We inspected Bespoke Home Care on 15 November 2016. It is a domiciliary care service that provides personal care and support services for a range of people living in their own homes. These were predominantly older people and some people were living with dementia. At the time of our inspection, 39 people were receiving a care service.

As part of this inspection, we checked what action had been taken to address the breaches of legal requirements we had identified at our last inspection on 21 October 2015. We found areas of practice that required improvement. There was not a robust quality assurance framework in place and systems were not in place for reviewing, monitoring and assessing the delivery of care and support. We also found employment procedures were not robust. The provider had not always obtained all the information required such as references from previous employers. Therefore, the provider could not be assured these staff were suitable and safe to undertake their role. After our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. We looked at the improvements made as part of this inspection. At this inspection, we found improvements had been made and sustained and all the breaches previously identified were addressed.

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.

People felt safe when staff supported them in their own homes. Systems were in place for staff to follow which protected people and kept them safe. People and their relatives told us they felt safe, that staff were kind and the care they received was good. One relative told us, “Yes, we feel safe with them in the house I can just leave them with him. I trust them and have no concerns.”

There were 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 provider made sure there was enough staff at all times to meet people’s needs.

People were supported by staff that were familiar to them for the most part. One person told us, “We do have different carers and they are very nice and polite and if there is a new one they are introduced to us,” Care calls were monitored by the office team to make sure staff arrived on time and stayed for the agreed amount of time. Checks were completed on potential new staff before they started work to make sure they were suitable to support people living in their own homes.

Staff had the skills and knowledge to understand and support people's individual needs. These skills were kept up to date through regular training and staff were also supported in their roles by managers and colleagues.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. Staff asked people's permission before they helped them with any care or support. People's right to make their own decisions about their own care was supported by staff. One relative said, “They encourage [named person] to use the walking frame which she likes to do if she can.” People were supported by staff who knew them well and were caring in their approach. A member told us, “We give plenty of time for those needing a lot of care; an hour or more sometimes and if we think someone needs more time because they are unwell, the office do listen.” Staff made sure people were involved in their own care and listened to what people and their relat

Bespoke Care Ltd is registered to provide support to people living in their own homes who need help with their personal care. At the time of the inspection there were 85 people using the service. The majority of people using the service were older people, some of whom had physical disabilities and some were living with dementia.

This comprehensive inspection took place on the 2 and the 21 October 2015. We gave the provider forty-eight hours’ notice to ensure management and staff would be available to speak with. This was the first inspection since the service re-registered following a change of address.

The service had a registered manager. 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.

We undertook this inspection earlier than initially planned so we could follow up on concerns we had received that the service did not employ enough staff to complete the calls they were contracted to fulfil. We had also been told that some people had experienced missed care calls and sometimes staff arrived late and left early. However our findings did not support what we had been told. We found the provider did employ sufficient numbers of staff, where ever possible action was taken to avoid late or missed calls and staff did stay for the full duration of the calls they were contracted to undertake.

The provider obtained feedback from people about the service provided on an on-going basis and dealt with concerns and complaints as they arose. However robust systems were not in place for reviewing, monitoring and assessing the delivery of care and support. The provider was not undertaking their own internal audits, therefore they were unable to demonstrate how they monitored and identified if standards were falling and improvements were needed. The absence of a robust quality assurance framework meant the provider had not identified and taken corrective action to address errors in the MAR (Medicine Administration Records) charts.

Employment procedures were not robust. Identity and security checks had been completed before new staff started work. However the provider had not always obtained all the information required such as references from previous employers. Therefor the provider could not be assured these staff were suitable and safe to undertake their role.

The registered manager and provider had failed to fulfil their legal responsibilities to notify the CQC of incidents where they suspected abuse may have taken place. Whilst action was taken to rectify this issue, it is an area of practice that needs to be embedded into every day practice.

People, relatives and care workers spoke highly of the service, the management and staff. One person told us they were “Completely satisfied” and that the staff were “very good”. People described staff as being kind, patient and considerate. One person told us “I’m happy with the carers. They are caring and very genuine.” Another said, “Each one who comes in has always been polite and friendly. I’m happy with the carers.”

When we asked staff what the philosophy of the service was, one staff member told us “To make sure the elderly are being cared for, its very family orientated it’s about caring for people as you would want other people to care for your nan”.

People’s privacy and dignity was respected. Staff had a firm understanding of respecting people within their own home and providing them with choice and control. People said the service met their needs and encouraged them to be as independent as possible. People were asked for their views of the service and complaints and concerns raised had been responded to promptly.

People confirmed they felt safe with the staff. Systems were in place to protect people from abuse and harm and staff knew how to use them. Where concerns had been identified these had been passed to the local authority for them to consider under safeguarding.

Staff knew the people they were supporting and were aware of their personal preferences, likes and dislikes. One person told us “They are very good and always find out how I feel”. A staff member told us “I love the job and my clients, I want to really make a difference to their lives and I think I do that”. Care plans were in place detailing how people wished to be supported and people and or their representatives were involved in making decisions about their care. They were supported with their healthcare needs and staff liaised with their GP and other health care professionals as required.

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. They felt supported within their roles, describing an ‘open door’ management approach, where the registered manager and management team were available to discuss suggestions and address problems or concerns. One member of staff told us “It’s brilliant I can just pop in the office whenever if you have any concerns or need anything. I’ve had some feedback about how I am doing and was told that I have had lots of compliments from clients which is really nice to be told this”. Another staff member told us “It’s a lovely place to work, the clients are all great and I love caring for them”.

The registered manager and provider, along with senior staff provided good leadership and support to staff who delivered care to people. They understood the needs of the people well and accommodated people’s preferences.

We identified two areas where the provider was not meeting the requirements of the law. You can read what action we have told the provider to take at the back of the full version of the report.