This inspection took place on 5 and 22 November 2018 and was announced.

Care A La Carte is a domiciliary care service and provides the regulated activity of ‘personal care’ to people in their own home specifically specialising in providing care staff to people requiring live-in care and support. The service acts as a referral and support service where care staff are recruited, but are self-employed and are matched with people who require this level of support. At the time of this inspection the service was working with 34 people who were receiving care and support from care staff that the service had placed with them.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

People and their relatives told us they felt safe when receiving care and support from the care staff allocated by the service. Care staff demonstrated a good understanding of safeguarding and the steps they would take to protect people from possible abuse.

Risk assessments detailed people’s individual risks associated with their health and care needs and gave clear guidance on how to reduce or mitigate the risks in order to keep people safe.

The service followed appropriate medicines management and administration processes which ensured people received their medicines safely and as prescribed.

Recruitment of staff was a rolling process as the service needed to ensure they always had sufficient numbers of staff to meet people’s needs. Recruitment processes in place ensured that only those staff assessed as safe to work with vulnerable adults were recruited.

The service carried out an assessment of need for each person so that the service could determine whether they had the appropriate staff to be able to meet the person’s needs effectively.

Lessons were learnt from incidents and accidents to minimise a re-occurrence. Staff were supported and trained to undertake their roles.

People were appropriately supported with their nutrition and hydration needs to ensure they maintained a healthy and balanced diet. Where people had specialist dietary requirements these had been incorporated into their care plan and delivery.

People were routinely supported to access a variety of health and social care services or where there was an identified need or concern.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their relatives confirmed that they were treated with dignity and respect and that care staff were kind and caring with whom they had developed positive relationships.

People were involved with the planning and delivery of their care and where appropriate relatives had also been involved in the process. Care plans were person centred and responsive to people’s needs.

People and their relatives knew how to make a complaint and were confident their concerns would be resolved.

People, relatives and staff commented positively about the registered manager and how the service was managed.

There was an open and transparent culture at the service. People received care that was focussed on meeting their individual needs.

Regular audits and checks were carried out on the quality of care people received.

Further information is in the detailed findings below.

This inspection took place on 8 March 2016 and was announced two days before the visit to ensure that the manager was available. We also carried out visits to two people using the service on 16 and 17 March 2016.

Care a la Carte is a domiciliary care agency registered to provide personal care to people living in their own homes and primarily provides live-in care staff to people on a self-employed basis. At the time of our inspection 40 people were receiving a personal care service, and the agency had 75 care staff on its books.

The service had a registered manager. 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.

People were happy with the live-in care workers supporting them, and described a high standard of personalised care.

We found that people were kept safe and free from harm with risk assessments in place to address relevant issues. There were enough staff on the agency's books to meet people’s needs and to provide a flexible service. Staff training and systems were in place to ensure that the Mental Capacity Act 2005 was followed with people’s consent recorded as appropriate.

Staff undertook regular training and were knowledgeable about their roles and responsibilities. They received regular supervision, and support from office staff including spot checks of their work.

Staff knew the people they were supporting and provided a flexible and responsive service. Detailed care plans were in place detailing how people wished to be supported. People spoke highly of the support staff provided and had formed good relationships with them. When incidents occurred, these were clearly recorded, and learning was taken forward.

When needed people were supported to eat and drink, and to attend health care appointments. Systems were in place for staff to administer their prescribed medicines safely. Where needed staff supported people to maintain their independence skills.

People told us that the management were accessible and approachable, and that they felt able to speak up about any areas for improvement. There were regular checks in place to review the quality of the service provided to people, and monitor satisfaction, with plans put in place to address areas for improvement.

We gathered information about the quality of service provided by speaking with three relatives and three care workers, we viewed care records of three people who used the service and staffing records of four care workers. We viewed additional records and policies relevant to the treatment and care provided by the agency. The agency specialises in providing live-in care workers to people who used the service, the majority of people funded their own care and paid the care workers directly.

People who used the service received appropriate care and support that met their individual needs and enabled them to stay independent. Relatives spoke highly about the care workers. One relative told us that without the care worker the person would not be able to continue to stay independent and another relative told us, "The carers genuinely care, are easy to talk to and are very supportive."

There were processes in place to protect people who used the service from harm and abuse.

Care workers provided appropriate information and were vetted, which ensured that people who used the service were protected from unsuitable staff.

There were systems in place to monitor the quality and safety of the service and accurate and appropriate records were maintained.

We spoke with two people who used the service and two people's relatives. One person's comments were representative when they told us, "the agency has been absolutely brilliant." Everyone we spoke with felt that they were in complete control of their care and that their needs were fully met. Care plans contained detailed information and were regularly updated to reflect changes in people’s needs.

Staff demonstrated the knowledge and skills needed to protect people from abuse. In relation to the care staff one person said, "I think they are superb." A relative we spoke with said "They're the best we have had." New staff received appropriate training and support to enable them to deliver the care to people that they needed. Staff had received regular individual supervision from a manager. The provider had ensured that staff were appropriately supported to deliver care to people.

The provider had an effective system in place for handling concerns and complaints.