This inspection was carried out over four days and included a visit to the office on 26 April 2018 and interviews on the telephone covering three days on the 24 April and 2, 3 May 2018. Our visit on the 26 April gave the provider just 24 hours’ notice to make sure staff were available at the office for the inspection. At the last inspection on 21 September 2016 we rated the service as requires improvement overall. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to, supervision of staff and effective governance systems.

This inspection was to check satisfactory improvements had been made and to review the ratings. The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations. At this inspection we found improvements to the service and the regulations were met.

Bridge Care Services is a domiciliary care agency that provides support to people who live in their own home, both older people and some younger adults with disabilities. They provide a service throughout the Stockport area to people who have a service commissioned via the local authority and to people who are privately funded. The office is situated in the centre of Marple on the first floor of an office building. The office did not have a lift or disabled facilities. However, the registered manager advised they would always make arrangements to see people in their own home to meet their needs.

A registered manager was in place. 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.

We received positive comments from relatives and people receiving support. Overall, they were very positive about the service provided with lots of opinions made about how staff got to know them and provided very personal care and support.

The registered manager had systems in place to monitor the quality of the service. Governance systems had been developed to show appropriate management and review of the service.

Staff were given appropriate support through a programme of training and on-going supervision, and an annual appraisal. Staff said the training provided them with the skills and knowledge they needed to do their jobs.

Staff were aware of their responsibilities in keeping people safe and had received training in safeguarding adults. Staff responsible for supporting people with their medicines had received training to ensure they had the competency and skills required.

The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers.

People told us that staff usually arrived on time, and they generally had no issues about staff turning up for duty. The service had a monitoring system that continually checked the promptness of their visits and could take action, if staff were running late for any reason.

Support plans contained up to date, information about each person’s care and support. The registered manager used a variety of methods to assess and monitor the quality of the service. They carried out a regular checks and visits to each person to make sure the care and support was a good standard and met each person’s needs.

There was a complaints procedure in place. The majority of people who used the service told us they knew how they could raise a complaint if they needed to and had no hesitation to approach staff about any issues.

This inspection took place on 21 September 2016 and was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the location office when we visited.

Bridge Care Services is a domiciliary care agency that provides support to people who live in their own home, both older people and some younger adults with disabilities. They provide a service throughout the Stockport area to people who have a service commissioned via the local authority and to people who are privately funded. The office is situated in the centre of Marple. At the time of our inspection 122 people were receiving support from the service.

The service is required to have a registered manager, and at the time of our inspection there was 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.

The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. There were some gaps in paper copies of risk assessments held in the office, but these were available on the computer system.

The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers.

People that we spoke with told us that staff usually arrived on time, or within the 15 minute timeframe allowed for the start of the care visit. On occasions when there was staff sickness other care staff covered their care visits. People told us that on the rare occasions staff were running late, or there was a problem, someone from the office would usually phone them to let them know.

Where staff supported people with their medication, we found that this was accurately recorded on medication administration records. Staff had received training in administering medication and the registered provider periodically observed staff competency. This showed that there were systems in place to ensure people received their medication safely.

Staff completed a range of training to help them carry out their roles effectively, and this was refreshed annually. Action was being taken to ensure staff who were overdue their refresher training completed this.

People were supported to maintain good health and access healthcare services. We saw evidence in care files of contact with other healthcare services, such as district nurses, GPs and the anticoagulant clinic. People were also supported with their nutritional needs, where this was part of their care plan.

People told us that the staff who supported them were caring and that they felt involved in decision making about their care. People also reported that they felt their privacy and dignity were respected. Staff we spoke with demonstrated a caring and empathic approach towards the people they supported.

Everybody who used the service had a care plan, which contained information about people’s needs and routines. Staff also demonstrated an understanding of people’s individual needs and preferences. However, some people’s annual care review was overdue, which meant that the registered provider had not consistently ensured that all people's care plan was up to date.

There was a complaints procedure in place and the majority of people who used the service told us they knew how they could raise a complaint if they needed to, and that they would feel comfortable doing so. People and staff told us t

We spoke with two people who used the service. We also spoke with three relatives. They all told us that they were happy with the support they received from the agency. One person told us; "I couldn't praise them enough. The carers and the managers are excellent." A relative said; "They have been a great service and we would have no hesitation in recommending them. The district nurses say what excellent care my husband gets."

We looked at safeguarding arrangements and found that there were procedures in place and the staff were trained in recognising abuse in vulnerable adults.

We looked at the systems in place for supporting staff and found that the service followed all of their procedures. The staff received regular support, supervision and training.

We looked at the complaints procedure and saw that this was available for people to access. We also looked at records and saw that they were completed and stored appropriately.

We visited the office premises of Bridge Care Services and spoke with the operations manager of the service. During our visit we looked at the care files of four people who used the service. All the care files were found to have all the information required to assist the care workers in meeting the needs of the people who used the service. We also looked in depth at the personnel and supervision files of two care workers and a number of others in less detail. The personnel and training files contained copies of references and showed that checks had been made to make sure as far as possible that only honest and trustworthy people were employed.

We visited three people who used the service in their homes and spoke with one carer during one of these visits. We also spoke with three family members and two care workers by telephone in order to obtain their views and opinions of Bridge Care Services.

Some of the comments we received were; "I feel safe and the staff respect my dignity". "I told them (the agency) that I did not want a male care worker and they have respected this". "I am happy with the notes made by the care workers they let me know what is going on; I also leave the staff notes". "I have had no reason to complain but if I did I have telephone numbers of people who I can contact". "I think the agency does a good job and I am pleased with them".

We were told by everyone that the care workers had never missed a visit and usually arrived on time.