What life is like for people using this service:

Improvements to the assessment of risks and implementation of plans to reduce these risks were needed in some areas for people to ensure their safety. Quality assurance processes were in place but needed some further development to ensure they were always effective in identifying areas for improvement promptly, as well as identifying trends.

People and staff were encouraged to provide feedback and make suggestions. People were supported by skilled and competent staff. People received their medicines safely and as prescribed.

People received compassionate support which met their needs from kind and caring staff. People had the developed meaningful relationships with the staff, which was helped by the registered manager ensuring consistency of staffing. Staff knew what was important to people and ensured people had support that met their needs and choices. People’s dignity and privacy were respected and their independence was promoted.

The registered manager was open and committed to making improvements.

Rating at last inspection: Requires Improvement (report published 15 May 2017)

About the service: 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 to younger and older adults. At the time of the inspection the registered manager told us they were providing personal care to approximately 150 people across Portsmouth, Hampshire and West Sussex.

Why we inspected: This was a planned inspection based on our last rating and aimed to follow up on some concerns we found in January 2017. In addition, we had received some information of concern prior to the inspection which we had asked the provider to investigate. We explored the areas of concern as part of our inspection.

Follow up: As the service remains rated as Requires Improvement, we will request an action plan from the registered provider about how they plan to improve the rating to Good. In addition, we will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly.

The inspection took place on 26 and 27 January 2017. We gave notice of our intention to visit BS Care Limited to make sure people we needed to speak to were available.

BS Care Limited is a home care service providing personal care services to people in their own homes in Portsmouth, Chichester and Hampshire. At the time of this inspection there were approximately 280 people who received personal care services.

There was a registered manager in place at the time of our inspection. 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.

Processes and procedures to ensure medicines were handled and administered safely were not consistently followed in all cases. Records did not always show people received their medicines at the right time and in accordance with their preferences. There had been periods where there were insufficient suitable staff deployed to make visits according to the agreed call rotas.

Records of people’s care were not always accurate and consistent. Reports used by the registered manager to monitor and assess the quality of the service were not always accurate and did not reflect concerns raised by people we spoke with.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting.

Staff received timely training and support to maintain and develop their skills and knowledge to support people according to their needs. Staff were aware of the principles of the Mental Capacity Act 2005 and of the need to obtain consent before supporting people. Where staff supported people by preparing their meals, this was done according to their preferences. People were supported to access healthcare services, such as GPs and paramedics.

Care workers had developed caring relationships with people they supported. People and their families were supported to take part in decisions about their care and support and their views were listened to. Staff respected people’s confidentiality, modesty, privacy and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. Processes were in place to make sure people’s care and support was in line with their plans. People were notified of the provider’s complaints procedure, and complaints were managed and followed up.

There was a caring, responsive ethos. Systems were in place to make sure the service was managed efficiently. People told us the care they received was flexible and responsive to their needs, but some raised concerns about the organisation and management of the service.

We identified two breaches of regulations. You can see what action we told the provider to take at the end of the full version of this report. We also made a recommendation with respect to people’s satisfaction with the timeliness of their calls.

As part of the inspection process we used an Expert by Experience to obtain the views of people who used the service. The expert spoke to 22 people. They spoke with 18 people who used the service and four relatives. People were happy with the care and support the agency provided. People told us that that the staff who supported them were punctual and stayed the correct length of time. They said staff were friendly and cheerful and treated them with dignity and respect.

One person told us. ‘They are very good and patient even though they are under a lot of pressure’. Other comments from people included: ‘The care workers are brilliant. They bend over backwards to do your wishes”. "They give me a sense of security when they come at night. I am 92 and live alone". A relative told us “They understand mum better than I do”.

We spoke with a member of staff from social services who told us that BS Care Limited provided a reliable timely service, with a low level of visits being later or early than planned. They said that they found high levels of staff training being completed and that the agency worked well with them.

We also spoke with the manager and nine members of staff. They all told us they were well supported by BS Care Limited. They told us training was good and they were provided with the information they needed to support people effectively.

We telephoned two people who used the service and spoke to two family members of other service users. Everyone we spoke to said they were happy with their regular care workers and gave us positive feedback about them. People told us their regular care worker knew their needs well and how they liked things to be done. A family member said about the care their relative received "it goes pretty well -- new staff need extra surveillance, but, on the whole we are satisfied with the service."

All the people we spoke to said that the agency arranged a replacement care worker when their regular care worker was away and almost all said that replacement care workers supplied were good. None of the people we spoke to, or their friends and families, said that they had ever had any concerns about the treatment they received from care workers. A service user told us "they are always polite." Another service user told us "they are very good, they always ask me what I would like."

We found that the agency considered people's individual needs and circumstances when providing care. The staff at the agency reported that they were well supported by the management team. We also found that the agency had policies and procedures in place to quality assure the services they provide to people.

People expressed satisfaction with the agency and care workers who visited them. They said that care workers treated them with respect and that they felt safe with the care and support they received.

Everyone said that they had been given a copy of their care plan. Some people said that they had regular contact with the agency to review their care and that they had completed questionnaires about the quality of service provided.

Most people that we spoke with said that they had a set of regular care workers who visited them.

Everyone said that usually care workers arrived on time for visits. They said that if they were going to be late they were usually informed of this.