Choices Care is registered to provide personal care to people in their own homes in the Bedfordshire and Leicester areas. At the time of our inspection 21 people were receiving personal care from the service.

This announced comprehensive inspection was undertaken on 28 and 30 June and 1 and 5 July 2016. We gave the service 24 hours’ notice of our inspection.

There were two registered managers in place. However, during this inspection one was on extended leave. 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager had an understanding of the formal process involved should people being supported by the service lack the mental capacity to make day-to-day decisions. Staff were able to demonstrate a sufficiently robust understanding of the MCA. This meant that any decisions made on people's behalf by staff would be in their best interest.

Records were in place for staff to monitor people’s assessed risks and support and care needs. Plans were put in place to minimise people’s identified risks and to assist people safely whilst supporting their independence.

Arrangements were in place to ensure that people’s medicines were administered safely. People had their nutritional and hydration needs met. People, who required this assistance, were supported to contact and access a range of external healthcare professionals to maintain their health and well-being.

People said that staff respected their choices about how they would like to be supported. People were supported by staff in a respectful and caring manner. Staff promoted people’s privacy and dignity.

People’s care and support plans gave guidance to staff on any individual assistance a person required. Records included how people wished to be supported, and what was important to them. These records documented that people and/or their appropriate relatives had been involved in this process.

There was a sufficient number of staff to provide people with safe support and care. Most people experienced punctual care calls.

Staff understood their responsibility to report any suspicions of harm or poor care practice. There were pre-employment safety checks in place to ensure that all new staff were deemed safe and suitable to work with the people they supported.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, spot checks and appraisals. This made sure that staff were confident and competent to provide the required care and support.

The registered manager sought feedback about the quality of the service provided from people who used the service and their relatives.

Staff meetings took place and staff were encouraged to raise any concerns or suggestions that they may have had. Quality monitoring processes to identify areas of improvement required within the service were in place. However, although a record documenting the administration of people’s prescribed medicines was kept. These records showed that improvements were needed by staff around the accurate recording of people’s medicine administration. These improvements required had not always been identified during the provider’s quality monitoring checks.

During our inspection on 31 October 2013 we reviewed three people’s plans of care. We noted that these did not always contain adequate information for staff. This was because they did always reflect the person’s current individual needs, or ensured their safety and welfare. Also, records we looked at showed us that the care visit times documented by staff were not always as planned in the person’s care file.

The provider’s medication policy outlined the arrangements in relation to obtaining, recording and disposing of medication. However, the arrangements for obtaining medication were not always documented within people’s care plans and the recording of medicine administration was not always followed.

The provider could not demonstrate that they had an effective quality monitoring system in place. This was because we were unable to evidence that the systems implemented, were effective.

During this inspection on 24 January 2014, we found that the provider had taken the remedial action required.

The provider had made the required improvements to the care plans to instruct staff on how to provide appropriate, safe care and support.

We saw that documented arrangements were now in place for obtaining people’s medication and we saw evidence that the recording of medicine administration was now in line with the provider’s medication policy.

The provider had improved their quality monitoring of the service they provided through documented checks and action taken.

Care plans and risk assessments did not always contain adequate information for staff to provide appropriate care and support to people.

People who used the service told us that timekeeping was a problem at times. Records we reviewed confirmed that visit times were not always as planned in the person's care file.

The provider had a medication policy that outlined the arrangements in relation to obtaining, recording and disposing of medication, however arrangements for obtaining medication and the recording of administration were not always followed.

We found that the provider had taken steps to carry out questionnaires and checks on daily notes and medication administration records, however the systems implemented were not always effective.

This is a new domiciliary care agency that currently provides care and support in the Lincolnshire and Bedfordshire areas.

People who used the service had the right level of information to make a decision about their care. Relatives we spoke with told us that choice was given by staff before undertaking any care and support. One relative told us that Choices Care staff, “Respect choice and communicate well whilst delivering care.”

We spoke with two relatives of people who used the service and they had positive comments about the quality of the care provided. One person told us that the care was, “Very good. (Staff) are friendly and do what they are supposed to do.” Another person told us that, “They do everything well.”

People's standard of health and welfare was maintained. Staff had access to care records to ensure that they provided people with safe and appropriate support and care. However, two of the three care records we saw did not have enough information in them to deliver safe care.

Staff underwent training to ensure they could deliver safe and appropriate care to people who used the service.

We did not see an effective quality assurance system in place. This was because we found no documented evidence that the monitoring of the service was on-going or that it had been analysed and collated for any improvements required and that these improvements had been acted on. This would ensure safe care and support for people who used the service.

This was a new small domiciliary care agency currently providing care in the Lincolnshire area. We spoke with the local authority which purchases care for people returning to the community from hospital. They said the agency had responded with requests for care to be provided. They said the care staff were very willing and provided the care they were asked to undertake.

We spoke with the family members of two people who received care and both were very happy with the quality of the care and the staff who provided it. One person said, "They're very friendly. Always have their gloves and aprons on. They handle my husband very well and manage to cajole him to do things when he won't do it for me."

Care staff were knowledgeable and aware of their responsibilities in safeguarding vulnerable people.

Staff in the office were friendly and able to put people at ease during telephone conversations we heard.