This inspection took place on 10 and 11 January 2018. This was an announced inspection as Careline the Agency for Care Staff is a Domiciliary Care Agency (DCA) and we needed to be sure someone would be at the office. A DCA is a provision that offers specific hours of care and support to a person within their own home. The DCA provided the regulated activity of personal care to people older adults and young people. Some of the people had physical disabilities, whilst others had health ailments that meant they required support with personal care.

At the time of the inspection a registered manager was in post. 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 service remained safe. Sufficient staff were employed to manage people’s needs, and enable them to engage in activities of their choice, through risk management. Staff were able to describe how to safeguard people from abuse and were aware of the protocols to follow. Staff further showed no hesitation to whistle-blow if the need arose. Where staff were involved in medicine management this were managed safely. Staff were competency checked annually and audits were completed monthly to ensure people were kept safe. If medicines errors were found during audits an investigation was completed and the necessary steps taken.

The service remained effective. Support was delivered by a highly experienced and knowledgeable staff team, who were able to respond to people’s changing needs, through risk management. Staff were supervised and supported by the management team and aimed at delivering support in the most appropriate way. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. This was evidenced with staff encouraging people to go on holidays and arranging this for people.

The service remained caring. Staff were reported to be polite, respectful and ensured they maintained people’s dignity whilst supporting them. They evidenced open communication with people and worked on motivating them to increase and achieve their independence.

The service remained responsive. Care plans whilst initially contained minimal information, requesting staff to seek direction from the person or the appropriate family member; were rewritten to contain detailed information on how to deliver the care. The service took necessary action to prevent and minimise the potential for social isolation. Activities were arranged and co-ordinated by the service to increase community engagement, and increase well-being. People and staff were protected from discrimination. Systems were employed by the service to monitor and investigate complaints.

The service had developed methods of governance that provided evaluation of practice. However, it was recognised that by not retaining old audits the service was unable to illustrate improvement over time. A thorough quality assurance audit was completed annually with an action plan being generated, and actioned, in addition to quarterly feedback sought for each staff member. People, relatives and stakeholders were asked for feedback on how to improve and make changes to the service. We found evidence of compliments and complaints that illustrated transparency in management.

This inspection was completed on 1 and 5 October 2015. Careline The Agency is a domiciliary care service (DCS). A DCS is a provision that offers specific hours of care and support to a person in their own home. We announced this inspection to be sure that someone would be in the office during the inspection process.

We found that at the time of the inspection a registered manager was in post. 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 were kept safe by appropriately trained and competent staff. Sufficient numbers of staff were involved in delivering the care packages of individual people. These were matched in accordance with needs, knowledge, age, hobbies and general personality. Systems were employed by the service to recruit suitable staff to work with people. Staff were trained in how to keep people safe by being aware and observant of signs of abuse, and how to report concerns promptly.

A rolling training schedule ensured that staff were receiving updated and relevant training to meet the care and support needs of the people. The induction programme took components from skills for care, and was delivered through face to face training, allowing staff the opportunity to discuss components of the training with a trainer. Specialist training was provided for those staff who would be working with people who required specific input. Employment, safety and competency checks were completed prior to staff being allowed to work independently with people.

We were told by people and their relatives that they were happy with the service that they were receiving. The staff were caring in their manner, and ensured that they maintained the person’s dignity at all times. Care plans were reflective of how support needed to be delivered incorporating the views of the person and their family. Continuing audits and reviews involving people and their relatives meant that they were involved in the evolving care document.

People were supported with their medicines by competent and suitably trained staff. Medicines were managed safely and securely. Medication administration records (MAR sheets) illustrated correct administration and were audited weekly. Where ‘as required’ (PRN) medicines were prescribed, guidelines accurately recorded how and when these medicines should be administered.

Those individuals who were unable to make specific decisions related to their care and support had their legal rights protected. The care plans showed that when decisions had been made for people about their care, where they lacked capacity, these were done in their best interest.

The service was audited and monitored by the management on a continual basis. Monthly internal audits, feedback from people was sought every month and 12 weekly as well as annual quality assurance audits, enabled the service to develop action plans. However, the outcomes of the action plans were not always recorded. We found evidence of compliments and complaints that highlighted how the management worked transparently.