how the information could be further improved. People's care and support was kept under review and they were involved in decisions about their care. Staff worked in partnership with relevant health and social care professionals when people's needs changed.

People considered there were enough staff to provide them with a reliable, flexible and consistent service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice.

The recruitment and selection processes had improved since our last inspection. Further improvements and a review of the recruitment policies and procedures were being undertaken. Arrangements were in place to make sure staff were trained and competent.

The management of people’s medicines had improved since our last inspection. Staff administering medicines had received training and supervision to do this safely. We discussed further improvements with the registered manager.

People had 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 respected people's diversity and promoted people's right to be free from discrimination; people's dignity and privacy was respected.

People's nutritional needs were monitored as necessary and staff knew their likes and dislikes. People told us they were happy and did not have any complaints but were confident they would be listened to.

The systems for assessing, monitoring and developing the quality of the service had been improved since our last inspection. Further improvements were being undertaken. People were consulted and their views were acted upon.

We carried out an announced inspection of Ashcroft Homecare Limited on 26 and 27 September 2017. We gave the provider 48 hours' notice because the service is small and we needed to be sure that someone would be available at the office for the inspection. We also wanted the registered manager to be present at the service on the days of the inspection to provide us with the information that we needed.

Ashcroft Homecare Limited is a domiciliary care provider located in Clitheroe, Lancashire and at the time of the inspection provided care and support to 35 people.

At the previous inspection on 22 and 23 March 2016 we found the service was not meeting all the standards assessed. The service was in breach of the regulations relating to the requirement to operate effective systems to check and improve the service and recommendations were made around supporting people with their medicines and assessing people’s care and support needs.

During this inspection we found that although there had been some improvements in the assessment of people’s care and support needs, the service was still in breach of regulations around the need to check and improve the service. There were continuing issues around safely administering medicines and other issues were seen relating to staff recruitment and overall governance of the service. This has resulted in breaches of the regulations and you can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in place who had been registered since 1 October 2010. 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 and were happy with the way they were treated by staff. They told us staff were caring and friendly. The registered manager and staff were observed to have positive relationships with people living in the homes we visited. During our visits we found staff were respectful to people and treated them with kindness. The atmosphere in each of the homes we visited was happy and relaxed.

There were sufficient staff deployed by the service to meet people's needs and staff received safeguarding adults training. Staff we spoke with demonstrated a good understanding of safeguarding practices and their immediate responsibilities with regards to safeguarding vulnerable adults. They were also aware of their responsibilities for reporting incidents and safeguarding concerns.

People were supported by staff who had the skills and training to effectively meet their needs. They also received support to maintain a balanced diet where this was part of their care plan and were supported by staff to access healthcare services where required.

People and relatives told us they had been consulted about their care needs and were involved in day-to-day decisions about their care and treatment. They told us staff treated them with kindness and compassion and respected their privacy. People had care plans in place which were reviewed periodically, in line with the provider's policy and improvements were noted in relation to the accuracy in the details of people's care planning.

Safe recruitment processes had not always been followed and had allowed a carer to be employed who may have been unsuitable to work with vulnerable adults. This was a significant issue which the registered manager was required to address.

Staff received regular supervision and an annual appraisal of their performance. They told us they felt well supported by the registered manager and worked well as a team. People and relatives spoke positively about the attitude and management of the service. The service sought the views of people through annual questionnaires and

We carried out an inspection of Ashcroft Homecare Ltd on 22 and 23 March 2016.

Ashcroft Homecare provides care and support for people in the Ribble Valley area. The range of services provided includes, personal care, domestic help and support. The service offers care and support for older people, people with a dementia, adults with physical disabilities and sensory impairment. The aim of the service is, ‘To provide care workers to service users, in their own homes, to assist and support individuals and organisations in promoting health, maintaining/and or improving independence.’ The service's office is located in the centre of Clitheroe and is open between 9 am and 5 pm. There is an out of hours emergency contact service. At the time of the inspection the service was providing care and support to 26 people.

The service was managed by 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.

At the last inspection on 8 October 2014 we found the provider was not meeting requirements relating to staff training and staff supervision. We received an action plan from the provider indicating they would meet the relevant legal requirements by February 2015. At this inspection we found sufficient action had been completed to make the required improvements.

During this inspection we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the provider not having effective systems in place for checking and improving the service. You can see what action we told the provider to take at the back of the full version of this report.

We found some further improvements were needed to provide people with safe care and support. Therefore we have made a recommendation about ensuring risks to people’s well-being and safety are properly considered. We have also recommended the service improve their practice on safely supporting people with their medicines.

People we spoke with told us they were satisfied with the service provided by Ashcroft Homecare Ltd. One person told us, “We would be very pleased to recommend them.”

People we spoke with indicated they felt safe with the service. Staff spoken with were aware of the signs and indicators of abuse. They knew what to do if they had any concerns and were confident in reporting matters. Staff had received training on safeguarding and protection.

Arrangements were in place to maintain staffing levels to make sure people received their agreed care and support.

We found the service was working within the principles of the MCA (Mental Capacity Act 2005).

Processes were in place to support and encourage people to make their own decisions and choices.

People made positive comments about the staff team including their caring approach and attitude. They said, “They are friendly,” “They are respectful” and “They offer support and reassurance.” Staff expressed a practical awareness of responding to people as individuals and promoting their rights, privacy and choices.

Arrangements were in place to gather information on people’s backgrounds, their needs and abilities, before they used the service. People were aware of their care plans and said they had been involved with them and the ongoing reviews. However we made a recommendation on making sure care records respond to people’s individual needs and choices.

Processes were in place to monitor and respond to people’s health care needs. Staff spoken with described the action they would take if someone was not well, or if they needed medical attention. People were supported as appropriate with food and drink.

There were systems in place to ensure all staff rece

We carried out this inspection as we had received some concerning information about the service. This was primarily in relation to a lack of staff training and unsafe staff recruitment practices.We therefore focused our inspection on checking whether the provider was meeting legal requirements in accordance with the associated regulations.

However, following the inspection we received further concerning information on various matters, including missed visits and ineffective medicine management practices. We were concerned about these matters and therefore raised safeguarding alerts with the local authority.

The inspection team consisted of one inspector. During the inspection we spoke with the registered manager and a director. We reviewed records in relation to staff training, development and recruitment. We considered all the evidence we had gathered under the outcome we inspected.

This is a summary of what we found:

We found proper arrangements were not in in place to train new employees on their role and conduct when they started work at the service.

Suitable arrangements were not in place to ensure staff received appropriate training and development, in relation to their responsibilities and care delivery.

We found attention had not been given to ensuring the proper checks and appropriate records were kept to protect people who used the service from unsuitable staff.

A compliance action has been set in relation to these matters and the provider must tell us how they plan to improve.

During the inspection we spoke with three people using the service, two relatives and two members of staff. We also discussed all matters relating to the inspection with the manager at our visit to the office.

Some people were able to tell us they had been involved in planning their care and support and had agreed to the service provided. They felt the support met their needs and therefore agreed and consented to it. Some had signed their care plan to indicate their agreement. One person said, "Oh yes I understand my care plan". A relative said, "Everything was explained very well".

People also told us they were very satisfied with the service and that all the carers were reliable, kind and caring. Those we spoke with made the following comments: "She (the carer) does everything kindly and with respect", "They (the carers) lift my day; I look forward to them coming", "They are all kind friendly people", "Excellent, very reliable" and "We are very satisfied with all of them". We found carers assisted people appropriately with their medicines. One person said, "They remind me to take my pills".

We found staff support systems had improved since the inspection in June 2012, and this helped them look after people properly. There were more training opportunities, better induction training for new staff and more staff meetings.

People could give their views about the agency and their support through formal and informal service reviews and through survey questionnaires.

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 as 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 Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We carried out telephone interviews with ten people using the service, and their main carers (relatives or friends) and visited two people at home, to gain their views about the service. We visited the office to look at records and talk to the person in charge. We also talked to two members of staff.

People using the service with whom we spoke said care workers always treated them with respect and called them by their preferred name. One person said, "My care worker is marvellous and treats me properly". One relative said, "We couldn't have a nicer care worker; he is very sensitive and respectful".

People also told us they felt they had sufficient choices in the care provided. They had been involved in the setting up of their care, and had been offered choices in having a male or female care worker and in the times of the visits.

Overall people using the service told us they were highly satisfied with the service. One person said, "It's a great firm; I recommend it". Another said, “I am very fortunate and happy about the care service and support I receive". One relative said, "No problems whatsoever, no complaints, very satisfactory up to now". People also told us the service was reliable and with good continuity and consistency of care with a group of care workers who were known to them.

People using the service told us that they felt that the service was meeting their needs and one person said that they felt their service was “excellent”. People felt the service was reliable, and flexible enough to cope with some changes to the routines. They also told us that the carers were “very nice and presentable” and “easy to get on with”. The people that we spoke to said that they had the same carers for support and this continuity of support was important to them.

Two people however highlighted that some new inexperienced members of staff did not appear confident and knowledgeable when they first started work.

We were also told that service users felt involved in the setting up and development of their service and that they were listened to.

People felt that the manager was approachable and accessible and would contact her if they were not happy with something.