Care Services Thirsk provides personal care and support to people who live in their own homes. The service supports people with a range of needs, including people living with dementia and people with complex health needs. The service works in partnership with health services such as district nurse teams and the community mental health team. The service currently provides personal care to 16 people.

This inspection took place on 26 October 2016 and was announced. This was a comprehensive inspection which provided a new rating for the service.

At our last inspection on 11 September 2015 we found areas of practice that required improvement. These were in relation to a lack of robust recruitment checks, poor record keeping and a lack of formal training. Following the inspection the provider submitted an action plan which detailed the action they would take to make improvements.

At this inspection we found that the required improvements had been made.

There was a registered manager in post at the time of our inspection. 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 told us that they felt safe and were confident that staff understood their needs and how to support them safely. We saw a number of examples where the service had helped people when there had been a problem or incident at home. There were sufficient numbers of staff to provide the care and support that had been agreed. Care staff were confident about how to protect people from harm and knew what to do if they had any safeguarding concerns.

The provider had introduced robust recruitment procedures to make sure staff had the required skills and were of suitable character and experience.

Risks to people had been assessed and plans put in place to prevent avoidable harm. An ‘out of hours’ service was in place so that people could contact a member of staff when the office was closed. Medicines were managed safely and people were supported to take medicines as prescribed.

Staff were trained by management in how support each person individually. People told us that staff were skilled and provided the support they needed, often going beyond the expectations of the care package to provide assistance. Staff received the training and support they needed to carry out their roles effectively.

There was an up to date policy in place regarding the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager and care staff understood their responsibilities under this legislation.

People were provided with the support they needed to maintain their health and well-being. The provider had established good links with other professionals, such as doctors and district nurses. The service took positive steps to involve healthcare services when concerns were identified.

People told us that they received good care which supported them in the way they wanted. The feedback we received was entirely positive. People said that they were always involved and informed about any changes or developments. People’s dignity was promoted and care staff provided a personalised service.

The provider had made improvements to the care planning documentation. There were clear and up to date plans in place which reflected people’s current needs and preferences. These were regularly reviewed with the involvement of the people concerned and their relatives.

Record keeping had improved since the last inspection. This included daily records such as medicine charts, as well as records relating to the management of the service, such as recruitment.

The registered manager and nominated individual were open and receptive throughout the inspection. A nominated individual

This inspection took place on 11 September 2015 and was announced. This was the first inspection of the service which was registered in April 2015.

Care Services Thirsk provides personal care and support to people who live in their own homes. The service supports people with a range of needs, including people living with dementia and people with more complex health needs. The service works in partnership with health services such as district nurse teams and the community mental health team. The service currently provides personal care to 10 people.

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

During the inspection we found a number of areas which required improvement. You can see what action we have asked the provider to take at the back of the full version of the report.

Recruitment procedures were not being followed and there was not a robust system for checking the backgrounds of staff before they started work. New staff had not provided references and decisions about their suitability for the role had been made on personal recommendation rather than written evidence. The lack of a robust process for checking that staff were ‘fit and proper’ placed people who used the service at risk of improper care or support.

Staff were trained by management in how support each person individually. People told us that staff were effective and provided the support they needed, often going out of their way to provide assistance However, there was a lack of formal training for staff. This meant that staff were not fully supported in their development and did not have opportunities to learn about wider areas of good practice.

There was a lack of records in relation to the care and support that people received. Most people did not have a copy of their care plan and some care plans had not been completed. Risk assessments were not always in place where risks to people had been identified. There was also an absence of records for training and supervision of staff. This presented a risk to people of receiving inappropriate care and treatment. Staff were also not fully protected should a complaint or incident arise about care practices with no records to refer back to.

The system for the administration of medicines required improvement. Although people received their medicines as required, there was a lack of information about the medicines administered, what they were for and any possible side effects. Care staff had not received formal training in medicine administration, although they told us they felt confident about what they were doing.

People told us that they felt safe and were confident that staff understood their needs and how to support them safely. We received a number of comments about how the service had helped people where there had been a problem or incident at home. There were sufficient numbers of staff to provide the care and support that had been agreed.

There was an up to date policy in place regarding the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had a clear understanding of the requirements of legislation related to capacity and DoLS.

People told us that they received good care which supported them in the way they wanted. The feedback we received was entirely positive. A repeated description of the service was that it “Went that extra mile”. People said that they were always involved and informed about any changes or developments. We found that people were well supported to maintain good health and that the service worked closely with other professionals to make sure that support was planned effectively. The service responded promptly to any changes in people’s needs and was pro-active in supporting people to access other services where needed.

The registered manager and registered provider were open and receptive throughout the inspection. They acknowledged that there had been an emphasis on making sure people received good care and support, rather than looking at the quality of recorded information, and that this was an area that required improvement. People, their relatives and other professionals all told us that they felt the service was well-led and there was good management. Staff told us that there was a supportive working atmosphere and that their main aim was to provide a personal and caring service.