This inspection took place on the 22 November 2016 and was announced.

Care @ Home Newbury Ltd is a domiciliary care agency which provides staff to support people in their own homes. People with various care needs can use this service including people with physical disabilities and older people. At the time of this inspection 14 people received care from this service.

At the last inspection on 5th August 2014 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as requires improvement in areas such as ineffective recruitment procedures, lack of assessment and monitoring of the quality of the service and appropriate training and supervision of staff.

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 2008 and associated regulations about how the service is run.

People and their representatives told us that they felt safe with staff and would be confident to raise any concerns they had. The provider’s recruitment procedures were thorough and medicines were managed safely. There were sufficient staff to provide safe, effective care at the times agreed by the people who were using the service.

There were procedures in place to manage risks to people and staff. Staff were aware of how to deal with emergency situations and knew how to keep people safe by reporting concerns promptly through processes that they understood well.

Staff received an induction and spent time working with experienced members of staff before working alone with people. Staff were supported to receive the training and development they needed to care for and support people’s individual needs.

People and their families were mostly complementary about the services provided. The comments we received demonstrated that people felt valued and listened to. People were treated with kindness and respect whilst their independence was promoted within their homes and the community. People received care and support from familiar and regular staff and would recommend the service to other people.

People’s needs were reviewed regularly and their care and support plans promoted person-centred care. Up to date information was communicated to staff to ensure they could provide the appropriate care and support for each individual. Staff knew how to contact healthcare professionals in a timely manner if there were concerns about a person’s wellbeing.

The provider had a system to regularly assess and monitor the quality of service that people received and identified areas for improvement.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an announced inspection.

Care@Home Newbury Ltd is a small domiciliary care agency which provides support with personal care to people in their own homes. There were nine people with a range of different care needs using the service at the time of our inspection.  

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At inspections in April and September 2013 we found breaches of the regulations for the recruitment of staff and monitoring the quality of service. At our last inspection on 4 December 2013 we found the provider had taken action and the requirements of the regulations were met.

Staff did not have a good understanding of the Mental Capacity Act (2005) and recruitment procedures were not robust. The provider did not have adequate plans in place to manage any unexpected emergencies. Although people told us thought staff were well trained, the provider had not ensured that care workers had received adequate training while working for the service.

While the provider had completed a satisfaction survey with people who use the service, there were no other quality monitoring procedures in place. Although the provider sought regular feedback from people in an informal way, they did not record this information. The provider was not taking steps to identify possible shortfalls which may help them improve the service.

The provider ensured people were supported to eat and drink when needed, and knew what to do if they thought a person was at risk of malnutrition or dehydration.

People who use the service gave consistently positive feedback about the care they received. The registered manager and nominated individual knew the people they were supporting and provided care in a personalised way. People were supported to express their views and preferences about the care they received.  

People had regular reviews of their care and they, and those who were important to them, were involved. People knew how to make a complaint but no-one had needed to.

The management team of the service were stable and they promoted an open culture among staff. There was an appropriate incident and accident process in place for staff to follow. No incidents had been reported recently.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.  You can see what action we told the provider to take at the back of the full version of the report.

During this visit we reviewed action taken to address concerns we found at our previous inspection. We spoke with the registered manager, who provided the majority of care to people who use the service, and the service's director.

The provider had implemented a new recruitment policy to ensure that their recruitment procedures met legal requirements.

We saw that the service had a system for identifying risk in relation to the care people received. Care plans contained risk assessments.

The manager informed us that the five people who use this service were unable to communicate using the phone. We spoke with two relatives of people who use the service, a care worker and the manager during this inspection.

We found the service had undertaken appropriate checks on a new member of staff before they began work. The service provided a new member of staff with an induction which included experience in caring for people who use the service alongside an experienced care worker. The service provided the new member of staff with training to ensure they had the skills necessary to care for people safely.

The service had implemented monitoring systems since our last inspection. The service had completed analysing results from a survey on people who use the service. There was a training monitoring system in place. People and staff told us the manager asked them for their feedback and considered people's opinions in how to improve the service.

We found the service's system for identifying, assessing and managing risks related to the care people received was inadequate. People were not protected from the risks of inappropriate or unsafe care.

We spoke with one person who uses the service and three relatives. People told us the care delivered by this service met people's needs, promoted independence and care workers respected people's privacy and dignity. One relative said a care worker for this service always encouraged their relative to undertake tasks independently where they were able. Another relative told us a care worker and their relative had "a great rapport." People told us the service responded to changes in people's care needs. The relatives we spoke with said the service worked with health and social care professionals when appropriate to plan people's care.

Although people we spoke with were satisfied with the service and response to people's care needs, they said there was no periodic monitoring of the care they received and they were not aware of a process by which they could provide feedback.

We saw the quality monitoring folder however this contained no recent documents on the monitoring of the service or recent feedback from people who use the service.

Staff files contained relevant information regarding recruitment and some training certificates. However not all the information required under Schedule Three was available.