We carried out an inspection of Care Visions at Home on 23 and 26 January, 1, 6 and 9 February 2017. The first day of the inspection was announced. We last inspected Care Visions at Home in December 2014 and found the service was meeting the relevant regulations in force at that time, with the exception of one relating to staff support.

Care Visions at Home provides personal care for people in their own homes. There were 72 people using the service.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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 said they felt safe with care staff and were well cared for. Staff were aware of safeguarding vulnerable adult procedures and expressed confidence that concerns would be appropriately dealt with. Incidents were investigated and dealt with to ensure people remained safe.

Risks associated with people’s care needs and working practices were assessed and steps taken to reduce the likelihood of harm occurring. Staff had access to personal protective equipment, such as gloves and aprons. They were aware of and trained in good hygiene practices.

People told us staff were caring courteous, professional and polite. Staffing levels were sufficient to safely meet people’s needs, with ongoing recruitment to improve the ability of the agency to ensure staffing consistency. The provider had a robust system to ensure new staff were subject to thorough recruitment checks.

Systems for the safe management of medicines had been developed to ensure medicines were handled safely and accounted for.

Where appropriate, people’s mental capacity was considered through relevant areas of care, such as with medicines and distressed behaviour. Staff routinely obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by the registered manager and other senior staff. The provider had met the assurances they had given in their action plan following a previous breach of legal requirements relating to supporting their staff.

People were supported with eating and drinking where this was an assessed need. People’s health needs were considered in the planning and delivery of care. Help from external professionals, such as the GP, was sought if necessary. This ensured people’s general medical needs were met.

Staff understood the importance of promoting people’s privacy, dignity and confidentiality. Staff were able to clearly explain how they met people’s needs and we saw care plans and associated documentation were clear and person centred.

People using the service and staff spoke well of the registered manager and they felt the service had good leadership. We found there were effective systems to enable people to raise complaints, and to assess and monitor the quality of the service. Staff performance was subject to periodic spot checks. Quality monitoring included feedback from people receiving care.

We used a number of different methods to help us understand the experiences of people using the service. We looked at five care records, spoke to two people who use the service, spoke to three relatives and four members of staff.

One person who uses the service told us, “The carers are very good. If I need anything they are there straight away.”

One relative told us, “In January he came out of hospital and was given one month to live and they could do no more for him. Since Care Visions came in he has gone from strength to strength.”

This inspection took place on 11, 22 and 23 December 2014. This was an announced inspection. This means the provider was given 24 hours’ notice due to it being a domiciliary care provider and we needed to ensure someone was available. We last inspected Care Visions at Home on 5 March 2014. At this inspection we found the provider was meeting all the regulations we inspected against.

Care Visions at Home are a domiciliary care company based in Newcastle upon Tyne who provided support and care for people with advanced or progressive complex needs within their own home. The service also provided support to people who were at the end of their lives. They provided support in the Northumberland, Gateshead, North Tyneside and Newcastle areas. At the time of our inspection 56 people were using the service.

The registered manager was in post at the time of the 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.

We found that the service was safe, staff had a good understanding of safeguarding adults and how to report any concerns and these were managed appropriately by the registered manager. Accident and incidents were recorded and investigated and appropriate action was taken such as further risk assessment and staff training. The provider also had a log of complaints and compliments and we found that these were responded to within specific time frames.

Staffing levels were appropriate to meet people’s needs although some people told us they would appreciate a more consistent staff team supporting them. Other people said they were supported by the same staff and told us they were “More than happy, the girls are lovely.”

The provider had a team of staff who dealt with recruitment processes working alongside the rota team and the training department to ensure sufficient numbers of staff were in post.

Medicines were managed safely and competencies were assessed by a registered nurse with regular observations of staff administrations of medicines.

Although staff were knowledgeable about safeguarding, mental capacity, dignity and respect we found that there were gaps in the provision of refresher training and supervision of staff. None of the staff had received an appraisal. This meant people using the service were at risk of being supported by staff whose competency and knowledge had not been appropriately assessed so the manager might not know if there were gaps in their practice. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager and the staff were knowledgeable about mental capacity and understood people’s rights to be involved in their care planning and review.

People were supported with their nutritional needs, social engagement and emotional well-being and care plans promoted people’s independence and choice. People told us they were treated with dignity and respect and staff asked for consent before offering any support.

Regular audits and observations were completed to ensure the quality of the service was being monitored regularly. It was acknowledged that the service was going through a lot of change in order to improve processes and systems but staff were positive about this and staff morale was positive. They felt well supported by the senior team and able to seek support as needed.