What life is like for people using this service:

• Improvements had been made following our previous inspection in October 2017 to address the areas we identified as requiring improvement.

• People were supported by staff to stay safe and who understood the need to ensure they consented to the care they received. People told us that they received care from regular staff who arrived on time and stayed for the agreed length of time. The provider ensured consistency in staff support so people and staff were able to build positive relationships.

• People were well cared for by staff who treated them with respect and dignity and encouraged them to maintain their independence. People received care and support based on their individual assessment, needs and preferences.

• Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing.

• Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted.

• Records needed to improve. The provider had quality assurance systems in place, however they were not fully effective as they had failed to identify some areas requiring improvements.

• Staff spoke positively about working for the provider. They felt well supported and that they could talk to management at any time, feeling confident any concerns would be acted on promptly.

• People spoke highly of the overall service and the management team positively encouraged feedback and inclusion and were keen to grow their service.

Rating at last inspection: At the last inspection the service was rated as ‘Requires Improvement’ (report published 6 October 2017).

About the service: This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing care to twenty-four people.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager for Clarence Care is also the provider

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We last inspected this service on 26 September 2016 when we found that improvements were needed in how effective the service was and how well led it was. At this inspection we found that although several improvements had been made further improvements were needed to ensure people received a consistent service.

Clarence Care Ltd provides personal care to people in their own homes. At the time of our inspection 27 people were receiving a service.

This announced inspection was carried out on 18 September 2017 and carried out by two inspectors. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be available to support the inspection.

At the time of our inspection there was a registered manager 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.

People received a good quality service in which they had confidence. There were processes in place to monitor the quality of the service and people were asked to comment on the quality of service. However, improvements were needed to the auditing process so that shortfalls and developing themes and trends were identified and actions taken to address them in a timely manner. Records regarding planning and attending of calls to people did not provide an audit trail of changes and reasons for the changes of call times and staff carrying out the calls. The registered manager was not always aware of these changes showing that there were some shortfalls in the management of the quality assurance systems.

There were not always sufficient numbers of staff to ensure that people received their calls at the times required and by the staff they expected to assist them.

People received their medicines as prescribed but records were not always accurately completed to show that people had been supported to take their medicines.

People received a safe service because the provider had procedures in place to ensure that staff were trained and followed the procedures to ensure the risk of harm to people was reduced. The risk of harm to people receiving a service was assessed and managed appropriately; this ensured that people received care and support in a safe way.

People received care and support from staff that were trained to be effective in their role and that were supported by the registered manager to carry out their roles effectively. People’s rights were protected and they had choices in their daily lives. People were supported to maintain their diet and health needs where required.

Staff were caring and people’s privacy, dignity independence and individuality was respected and promoted by staff and the registered manager.

People’s views about the service were sought through surveys and complaints. People were able to raise their concerns or complaints and their complaints were acted upon, so people could be confident they would be listened to and their concerns resolved.

We last visited this service on 18 January 2016 when we found that improvements were needed in all the five questions we ask and there was a breach of regulations in respect of monitoring and improving the quality of the service. At this inspection we found that the many improvements had been in the service and there was no longer a breach of regulations.

Clarence Care Ltd provided personal care to people in their own homes. At the time of our inspection 28 people were receiving a service.

At the time of this inspection there was no registered manager 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.

People were able to consent to the care they received and systems were in place to protect people’s rights if they did not have the ability to make decisions for themselves. The need for restrictions on people’s liberty to be appropriately authorised were not always followed up with the appropriate authorities.

The quality of the service had improved and systems had been put in place to monitor and improve the quality of the service but not all the systems were fully embedded at the time of our inspection.

People felt safe using the service and they were protected from the risk of abuse because the provider had systems in place to minimise the risk of abuse.

Risks associated with people’s care had been assessed and management plans put in place to keep people as safe as possible.

People were supported to receive their medicines as prescribed.

Staff were safely recruited and trained and supported to carry out their role

People were supported by staff that were friendly, relaxed and polite and they received a service that met their individualised needs.

People’s right to privacy was promoted and people’s independence was encouraged.

People were able to raise any concerns or complaints they had and felt reassured that they would be appropriately addressed.

This inspection took place on 18 January 2016 and was unannounced. This was the first inspection of this location since it's registration with us in March 2015 and had been brought forward because we had received some concerns that staff had not received appropriate training, management of medicines, missed calls and that times of calls had been changed so that staff were able to have a Christmas meal together.

Clarence Care Ltd provided personal care to people in their own homes. At the time of our inspection there were 22 people who were receiving a service.

There was a registered manager 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.

The provider had some systems in place that enabled them to assess and monitor the quality of the service provided. These systems were not used effectively to ensure that people received a consistently good quality service and further improvements in the quality of the service were needed. We identified that this was a breach of regulation. You can see the actions we have asked the provider to make at the end of this report.

People told us that they felt safe with the staff that supported them because staff knew how to protect people from harm. Where concerns had been raised the registered manager liaised appropriately with the authorities to ensure people’s safety was maintained.

There was a system in place to ensure that checks were undertaken when staff were first employed by the provider. These included police checks and checks with previous employers but evidence available did not show that that the checks were carried out consistently.

There were sufficient members of staff employed to meet people’s needs but the deployment of staff had not ensured that people always received support at the agreed times.

Risks associated with people’s care needs were identified and plans put in place to ensure people were protected from unnecessary risk.

People were not always supported to take their medicines as prescribed and according to the manufacturer’s advice. People received support to ensure that they received meals of their choice and that met their needs.

People were supported by staff that had the skills and knowledge needed to support them safely but training was not always provided in a timely manner.

People were supported to make decisions about the care they received and there were no restrictions on their liberty.

People received care and support from staff they had got to know and built up a relationship with them. Staff were caring towards people and ensured that they maintained people’s privacy and dignity. People were supported to remain independent.