The inspection took place on 22 and 25 May 2018 and 15 June 2018 and was announced. This was the first inspection of the service since it was registered in March 2017.

Burton Home Care is a domiciliary care agency. It provides personal care to older adults and younger adults living with a disability people living in their own houses and flats in the community. At the time of the inspection the service was providing 350 hours of support to 32 people.

Burton Home Care was managed by a person who was registered with the Care Quality Commission as the provider and registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service was not always safe because risk assessments, did not consistently provide the information and guidance staff needed to understand and minimise risks, particularly when people were at risk of choking. This concern was discussed with the registered manager and field care supervisor. They responded by reviewing all risk assessments and care plans, and amending them where necessary to ensure their accuracy and help keep people safe.

There was a risk that people’s rights were not protected because they had been assumed to have the capacity to make decisions about their care. However, their capacity assessment, information in their care records or feedback by family members suggested this may not be the case. In addition consent forms had not always been signed, where people had been asked to consent to the support being provided and information being shared. We discussed this with the registered manager and field care supervisor who responded by reviewing all of the capacity assessments and consent forms to ensure they were correct and people’s rights were protected.

There were systems in place to regularly monitor the service and make improvements where necessary. This included regular audits of care records, which had not identified some of the issues we found. We discussed this with the registered manager and field care supervisor who then carried out an audit of all care records and were considering how their quality monitoring processes could be more effective. Although, there was a positive and immediate response to the concerns raised and action was taken, more time is needed to allow the changes to become embedded into practice.

Other quality monitoring processes included feedback from the people using the service and the staff supporting them, and unannounced spot checks of staff practice. In addition an electronic monitoring system allowed office staff to monitor visit times and duration and ensure people were supported in line with their care plans. The management team themselves provided hands on care, and knew the people using the service well. This provided additional opportunities to ask people about the quality of the support they were receiving.

People told us the service was well run, and praised the management team and all the staff. The management team had learnt from their experience as care workers for larger companies, and, although the registered manager was increasing the level of service provision, they planned to keep the service small so that the quality of support could be maintained. One person said, “If there was an award for care companies there is only one care company that would be up there.” The registered manager had an open and transparent management style, and welcomed the feedback given during the inspection. They were committed to learning from any mistakes and acted immediately to address the concerns raised.

Staff told us they felt well supported. They received regular supervision and attended quarterly staff meetings where they were able to express their views about the development of the servi