This inspection took place on 17 April 2018 and was announced. At our previous inspection of November 2016 the service was also ‘inspected but not rated’. At this inspection we were able to rate the service, as the provider had been delivering services to people over a continuous period of time.

This service 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, presenting with dementia, mental and/or physical disabilities.

Not everyone using Caxton Recruiting Services receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of this inspection only one person was receiving regulate activity. The person using the service received care over 24 hours seven days a week.

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.

We identified a breach of regulations during the inspection. This was in regards to good governance. You can see the action we have told the provider to take with regard to this breach at the back of the full version of this report.

The service was not as well-led as it could have been. Records in relation to staff supervision, appraisals and policies were not accessible or in place. The registered manager had not identified that the person using the service required a care plan review. The registered manager did not keep records of all of the quality assurance checks they completed.

Some improvement was required to ensure that recruitment processes were safe and that staff provided full employment histories and appropriate references. We raised this with the registered manager who told us they would take action to ensure these issues were remedied.

There were sufficient numbers of staff to carry out the duties required. Risk assessments were in place to enable staff to understand how best to support people safely. Medicines administration was accurately recorded in line with the person’s needs. Staff were aware of the signs to look out for in protecting people from the risk of abuse.

Staff were supported and encouraged to undertake qualifications relevant to their role, as well as appropriate training. Staff told us that they received regular support from management through supervision and appraisals. The person using the service was supported to maintain a healthy diet and access healthcare professionals when they needed to. The registered manager was aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA).

The person was cared for by staff that knew them well. Staff supported the person to make decisions for themselves and respected their privacy and dignity.

Care plans were based on a thorough pre-assessment and reflected people’s preferences in how they liked to be cared for. The provider had a complaints policy in place, and had not received any complaints since our last inspection.

Staff were positive about the support they received from management. The registered manager was clear in their role and responsibilities in notifying the CQC of important incidents.

This inspection took place on 14 September 2016 and was announced. We were however unable to gather sufficient evidence to support a robust judgement and provide a rating for the service as there was only one person using the service at the time of this inspection.

Caxton Recruitment Services is a domiciliary care service that provides personal care as well as general support to people in their own homes such as meal preparation, prompting medicines, laundry and general household support. The registered manager told us the service provided personal care to one person at the time of this inspection but that this was the start of a new contract the agency had recently gained. They expected to take on more work in the near future. The person concerned received 24 hour care each day of the week from this agency.

At the time of the inspection, there was 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.

We were told by those people we spoke with this was a good, safe service and said they were quite happy with it. They told us that the staff who supported them knew them and how to provide the care and support to meet their needs.

Appropriate risk assessments were in place that helped protect the person and staff in the delivery of care and support.

The person and their relatives told us there were sufficient numbers of staff who helped support them in the way they needed to be cared for. We saw the service had sufficient staff available to support people. Safe systems were used when new staff were recruited to ensure they were suitable to work in people's homes.

We saw evidence that the person received their medicines safely and appropriately. People told us they were treated with kindness and respect and was included in all decisions about their care.

We found that the provider involved the person and their relatives in planning their care and their views were sought when decisions needed to be made about how they were cared for. The service involved them in discussions to help keep them safe and promote their wellbeing. Staff treated them with respect and dignity.

The person and their relatives indicated that they felt that the service responded to their needs and individual preferences. Staff supported the person according to their personalised care plans. Care plans were reviewed annually or earlier if the person’s needs changed.

We saw there was an appropriate complaints policy in place that people were aware of. People told us that the provider encouraged people to raise any concerns they had and responded to them positively and in a timely manner.

There was a clear management structure to ensure the service was running in a way that was efficient and effective in supporting staff and to ensure the quality of the service offered to people.

The provider had arrangements to deal with complaints and concerns that might be raised by people or their relatives. The registered manager asked people for their views about the care they received and acted in response to their feedback.

We received positive feedback about the management of the service. The registered manager and the staff were approachable and fully engaged with providing good quality care for people who used the service. The provider had systems in place to continually monitor the quality of the service and there were arrangements for people to be asked for their opinions via surveys. Action plans were developed where required to address areas for improvements.

People we spoke with told us that they were very happy with the service they received from Caxton. They told us that they had a consistent and reliable service that provided sensitive care and support. One person said, “They are competent and punctual, always very happy with the service provided”. People said that their care plans covered all their assessed needs. They also said that they were able to express their wishes and preferences in the process. The person we spoke with said, “Yes they do what has been set out in the care plan but they always ask us if there is anything else mother needs to be done”.

People said they were told by the office when the care worker might be late and they said they knew how to make a complaint if they needed to do so. One person said, “I’d ring the office to make a complaint and speak to the manager”.

People we spoke with told us that they were very happy with the service they received from Caxton. They told us that they had a consistent and reliable service that provided sensitive care and support. Comments included; “competent and punctual –always very happy with the service provided”. “Very happy with the services we get, thank you very much”.

People said they were told by the office when the care worker might be late and they said they knew how to make a complaint if they needed to do so.

One person said, “First of all I’d ring the office to make a complaint and I’d speak to the manager, after that if I wasn’t happy I’d speak to the council”.

Please see the main body of the report for this information.