This inspection of Blue Ocean Services took place on 9 January 2018 and was announced. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. Not everyone using Blue Ocean Services receives a regulated activity; 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 the inspection 51 people were using the service.

The service had 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.

At the last inspection on 25 February 2016, the service was rated Good. At this inspection we found that the service had not met all the regulations we inspected. We found breaches of regulation in relation to safe care and treatment, good governance and notifications of other incidents and the service has therefore been rated Requires Improvement.

The registered manager completed individual risk assessments for people. The risk management plans helped guide staff in minimising risks for people. However, we found risk management plans were not always sufficiently detailed.

Care plans were person centred and contained information about people's backgrounds and needs so staff could support them in ways they preferred. Plans contained instructions for care workers about what to do on each visit. However, we found care plans did not always contain people’s assessed needs for staff to care for people in an effective way.

Medicines were administered to people as prescribed. Staff received training to administer medicines and had their competency assessed to ensure they continued to do this safely. However, medication administration records were not always completed accurately.

Accidents and incidents were logged as were the actions to mitigate them happening again. However, we found that on some occasions that actions to reduce the risk of this recurring had not been fully implemented.

The registered manager did not always fulfil the requirements of their registration with CQC. They did not always notify us of safeguarding concerns as required by law.

The service was monitored and reviewed to ensure the care provided was of good quality. However, we found some areas of the service were not of good quality because the quality assurance systems were not effectively used.

Enough staff were available to care for people. Staff were allocated to people to provide care and support to them, where necessary two care workers were provided.

Safer recruitment processes ensured suitably skilled staff were employed to work with people. Checks were carried out on staff before they were approved as suitable for employment.

There was a safeguarding policy in place and staff regularly attended safeguarding training. Care workers understood what whistleblowing meant and said they would contact the registered manager to inform them if they had any concerns about the quality of care.

The registered manager supported staff through training, supervision and appraisal. Staff discussed the challenges and rewards they experienced while working with people. Staff reflected on and took action to improve their practice.

The principles of the Mental Capacity Act 2005 (MCA) were followed by the registered manager and staff. MCA training was made available for all care staff. People were supported to have maximum choice and control of their lives and staff provided care in the least restrictive way possible for people. The policies and systems in the service support

This inspection took place on 25 February 2016 and was announced. Blue Ocean Services is a domiciliary care service that provides personal care for people living in their own homes. At the time of the inspection, 60 people were using the service.

The service had 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.

At the last inspection on August 2014, the provider had not met all the regulations we inspected. The provider did not manage people’s medicines safely and we issued a compliance action. We asked the provider to take action to make improvements and to send us an action plan. We did not receive this.

However, at this inspection, we found the provider had met the all the regulations we followed up on and inspected.

People had their medicines as prescribed. Staff had an awareness of the appropriate management of medicines. The registered manager completed medicine audit checks of medicine administration records (MAR) to ensure safe administration.

Staff demonstrated awareness of the signs of abuse and took appropriate actions to report an allegation of abuse. Staff identified risks to people and plans were in place to monitor and manage them. The provider’s safeguarding policy gave staff guidance on how to protect people from abuse.

People were cared for by sufficient numbers of staff to meet people’s needs. Staff had a weekly work rota that held the details of people they were providing care. Recruitment processes in place ensured the employment of suitably skilled staff to work safely with people. The registered manager carried out appropriate checks before staff worked with people.

The registered manager arranged support for staff. Staff received regular supervision, appraisal, and training to support them in their caring roles. The registered provider had a training programme and systems in place to ensure staff completed all mandatory training.

The registered manager and staff demonstrated their understanding of the requirements and their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People gave staff their consent to care and support and a record made of this in their care plan.

Staff members shopped and provided meals for people on a regular basis, which met their needs and preferences.

Staff supported people to access health care services and professionals when their needs changed or required this service. Staff referred people to health and social care professionals for additional support or equipment to meet that need. Staff provided a service to people, which was flexible and responsive to their needs.

People were treated with kindness and compassion by staff. People told us that staff provided care to them in a thoughtful and considerate manner.

People and their relatives had an opportunity to make decisions about the way in which they received care. The registered manager had a system in place to empower people to be involved in and making informed care choices.

People had their care needs met by staff who respected them. People told us and records showed that staff had delivered care which, demonstrated staff respected their privacy whilst retaining their dignity. People had care delivered in their home and had privacy when they wished.

People had assessments of their needs completed and they were encouraged to contribute to them. The registered provider had systems in place to ensure people had regular reviews of their care needs.

People had an opportunity to complain about the service or aspects of their care if they were dissatisfied. Staff provided people with a copy of the complaint procedure that was included in the service user’s handbook.

The registered manager provided clear leadership and support to staff in order to deliver their roles effectively. The registered manager maintained an overview of the service because they were involved in the arrangements for the delivery of care.

The registered manager informed CQC of incidents at the service that required notifying.

The provider had a system in place for people to give feedback on the service. People and their relatives had opportunities to give their views about the quality of care. The registered provider monitored, reviewed, and made improvements to the service delivery and quality of care.

One inspector carried out this inspection. During the visit we gathered evidence to 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?

Is the service safe?

Care was planned and delivered in a way that ensured people’s safety and welfare. Care records were complete with risk assessments and risk management plans in place for people where required.

Medicines were not always managed appropriately for people. Records for medicine management were not always complete and medicine audits were not carried out. Therefore errors in medicine management could not be identified or action taken to reduce risks.

Is the service effective?

Before people received any care they were asked for their consent and the provider acted in accordance with their wishes. The provider knew their responsibilities in accordance with legal requirements where people did not have the capacity to consent.

Is the service caring?

The majority of carers we spoke with told us that they enjoyed working with people they cared for. The majority of people we spoke with told us, their carer was helpful and supported them as they needed.

We saw in care records that people were encouraged and supported by carers to attend social activities outside their home.

Is the service responsive?

There was a complaints policy in place for people and this information was located in the service users’ guide. This was provided to people when they started receiving care from the service. At the time of the inspection, there were no current complaints made to the service. We saw records of how previous complaints were managed and a response provided to the complainant.

Is the service well led?

The provider had systems to assess and monitor the quality of service that people received. This included obtaining feedback from people using the service in an annual survey.

The majority of the people we spoke with told us they were happy with the service they received.

There was evidence that staff learnt from incidents that took place and that appropriate changes were implemented as a result of the learning. For example, staff bring carers logs to the office promptly so that errors or complaints could be dealt with in a timely manner.

During our inspection we spoke with eight people using the service or their relatives or carers. We looked at nine sets of care records, and spoke with five members of staff, including the registered manager.

People were not always involved appropriately in making decisions about their care and support.

We saw examples of care plans which reflected the assessment of people’s needs and detailed the tasks care workers were expected to carry out, with information about how people should be supported. However, care plans did not always reflect the assessment, and sometimes care was not being delivered in line with the care plan. Risk assessments were not always complete.

Care workers were trained in assisting people with taking their medication. There were appropriate recruitment processes for new staff.

Although we saw evidence that some monitoring of service delivery was taking place, some people we spoke with said there were no checks that the service was meeting their needs. The service did not always take action to address complaints made by people using the service. We did not see evidence of quality checks of people's care records.

During our inspection we spoke with five people using the service and family members. We looked at six sets of care records, including electronic records, and spoke with six members of staff, including the registered manager.

People’s privacy, dignity and independence were respected. Staff and people using the service told us that they were involved in choosing how and when their care was provided and how they wanted things done. People we spoke with were satisfied with the service and their carers. One person said, “they are very good carers, you can’t fault them, I would recommend them”. Another person said, “I am extremely pleased. My carer is always cheerful, he chats to me, I have a very pleasant relationship with him, and he’s respectful. I enjoy his company and he’s efficient”. Office staff and managers were described as having a good manner.

People’s needs were assessed and care was planned and delivered in line with their individual care plans. Care plans and associated risk assessments were personalised and had been reviewed and updated regularly to ensure that the care provided continued to meet people’s needs appropriately and safely.

The provider had an effective system to regularly assess and monitor the quality of service that people received, and took account of people’s feedback to improve the services the agency provided.