We previously carried out an announced comprehensive inspection at Carewise Ltd on 16 & 17 July 2015. Breaches of legal requirements were found. After that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to gaining people’s consent and working in accordance with the mental capacity act 2005 (MCA) and in the completion of accurate records that reflected people’s care needs and the development of systems that identified shortfalls in practice. This inspection took place on the 6 and 7 July 2016 and was announced.

Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available in the office. At this inspection we found that the breaches of regulation had been met. However there remained some practice in relation to MCA that needed improvement.

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Carewise Ltd is a domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people, people living with dementia and people with a physical disability. At the time of our inspection 138 people were receiving a care service.

The service had a registered manager. The registered manager was also the owner of the business. 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.

Improvements had been made in seeking and recording consent in line with the Mental Capacity Act (MCA). At this inspection we found that staff had received training in MCA and were knowledgeable about the principles of the legislation. People’s consent was being sought and where people had a lasting power of attorney in place a copy of this was in people’s care records. However some assessments regarding people who lacked capacity were not decision specific so it wasn’t clear in which areas they lacked capacity to make decisions. We have therefore identified that this remains an area that needs ongoing improvement.

Improvements had been made in the completion of accurate records which meant that the registered manager could be assured that people were receiving the correct care. This was because the registered manager had introduced audit systems that ensured reviews took place and that any shortfalls in practice were identified and then addressed.

People told us they felt safe. One person said “I’m very pleased with them, they look after me very well.” People were safe as they were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Staff were appropriately trained holding a Diploma in Health and Social Care and had received all essential training. Staff told us they felt supported to carry out their roles and received supervision and attended staff meetings. New members of the management team were in place that provided support with co-ordination and staff supervision.

People were cared for by kind and compassionate staff. People told us how well the staff knew them. One person said “Staff are nice, cheerful and caring, they really are good, we have a lovely rapport”. Another person said “I think they’re excellent, lovely girls”. People also told us they were treated with respect and dignity and that staff were always willing to help. One person said “Anything I want done, they do it”.

People were encouraged to eat and drink. If needed food and fluid intake was monitored to ensure that people maintained a healthy weight. Pe

We visited Carewise domiciliary agency and looked at the care and welfare of people who used the service. We looked at files and audits in the office and spoke with the registered manager and three care staff.

We visited four people in their homes and spoke with 16 people who used the service, or their relatives; all but one said they were very happy with the service being provided. One person said ‘ we are very happy with the staff, they are respectful and ensure our privacy’.

All the people we spoke with said that staff acted with their consent. One person said

‘they always ask before doing’. Another told us ‘the staff are very nice and always respects our wishes’.

People told us the service met their care needs. One person told us ‘the staff have been very supportive and very quick to respond to any issues we raise’.

People using the service told us they felt safe with staff. People were happy with the skill and experience of staff. One person told us ‘all the staff seem to know what they are doing’. Another told us ‘we have a good relationship with all the workers who are respectful of our ways and wishes’. However one person said they felt that staff were better experienced with older people rather than those that were younger.

The manager was regularly seeking the views of people to ensure they were satisfied with the service. People told us if they were unhappy about anything they could tell the staff and something would be done.

The inspection took place on the 16 and 17 July 2015 and was announced. Forty eight hours notice of the inspection was given to ensure that the people we needed to speak to were available in the office.

Carewise Ltd is a domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people, people living with dementia and people with a physical disability. At the time of our inspection 190

people were receiving a care service.

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 told us that they were happy with the service they receive from Carewise Ltd. One person told us “I don’t think anything could be any better, they do a good job, I’m very happy with it all”. Another person said “I’ve no problems at all, they’re wonderful”.

People were cared for by staff that knew them well and were aware of the risks associated with most of their care needs. Staff were aware of the potential signs of abuse and who to report this to. However risk assessments for some people were not up to date and did not accurately reflect the care that people were receiving. Peoples medicines were not always recorded correctly and these are areas that need improvement.

Peoples consent was not always sought in line with the Mental Capacity Act 2005. Where people were suspected to lack capacity to consent to decisions, this was not always assessed and best interest decisions were not always recorded.

Staff were appropriately trained and some held a Diploma in Health and Social Care. All staff had received essential training including how to support people living with dementia. New staff completed the nationally-recognised Care Certificate which provides a benchmark for training in adult social care. Staff ensured people had enough to eat and drink.

Staff knew people well and were aware of their individual needs. One person said “They know me and what I like”. Staff gave us examples of how they treated people with dignity and respect. Some people received care calls that supported them with activities of daily living. Complaints were responded to in a thorough and timely way.

People and staff told us they thought Carewise Ltd was well led. There were systems in place for communicating regularly with staff and people. However auditing systems hadn’t picked up the inaccuracy and lack of detail in care records and reviews were not taking place in a timely way.

We found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.