Clark James is a domiciliary care agency, and it provides personal care for people in their own homes. It provides a service to a broad range of people, including older people, younger people and those with mental health support needs. At the time of our inspection, 32 people were using the service. We last inspected the service in January 2016 and the service was rated, ‘Good’.

This was an announced comprehensive inspection which took place over two days. We gained feedback from people on the phone on 19 April 2018, and followed this up with an inspection visit to the provider’s offices on 23 April 2018.

There was not a registered manager in post, and the provider had not had a registered manager in post since May 2017. 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. This meant that there was not a manager who was legally responsible for the service. There was a manager in post who was beginning their registration process with CQC, and they will be referred to as ‘manager’ throughout the report.

There were auditing systems in place, and some of these required further improvement to maintain oversight of the records, and therefore the care being provided. Audits relating to the administration of medicines were not fully effective as they did not identify all gaps or errors in records. The care plans required additional detail in relation to people’s health conditions and associated risks. There was a risk that staff could not always mitigate risks to people because there was not always guidance in place relating to risks associated with their health needs.

People felt safe when staff were with them, and staff had a good knowledge of how to contribute to keeping people safe. There were enough staff to deliver the service as planned, and they were recruited safely.

Staff were trained in areas relevant to their roles and their competency had been checked. They undertook supervisions and discussions about their roles with senior staff. New staff shadowed experienced staff before delivering care to people on their own.

Where it was part of their care delivery, staff supported people with their meals and to drink enough throughout the day. Staff understood how to support people with special dietary needs. If needed, staff also supported people to access healthcare.

People’s daily care needs were assessed before the service supported them, and these were written into a care plan which involved people and the families. Care plans included details of what was expected from staff during the visits, and included people’s preferences.

Staff asked for consent before delivering care and respected people’s choices, supporting them to make decisions when their mental capacity was variable. People and staff had positive relationships and staff got to know people well. The staff including the management team were caring towards people.

People’s dignity was upheld during personal care and staff respected people’s privacy. The service supported people’s independence in different ways, from personal care to supporting people to go out, and this was identified in care plans.

The service responded to people’s changing needs and communicated within the team about these. People’s preferences during visits were adhered to. When people or their relatives raised concerns or complaints, the management team and staff worked to resolve these.

There was good teamwork and support among the staff. The service was striving to make improvements and gained feedback from people in order to take action to improve.

The inspection took place on 28 January and we contacted the service before we visited to announce the inspection. The service was registered at their current address in January 2014 and this was the first inspection since they registered with the Care Quality Commission (CQC).

Clark James Norwich Limited provides domiciliary care to around fifty people living in their own homes, some of whom may be living with dementia or long term conditions.

At the time of our inspection the manager had submitted an application to become registered with the CQC. This was approved the day after our inspection and the manager is therefore referred to throughout this report as the registered manager. A registered manager is a person who has registered with the 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.’

People were supported by staff who were knowledgeable in their roles and demonstrated the skills required. They had been safely recruited and well-trained. Staff had been selected for their diverse skills and abilities. They told us they felt supported and happy in their roles. Staff showed passion for the people they cared for and the service they provided.

Staff demonstrated they understood how to prevent and protect people from the risk of abuse. The service had procedures in place to report any safeguarding concerns they may have and staff understood these. Staff had knowledge of other agencies they could go to report incidents of suspected abuse. People and staff were protected from harm as the service had identified and assessed any risks to them and reviewed these on a regular basis. Risk assessments were individual to the person and their environment.

Medicines were administered in a consistently safe manner. Medicines administration records were clear and accurate and contained relevant information. Where medicines were not administered this was fully documented. Staff understood safe procedures for administering medicines.

Staff received training, regular support and encouragement to further improve their skills and knowledge. Staff were undertaking qualifications and were given regular opportunities to discuss their performance with the management team. The competencies of staff were regularly assessed and recorded to ensure an appropriate standard of care was delivered.

People benefited from staff who felt valued by the service and were happy in their work. They felt listened to and involved in the changes that occurred. They had confidence in the management team and were positive about the changes the service was making.

People were treated in a respectful, compassionate and caring manner. They told us they felt in control of their lives. Staff demonstrated that they understood the importance of promoting people’s dignity, privacy and independence. They gave examples of a caring and empathetic approach to the people they supported.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 and report on what we find. Staff had received training in the MCA and demonstrated they understood the importance of gaining people’s consent before assisting them.

Care and support was delivered in a person-centred way as the service had completed thorough assessments of people’s needs. People received individualised care as their care plans had been developed in collaboration with them. The service regularly reviewed people’s needs and made changes as required.

Staff assisted people, where necessary, to access healthcare services. Staff had a good understanding of people’s healthcare needs and demonstrated they had the knowledge to manage emergency situations should they arise.

Where required, staff supported people to maintain their interests and avoid social isolation. The service arranged events for people who u