We carried out this inspection on 5 April 2017. We told the provider 48 hours before the visit we were coming so they could arrange for staff to be available to talk with us about the service.

Barnfield Care Agency is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the agency supported approximately 70 people with personal care.

People who used the service had a variety of care needs. Some had 24 hour live in care staff, some had very complex needs with several care calls a day and others required one call a day.

The service has a registered manager who was also the provider. 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 our last inspection in September 2015 we found there was a breach of the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. The breach was because although the registered manager was investigating concerns of alleged abuse, they were not always reporting these through the appropriate channels. At this inspection we found the registered manager had taken the action they said they would take, and had reported any safeguarding concerns to the local authority and to us.

People were supported by a consistent group of care workers who arrived at the times that were agreed. People who used the service said they felt safe with their care workers and relatives were confident their family members received safe care. Care workers demonstrated a good understanding of how to manage individual risks to people’s health and wellbeing and checked equipment was safe before they used it. Care workers understood their responsibilities to report any concerns about people’s health or safety to their managers. Checks were carried out prior to care workers starting work to ensure their suitability to work with people who used the service.

People and their relatives said that care workers had the skills and knowledge to meet their needs consistently and effectively. Care workers felt confident in their roles because they received appropriate training and support.

People told us care workers were exceptionally kind and thoughtful and relatives spoke overwhelmingly about their kindness and caring attitude. Care workers were allocated sufficient time to carry out their calls and had time to talk to people as they didn’t have to rush. Care workers understood the importance of maintaining people’s privacy and dignity when delivering care and encouraged and respected people’s independence.

The registered manager understood the principles of the Mental Capacity Act (MCA), and staff respected people’s decisions and gained people’s consent before they provided personal care.

Care workers had a good understanding of people’s individual needs and how to respond to them. Care workers were encouraged by the registered manager to be flexible and to respond if people wanted things to be done differently or at different times.

Care workers helped people manage their health and well-being if this was part of their care plan or they had any concerns. They accompanied people to healthcare appointments if required. Where care workers supported people with their medicines, people told us it was done safely and as prescribed.

The registered manager had a ‘hands-on’ approach and was clearly very well known to, and respected by people who used the service and their relatives. They described her as approachable and receptive. Care workers were universally positive about the registered manager, their leadership, their practice and how they supported people and staff.

The registered manager regularly checked p

We carried out this inspection on 28 September 2015. We told the provider 48 hours before the visit we were coming so they could arrange for staff to be available to talk with us about the service.

Barnfield Care Agency is a domiciliary care agency which provides personal care support to people in their own homes. At the time of our visit the agency supported approximately 80 people with personal care. People who used the service had a variety of care needs. Some had 24 hour live in care staff, some very complex needs with several care calls a day and others required one call a day.

The service has 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.

People and their relatives told us they felt safe using the service. Care workers had a good understanding of what constituted abuse, however referrals were not always made to the local authority when safeguarding concerns were raised

There were processes to minimise risks to people’s safety; these included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Checks were carried out prior to care workers starting work to ensure their suitability to work with people who used the service.

Staff understood the principles of the Mental Capacity Act (MCA), and care workers gained people’s consent before they provided personal care.

People who required support had enough to eat and drink during the day and were assisted to manage their health needs, if this was part of their care plan.

Most people had consistent care workers who mainly arrived on time and completed the required tasks. Care workers received an induction and a programme of training to support them in meeting people’s needs effectively. People told us care workers were kind and caring and had the right skills and experience to provide the care and support they required. Care workers supported people with dignity and respect.

Care plans and risk assessments contained relevant information for care workers to help them provide the personalised care people required. People knew how to complain and could share their views and opinions about the service they received. Staff were confident they could raise any concerns or issues with the registered manager knowing they would be listened to and acted on.

There were processes to monitor the quality of the service provided and understand the experiences of people who used the service. This was through regular communication with people and staff, surveys, checks on care workers to make sure they worked in line with policies and procedures and a programme of other checks and audits.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

When we visited Barnfield Care Agency, we spoke with the registered manager, (who was also the provider) and one person who used the service. Following our visit we gathered evidence of people's experiences by telephoning 10 more people who used the service. We also telephoned three care workers. Speaking with these people helped answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We inspected this service previously on 14 August 2013 and identified improvements were required in the quality of the service’s records. There were concerns that some people’s care records were not accurate. We found the provider had made changes since our previous inspection and improvements had been made in this area of concern.

We saw people’s care records accurately reflected their care needs. We found people had appropriate risk assessments in place that made sure any risks were managed. We found people’s care records were regularly evaluated and reviewed by senior staff.

People we spoke with told us they felt safe using the service. One person told us, “I feel completely safe in their care.” Staff understood how to safeguard the people they supported.

We found evidence that learning took place from incidents and investigations within the service and appropriate changes were implemented to improve the service.

Is the service effective?

People told us the care they received met their needs. People told us they had been involved in planning the care they received.

Staff we spoke with had a clear understanding of the needs of the people they supported and what they told us was reflected in people’s care plans.

We spoke with staff and found they felt supported by their manager. They told us they felt their manager listened to them and they could raise any issues.

Is the service caring?

We spoke with 11 people who used the service and they were all positive about the staff who supported them. For example people told us; “I feel quite relaxed. I feel I can depend on them”, “They were recommended to me”, and “I couldn’t have a better care agency. I know I can ring and ask for extra help.”

Staff we spoke with were positive about their role as carer and enjoyed their job.

Is the service responsive?

We found people were asked for their views about their care and these were acted on. We saw the provider's latest customer quality survey results from March 2014.The results of the survey were good. We found that the any issues raised, were responded to by the manager.

People told us the service was flexible and they could contact the care office at short notice and request changes to their care. One person told us, “I have two or three regular carers and they have all been really good. I can contact them (the service) and ask for changes, for example a longer call.”

People told us that care staff noticed when their needs changed and took action. People received help and support from other health professionals when required, such as GPs and district nurses.

Is the service well led?

We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service people received.

People who used the service and staff told us they were able to speak with the manager and felt able to raise any issues or concerns they had. We found evidence that improvements had been made to the service following investigation of any concerns.

When we visited Barnfield Care Agency, we spoke with the registered manager, (who was also the provider), two care workers and a senior care worker. We read the care records for three people who used the service. We gathered evidence of people's experiences by telephoning eighteen people who used the service, after our visit.

People we spoke with were positive about the care they received. People told us that care staff had the right training and that their knowledge and skills were adequate. One person told us that they, “Liked the carers we have, they are helpful.” They told us that, “The manager is fantastic.” Another person told us that, “They are very good.”

We found there was no policy concerning people giving their consent to care they received and there were no consent documents on people’s care records. However people who used the service told us that they were treated with respect and given choices. One person told us, “They are wonderful carers. They are very polite to me and always speak in a caring manner.”

We found that care staff were aware of safeguarding procedures and knew how to keep people safe. People who used the service and their relatives told us they felt safe.

We found that some people’s care records including medical records were not accurate.

We followed up this regulation as our July 2012 inspection to this provider identified some concerns which related to the completeness of people’s records. We did not speak with people using the service during this inspection as our aim was to review random records belonging to people using the service to ascertain whether the provider was now compliant with this regulation.

Although, we have found some information was still missing from the electronic ‘client contact sheets’ we noted that otherwise the records we reviewed were complete. We informed the manager of the information gaps we found and asked that people’s contact sheets be audited and fully completed. This was confirmed by email as completed by the provider the day after our inspection.

We did not speak with people using the service during this review of compliance. We visited the agency to check the provider had taken the necessary steps to ensure records about care delivery to people were being maintained up to date and stored safely. This was because when we visited Barnfield Care Agency in May 2011 we found that, although information they held about people was secure, up to date records about people's care were not available at the agency office. We also found that care plans which provided guidance to staff about the care and treatment to be given to people were not being updated promptly. Because of this the provider could not be sure that care given by staff was consistent with people's current care needs.

To inform our findings from our visit to Barnfield Care Agency we spoke with three relatives, two people using the service, four care workers and the manager.

People using the service and their relatives told us they had been happy with the care provided through the agency. Two peoples’ comments about their care and the staff were: ‘’ Care is extremely good’’ and ‘’They're lovely! Think they are great, really good!’’ People told us they had been able to air their views, which were respected and had been listened to.

People told us they had been involved in agreeing their care package, felt safe and would raise any concerns with either their care worker or the manager. People said their care worker had taken them out into the local community to visit local garden centres and go on shopping trips.

We spoke with one person using the service and read the comments from people made in the Satisfaction Survey undertaken by the provider during March 2011. 64 surveys had been sent out and 44 returned.

People said that care provided was of a 'good standard' and they were 'very happy' with the service.

Other comments that we read in the survey included;

'A great relief to know I am so well looked after.'

'A very acceptable service.'

People told us they felt very' safe' when care was being given and that staff listened to them and asked them about how they would like to be cared for.

Other comments about staff included;

'I am looked after very well.’

'All carers friendly and very helpful.'

‘Staff always check what I eat & drink. They know this is important.'

One person had a concern about some of the information recorded in their family members care notes. They had felt the comments were not respectful. The provider has since dealt with this concern and we did not read any inappropriate comments in the records we looked at.

Another person commented that staff sometimes 'missed appointments' however they stated also that an explanation was always given if a staff was late getting to them.

The person we spoke with told us said that they always received the care they expected from the agency. They told us, 'Barnfield staff have helped my well being improve, they always meet your needs'