This inspection activity took place on 28 August 2018 and was announced. We gave the provider 48 hours' notice that we would be visiting the service. This was because the service provides domiciliary care to people living in their own homes and we wanted to make sure staff would be available in the office.

Care and Support Solutions is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults some who may be experiencing mental health problems. At the time of the inspection 11 people used the service.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in June 2016. 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.

The last inspection of the service was carried out in June 2017 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We found concerns relating to risks to people arising from their health and support needs and medicines were not administered safely. Audits were not effective enough to highlight the concerns we found. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of: Is the service safe and is the service well-led to at least good.

At this inspection we found that sufficient improvements had been made to say that the breach of regulation had been met.

We looked at the systems in place for medicines management and found that improvements had been made. Medicines were now audited monthly and people were receiving their medicines as prescribed.

Risk assessments had now been implemented and reviewed where required. They provided staff with sufficient information to manage and reduce risks where possible.

The registered manager now completed audits. However, some records needed further detail to make them person centred.

People were supported to receive care from the agency following an assessment. This covered all aspects of the care required by the person. Such as how many calls they would need each day, what their needs were in relation to mobility, continence and personal care, moving and handling and nutrition.

Staff had received safeguarding training and appropriate policies and procedures were in place. Staff were able to explain the action they would take if they suspected abuse.

Recruitment checks were in place and demonstrated that people employed had satisfactory skills and knowledge needed to care for people. All staff files contained appropriate checks, such as two references and a Disclosure and Barring Service (DBS) check.

There were sufficient numbers of staff employed. People received support from a consistent team of staff who were familiar with their needs.

Staff had received training and supervisions to ensure they had the skills and knowledge to carry out their roles. Staff were encouraged to develop their skills through continuous training.

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 signed consent to acknowledge they had read and understood the support they were to receive.

Staff supported people to maintain a healthy balanced diet.

Care plans provided enough detail to enable staff to support the person in a way the person wished. We found some care plans needed more work to make them person centred.

People were complimentary about staff and told us that they were treated with kindness and consi

We inspected this service on 21 June 2017. We informed the registered manager that we would be inspecting the service before our arrival to ensure that someone would be in the office. This meant that the provider and staff knew we would be visiting before we arrived. This was Care and Support Solutions first inspection since they registered on the 28 June 2016.

Care and Support Solutions is a service which offers care and support to people with physical, mental and learning disabilities. Support is provided to people in their own homes and within in the community. At the time of inspection 11 people were being supported with personal care.

The service had a registered manager who was also the provider. 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. This service had not been previously inspected by the Care Quality Commission.

Care records identified risks to people, however care plans did not direct staff on how to minimise these risks. Where people required assistance with their medicines we found that this was not always done safely. Medication and care plan audits did not highlight the concerns we raised.

When we spoke with people who used the service they told us they felt safe with the care workers who provided their care and support. We saw that there were good systems in place for the safe recruitment of staff, and the care workers we contacted were aware of their responsibilities in protecting people from harm, and knew how to report any concerns about people's safety or wellbeing.

People told us the staff responded to their needs and provided care in the way they wanted it to be provided. Having a small and dedicated staff team meant that people who used the service had the same group of staff the majority of the time, which was important to them and made them feel safe. Staff told us that they had enough time with people to meet their assessed needs.

People received care and support from staff who had the skills and training to meet their needs. We saw from training records that new starters received a thorough induction and on-going training was provided to ensure staff were able to carry out their duties. Staff received support through supervision and yearly appraisals.

People who used the service had agreed to the delivery of their care, and signed to consent to this. They told us that staff always offered and respected their choices, but would be attentive to their needs, such as dietary requirements or medical needs.

The service had established good links with healthcare professionals and ensured that people who used the service maintained good access to healthcare.

Staff were kind and caring, and people who used the service told us that they were treated with dignity and respect. We saw that care was person- centred and recognised the individuality, culture and values of the people being supported. Staff knew how to provide personalised care however not all this was documented in people’s care plans.

People told us that they were happy with their care and knew how to complain if they were not. We saw that there were systems in place to investigate any complaints or concerns raised about the service. They told us that they were able to contact someone in the office when they needed to; support was also available out of hours. The registered manager and office manager visited people in their homes or talked to people on the telephone at least once a week.

Surveys and regular spot checks were used to identify trends, including good practice and areas for development.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered