The inspection took place on 20 and 21 September 2018. The inspection was announced.

At the last Care Quality Commission (CQC) comprehensive inspection on 19 and 20 January 2016, this service had an overall rating of Good.

At this inspection, we found the evidence continued to support the rating of Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Blossoms Care Service Ltd DCA, on our website at www.cqc.org.uk

This service is a domiciliary care agency. Blossoms Care Services is a care agency that provides care services to people in their own homes and people living in supported living accommodation. Not everyone using the service receives a 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 administration of medicines. At the time of the inspection the service was providing support to 68 people, in the Isle of Sheppey, Sittingbourne, Faversham and the Swale area. The service can provide a range of visits to people, from one to two hours per week, up to several visits per day. Support is primarily given to older people, people with learning disabilities, people with sensory impairment, and people with mental health difficulties. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge. The support provided aims to enable people to live as independently as possible.

Staff enabled people to use assistive technology to support people to be as independent as possible. They had initiated and led projects to help people move from residential services, where they had previously required constant staff supervision, to allow them more privacy and independence in their own homes or supported living services. Staff were available and easily accessible nearby. Staff and the management team had an understanding of managing risks and had supported people that had previously challenged services to reach their full potential.

There was a registered manager at 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 and associated Regulations about how the service is run.

The service provided care and support to people enabling them to live fulfilled and meaningful lives. Staff were skilled at ensuring people were safe whilst encouraging them to reach their potential and live independent lives. People and their relatives were overwhelmingly positive about the service they received. One person said, “The carers are ok, nice and they do help me. They support me and are helping me to maintain my independence. I am working towards getting my own house and recently staff have started helping me to take my own medicines”.

The service continued to have suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the registered manager, the managers of services or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.

Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood the processes to follow and knew who to contact, if they felt a person’s normal freedoms and rights were being significantly restricted.

The management team involved people in planning their care by assessing their need

The inspection was carried out on 19 and 26 January 2016. We gave short notice of the inspection because the registered manager was often out of the office supporting staff and some of the people using the service were often out at their daily activities. We needed to be sure that they would be available to speak with us.

Blossoms Care Services provides a domiciliary care service which provides personal care and support to people who are living in their own home. At the time of the inspection the service was providing support to 57 people, in the Isle of Sheppey, Sittingbourne, Faversham and the Swale area. The service is able to provide a range of visits to people, from one to two hours per week, up to several visits per day. Support is primarily given to older people, people with learning disabilities, people with sensory impairment, and people with mental health difficulties. Blossoms Care Services provides supported living services to people in their own home. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge. At the time of the inspection the service was providing support to 22 people, in a range of supported living houses. The support provided aims to enable people to live as independently as possible. Blossoms Care Services also provides a day service currently for 12 people.

The service provided care and support to people enabling them to live fulfilled and meaningful lives. Staff were skilled at ensuring people were safe whilst encouraging them to reach their potential and live independent lives. People and their relatives were overwhelmingly positive about the service they received. Comments included, “Staff are caring individuals, they care for the person they are looking after and it is genuine”, and “I would recommend this service, the staff are very caring”.

There was a registered manager at 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 and associated Regulations about how the service is run.

The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the registered manager, the managers of services or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.

Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood the processes to follow and knew who to contact, if they felt a person’s normal freedoms and rights were being significantly restricted.

The registered manager and managers of the services involved people in planning their care by assessing their needs on their first visit to the person, and then by asking people if they were happy with the care they received. There was a strong emphasis on person centred care. People were supported to plan their support and they received a service that was based on their personal needs and wishes. The service was flexible and responded positively to changes in people’s needs. People were able to express their opinions and views and they were encouraged and supported to have their voices heard within their local and wider community.

The registered manager and managers of the services carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the service and the individual person concerned. Some pe

We spoke with the registered manager, the general manager, the human resources manager, and one of two home care managers. We looked at twelve sets of records for people who used the service, ten personnel files, staff training records, the service's satisfaction surveys and policies and procedures. We spoke with six people who used the service and two of their relatives.

During this inspection, the inspector focused on answering five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us.

- Is the service safe?

We found that people who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw that all staff were trained in the safeguarding of vulnerable adults, that the training included the principles of the Mental Capacity Act 2005 and refresher courses were scheduled. All staff had been subject to Disclosure and Barring Services (DBS) checks before they started work. We found risk assessments with clear action plans were in place to ensure people remained safe. People's consent to care and treatment was sought appropriately and people's records were kept securely.

- Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. People who used the service commented, "I was given all the information I needed at the start, it was very thorough" and "The staff and I worked together on a plan that suited my needs in my own home". We looked at some people's assessment of needs and support plans and we checked with people who used the service that the delivery of care was in line with their care plans and assessed needs. We found that care was appropriately delivered and that set goals were determined. Blossom's staff had received training to meet the needs of people who used the service.

- Is the service caring?

We found that people who used the service were supported by kind and attentive staff. A member of staff told us, "I am delighted to be working for such a caring organisation; it is so rewarding to help people and see that all my colleagues have the same approach". One person who used the service said, "The carers are absolutely wonderful; they go the extra mile and I only have praise for their professionalism and caring attitude". Another person commented, "The care workers listened and offered empathy when I was going through a period of bereavement".

- Is the service responsive?

People's needs had been assessed before care and support began and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's care plans included their history, wishes and preferences. People and/or their representatives were involved with reviews of care plans and they were kept informed of any changes. People's views were sought about the quality of care that they received and their views were taken into account. A person who used the service told us that staff had listened to them and were respectful of the decisions they had made. Staff were listened to and their suggestions were considered and implemented.

- Is the service well-led?

We found that comprehensive policies and procedures were in place that addressed every aspect of the service. Policies were updated regularly and staff were made aware of the updates. The registered manager and owner oversaw a system of quality assurance to identify how to improve the service. People and their relatives or representatives were regularly consulted about how the service was run and annual survey questionnaires were sent, collected and analysed. Staff told us they were encouraged to express their views at team meetings or at any other time and that they were listened to. Two members of staff told us, "We are encouraged to talk about how things really are and discuss any changes we feel would benefit people" and "I am delighted to be working for such a caring organisation". Staff's practice was regularly observed and monitored to identify whether additional training or refresher courses were needed.

We carried out a visit to the head office in Sittingbourne, and viewed documentation as well as talking with management staff. We also talked with some Social Services care managers.

We saw from reading support plans that people’s views were taken into account with all of the planning about their support and care needs. Their consent was obtained before any support or care was carried out.

We found that support plans contained comprehensive information, so as to enable staff to provide the exact care required by the individual people.

The service demonstrated that there was good ongoing liaison with other providers of health and social care so as to assist people with meeting their care needs through different services.

We found that there were reliable processes in place to enable people to take prescribed medication accurately.

The agency had robust staff recruitment processes in place, and a detailed induction programme.

We saw that people were enabled to voice any concerns or complaints, and their views were taken seriously. The records showed that appropriate action was taken to address these and to develop improved services as a result.

A Social Services care manager stated that “Comments about the agency at care reviews tend to be very positive.”

The inspection visit was carried out by one Inspector over the course of three and a half hours. We (i.e. CQC) obtained people’s views by reading comments in the comments and complaints records, and by viewing survey forms and records of quality assurance phone conversations.

People’s comments included:

“My support workers do everything I ask them to do. They look after me and are the best carers I have had.”

“The staff work very well and are a brilliant team.”

“I am very happy with the current support. No problems.”

“I am happy with the service provided.”