City Care Services is registered to provide personal care to people living in their own homes. There were 123 people receiving personal care from the service when we visited. Personal care calls were being provided along with 24 hour live in care packages.

At the last inspection on 27 August 2015 the service was rated as ‘Good’. At this inspection we found the service remained ‘Good’.

Two registered managers were in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff received training to protect people from harm and reporting any suspected harm. There were a sufficient number of staff employed and recruitment procedures ensured that only suitable staff were employed. Risk assessments were in place and actions were taken to reduce these risks. Arrangements were in place to ensure that people were supported and protected with the safe management of their medicines.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Appropriate procedures were in place and staff were supported and trained regarding the MCA

People were supported to access healthcare professionals and they were provided with opportunities to increase their levels of independence. Health risk assessments were in place to ensure that people were supported to maintain their health. People had adequate amounts of food and drink to meet their individual preferences and nutritional needs where appropriate.

People told us that their privacy and dignity was respected and their care and support was provided in a caring and a cheerful manner.

A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainant. People could raise concerns with the management team and care staff at any time.

There were quality assurance processes and procedures in place to improve, if needed, the quality and safety of people’s support and care. People and their relatives were able to have their say in relation to the support and care provided and staff acted on what they were told.

There were links with the external community. A staff training and development programme was in place and procedures were in place to review the standard of staff members’ work performance.

Further information is in the detailed findings below

City Care Services provides personal care to people who live in their own homes. There were approximately 200 people using the service when we visited. The inspection took place on 27 August 2015 and we gave the provider 48-hours’ notice before we visited. This was to ensure that the registered manager was available to facilitate the inspection.

The previous inspection took place on 24 September 2014 during which we found that Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 regarding people’s care plans were not being met. The provider sent us an action plan informing us that improvements would be made by 29 October 2014. At this inspection on 27 August 2015 we found that the required improvements had been made.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new registered manager had been appointed.

Staff were knowledgeable about reporting any abuse. There were a sufficient number of staff and recruitment procedures ensured that only suitable staff were employed. Risk assessments were in place to ensure that care and support could be safely provided and actions were taken to reduce people’s identified risks. Arrangements were in place to ensure that people were supported and protected with the safe management of medication.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that people who used the service had their capacity to make day-to-day decisions formally assessed. At the time of our inspection no one in receipt of care had been deprived of their liberty.

Staff were supported and trained to do their job. The agency and care staff were in contact with a range of healthcare professionals to ensure that care and support was well coordinated.

People’s nutritional and dietary needs and preferences were recorded.

People’s privacy and dignity were respected and their care and support was provided in a caring and a patient way.

A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainant. People felt able to raise concerns with the staff at any time.

The provider had quality assurance processes and procedures in place to monitor the quality and safety of people’s care. People and their relatives were able to make suggestions in relation to the support and care provided.

An adult social care inspector carried out this this inspection on 24 September 2014. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with17 people who used the agency, two relatives, the manager, four office based staff, nine members of care staff and four healthcare professionals who had contact with the agency. We reviewed records relating to the management of the service which included: five care plans, daily records, medication records, staffing records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people who used the agency, their relatives and the staff told us, what we observed and the records we looked at.

Is the service caring?

The agency provided care and support for people living in their own homes. People told us that they received kind and respectful support from care staff and felt able to make choices and changes to their care when necessary. Relatives that we spoke with were positive about the care and support provided to their family member. Care staff told us that they were supported and supervised so that they could provide safe care and support to people. Courtesy calls were made to people using the agency and their relatives to discuss any care and support issues.

Is the service responsive?

We saw that people’s personal care and support needs were assessed and generally met. This also included people’s individual choices and preferences as to how they wanted their care to be provided. People we spoke with told us that they had been able to make changes to their support and had been involved in reviews of their care. Relatives that we spoke with also confirmed that they had been involved in reviews. We saw that changes to documentation were made to ensure that care and support being provided was up to date and met people’s needs. However, it was evident that some care plans had not always been available to staff prior to them providing care and support to people.

Is the service safe?

Risk assessments regarding people’s individual needs were carried out and measures were in place to minimise any identified hazards. Care staff understood their roles and responsibilities in making sure that people were protected from the risk of abuse. We saw that the provider was taking appropriate action to ensure that all care workers had received safeguarding training to ensure peoples’ safety. There were arrangements in place to ensure that staff were trained and supervised so that they could safely provide care and support to people. However, care staff told us that care planning documentation had not always been in place to provide them with sufficient information prior to providing care and support to people.

Is the service effective?

We found that care workers were knowledgeable about people’s individual care and support needs. People who used the agency that we spoke with, and their relatives, confirmed that care staff provided consistent care and support and were keen to address any concerns or issues. The manager confirmed that reviews of care and support were in place to meet people’s changing/ assessed needs.

Is the service well led?

Staff that we spoke with told us that they were generally well supported by the management team so that they could safely provide care and support. People and their relatives that we spoke with told us that they felt they were listened to and that support was consistently and safely provided. Quality assurance systems were in place to audit the care and services provided. Surveys were carried out to gather opinions from people who used the agency and members of staff. The manager and care staff were in regular contact with people and their relatives to respond to their concerns or queries

People that we spoke with were positive and complimentary about the care and support they received from the agency. One person said, “The care staff really help me and are very good.” Care and support plans were ‘person centred’ and documented in detail. There were regular reviews to ensure that any changes to people’s needs were being met. People were involved in the planning of their care and support.

Care staff were trained in safeguarding people from harm and they had access to policies and information regarding how to report any incidents or allegations to the local authority safeguarding team.

We saw evidence that staff were trained and monitored regarding the administration of medicines. Staff were aware of their responsibilities when recording the administration of medicines that they had given or prompted people to take.

There were training programmes and regular supervision sessions in place to ensure that care staff remained competent to deliver care and support to people using the service.

The agency had effective procedures in place to regularly assess and monitor the quality of the service that was provided to people.

We carried out this review to check whether City Care Services had made improvements in relation to compliance actions made following our inspection on 07 February 2012 concerning the following outcomes; Care and welfare of people who use services, Safeguarding people who use services from abuse, Management of medicines, Requirements relating to workers, Staffing and Records. All evidence indicated that improvements had been made and we noted that all compliance actions we made following our last visit had been met by the provider

We spoke with eight people who use the service, and two relatives, regarding their experience of the care and support provided. People’s comments were generally positive about the service and the support they received from care staff. One person commented, “The carers are brilliant and respectful;” and another person commented that, “The service is good and reliable and I have no concerns”. One person did however tell us about a visit which had not taken place due to confusion in communication and that this had caused them concern.

People we visited told us that staff helped them with everything they needed help with and that staff were very good.

They said they were happy with the way care workers support them with their medicines.

They confirmed that staff were usually on time, although there continued to be times when staff did not arrive to provide care.