The inspection took place on 26 November 2018 and was announced.

Blessings Healthcare provides personal care to people who live in their own homes. The service is provided to both younger and older people who may have a physical disability or be living with dementia. On the day of the inspection 30 people received the regulated activity of personal care.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were safeguarded from the risk of harm and abuse. Potential risks to people had been assessed to minimise the risk of harm. There were sufficient staff to provide people with their care safely. People received their medicines as required, from trained and competent staff. Staff ensured people were protected from the risk of acquiring an infection during the provision of their care. Processes were in place to ensure any incidents were reflected upon and relevant changes made for people's future safety.

People were cared for by staff who had received appropriate training, support and supervision in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to eat and drink sufficiently for their needs. Staff supported people to see a range of healthcare professionals in order to maintain good health and their wellbeing.

People consistently reported they were treated in a kind and caring manner by staff. People were supported by staff to express their views and to be involved in decisions about their care. Staff ensured people's privacy and dignity were upheld and independence promoted during the provision of their personal care. People's human rights were respected and supported.

People received personalised care which was responsive to their needs. People were supported to access activities and hobbies if this was required. People's concerns and complaints were encouraged, listened to and relevant action taken in line with the providers policy and procedures. The provider did not support anyone at the end of their life at the time of inspection but staff were trained in this area.

The provider had governance processes in place. People and staff were encouraged to be actively involved in the development and continuous improvement of the service. The provider had quality assurance systems in place. Staff had worked effectively in partnership with other agencies such as GPs, pharmacies, social workers and mental health professionals to promote positive outcomes for people.

This inspection took place on 22 September 2016 and was announced. Blessings Healthcare limited provides domiciliary care services to people who live in their own home. At the time of our inspection there were 20 people with a variety of care needs, including older people and people living with dementia using the service.

We last inspected in January 2014. At the January 2014 inspection we found that the provider was not meeting all of the requirements of the regulations at that time. The provider had not ensured staff had the training and support they required to meet people’s needs. People’s needs were not always assessed and their views were not always being acted upon. At this inspection (September 2016) we found the provider had taken appropriate action.

There was a registered manager in post. The registered manager was also the provider 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.

People received safe and effective care which enabled them to live in their own homes. People and their relatives praised the care staff and spoke positively about the care they received. The care people received was personalised to their needs. People and their relatives felt involved in their care and spoke positively about the relationships they had with staff.

People told us they felt listened to and could not fault the care they received. People were cared for by care staff who were supported by the registered manager and provider. Staff had access to professional development. The registered manager and provider knew the needs of staff and had systems to ensure staff had access to the training and support they needed.

The registered manager and provider had systems to monitor the quality of service people received. The systems enabled the registered manager and provider to identify concerns and drive improvements.

People who used the service were generally positive about the care provided. One told us, “I’ve been using the service for a short period of time. Usually the same person or people turn up. They seem to know what they’re doing and I have been very pleased so far”. We found that one person who had begun receiving care from the service on 17 December 2013 had neither had their needs assessed by the service nor had a care plan produced for them six weeks later. We also found that only two staff in the service had received any training in managing medical appliances which four people who used the service required. This meant that their care needs were not being met by the service.

We found that the service had an effective staff selection process in place and that that the provider had taken steps to ensure that suitable staff were recruited by the service.

The registered manager and staff told us that the service was understaffed. One care worker told us “No. We definitely don’t have enough staff. Although there are gaps in between calls, I will be out working for more than 12 hours today”. We found that there were insufficient care staff and that that not all care workers were suitably qualified, skilled and experienced to meet people’s needs.

We found that the service had systems in place to monitor care standards but that not all were being used effectively. This meant that there may have been an increased risk of unsafe or inappropriate care being provided.

On the day of our visit the provider was delivering home care services to five people, two of whom required end-of-life care, one who required personal care, and two who required cleaning services. We were met by the registered manager and later joined by the proprietor.

We found that people were being asked for their permission to have care provided to them, and had the right to refuse care. We also found that the provider had a proper understanding of mental capacity issues.

We looked at the care and welfare of people who used the service and found that they and their relatives were happy with the level of care they were receiving. We also found that a proper system of care planning and management was in place.

We found that staff were properly trained in safeguarding people from abuse, and were prepared to report any instances of abuse even if this involved close colleagues.

We found that there were appropriate staffing levels in the service for the current level of demand, although we did have concerns about how the provider would cope if staff left or demand increased.

We found that the provider did not currently have a formalised and structured system of monitoring and assessing the quality of the service.. However, because of the small number of people who used the service and the ‘hands-on’ management approach we were satisfied that the provider was able to maintain an acceptable level of quality assurance.

At the time of the inspection we found that the provider only delivered care to one person and therefore we did not seek their views directly as anything referred to would identify them. We did seek evidence of compliance through other means in this instance.