We carried out an announced inspection of the service on 25 July 2018. Choose 2 Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It currently provides a service to older adults. Not everyone using Choose 2 Care 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.

There was no requirement for the service to have a registered manager. The provider was the manager and oversaw the day-to-day running of the service. We have referred to the provider as the ‘responsible person’ throughout this report.

At the time of the inspection, eight people received some element of support with their personal care. This is the service’s first inspection under its current registration.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

The risks to people’s safety were not always appropriately assessed. This included how to support people with poor mobility and supporting people to leave their homes in an emergency. The process for the investigation and reviewing of accidents and incidents was not always effective. People felt their medicines were managed appropriately by staff; however, the care planning records and risk assessments in relation to medicines were limited in detail. Staff did not wear company uniforms when supporting people; however, the responsible person ensured they had enough personal protective equipment to reduce the risk of the spread of infection. People felt safe when staff supported them in their homes. There were enough staff to support people and staff were recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not support this practice. Improvements were required to ensure all people’s rights under the Mental Capacity Act (2005) were respected.

We have recommended that the responsible person improve their understanding of the Mental Capacity Act 2005.

People’s care was not always provided in line with current legislation and best practice guidelines. However, people felt staff understood how to support them. Staff were well trained, felt supported and understood people’s needs. Staff performance was not regularly monitored. People were supported with their meals where needed. Other health and social care agencies were involved where further support was needed for people.

People liked the staff and found them to kind and caring. Staff treated people with respect, dignity and compassion. People’s independence was encouraged and people were able to contribute to decisions about their care. Improvements were needed to ensure people’s personal data was secure.

From the records viewed, care plans lacked detail and did not always provide staff with the guidance needed to support people with specific health conditions and their preferences. People felt care staff responded effectively to complaints or concerns raised. People’s diverse needs were discussed with them and respected. There had been limited discussions to ensure that people’s wishes were respected when they neared the end of their life.

Quality assurance processes, including ensuring the assessment of the risks to people’s health and safely were not effective. The risk to people’s health and safety had not been appropriately assessed. The responsible person did not fully understand the requirements of their role to ensure the CQC were informed of notifiable events. The responsible person was well liked and respected by people and their staff.