Community Care Line Service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger adults in Amber Valley, Bolsover, Chesterfield and North East Derbyshire. Not everyone using this service receives a 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. At the time of our inspection 264 people were receiving a service.

On our last inspection in August 2016 the service was rated as requires improvement as improvements were needed with how people were supported to make decisions where they needed help; how risks were assessed and how the quality of the service was reviewed. On this inspection we found improvements had been made.

The service had a registered manager in place at the time of our inspection. 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.

Improvements had been made to ensure that people felt safe and were happy with the care and support they received from staff. Risks to people’s health and wellbeing were now assessed and this was reviewed to ensure people were assisted in a safe manner. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about how they wanted to receive support and when they needed help, decisions were made in their best interests.

The staff understood how to protect people from harm and knew how to raise alerts if they were concerned about people’s welfare. People received assistance to take medicines and records were kept to ensure that this was done safely. There were safe recruitment procedures in place to ensure new staff were suitable to work with people. Staff were provided with opportunities to develop their skills and knowledge to support people effectively.

Staff felt supported by the registered manager. People could comment on the quality of service provision and were informed about improvements the provider planned to make. The staff worked in partnership with other professionals to maintain the care and support people needed.

This inspection took place on 3, 4, 10, 15 and 16 August 2016. The service was last inspected on 4 August 2014 when they were rated as Requires Improvement overall. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. On 3 and 4 August, phone calls were made to people who used the service and their relatives. On 10 and 15 August, the inspector visited the provider’s office, and on 16 August, the inspector visited the provider to give high level feedback on the inspection initial findings.

Community Care Line Services is a domiciliary care agency providing personal care for adults living in their own homes. At the time of our inspection, 242 people were using the service. Community Care Line Services provides personal care for people with a range of needs, including dementia, learning disabilities and physical disabilities.

The service had a registered manager at the time of our inspection visit. 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 registered manager was not available during our inspection visits.

People were not consistently protected from the risk of avoidable harm. Risks associated with care were not always identified and assessed. People were kept safe from the risk of potential abuse. Staff felt confident to recognise and report concerns.

People were happy with staff who provided their personal care. They were cared for by sufficient numbers of staff who were suitably skilled, experienced and knowledgeable about people’s needs. However, people had mixed views about staff arriving at the times they expected them.

The provider took steps to ensure checks were undertaken to ensure that potential staff were suitable to work with people needing care. However, they could not always demonstrate that staff had received a consistent induction. Staff received supervision and had checks on their knowledge and skills. They also received training in a range of skills the provider felt necessary to meet the needs of people at the service.

The systems for managing medicines were safe, and staff worked in cooperation with health and social care professionals to ensure that people received appropriate healthcare and treatment in a timely manner.

Appropriate arrangements were in place to assess whether people were able to consent to their care. The provider met the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS).

People felt cared for by staff who treated them with dignity and respect. People were supported to be involved in their care planning and delivery. The support people received was tailored to meet their individual needs, wishes and aspirations. People, their relatives, and staff felt able to raise concerns or suggestions in relation to the quality of care. The provider had a complaints procedure to ensure that issues with quality of care were addressed.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care. However, the systems did not always identify areas where improvements needed to be made. Checks were undertaken on all aspects of care provision and actions were taken to improve people’s experience of care.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was announced which meant the provider and staff knew we were visiting.

Our previous inspection was conducted on 11 February 2014 where we identified one breach of legal requirements in relation to care and welfare because people’s care was not being reviewed and records were not always updated.

At the time of our inspection Community Care Line Services delivered care and support to 200 people in their own homes.

There was a registered manager for the service. 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 and associated Regulations about how the service is run.

People told us the staff were respectful and provided dignified discreet care. People who used the service said they had confidence that the staff had the skills necessary to meet their needs and were caring and compassionate. Staff received specific training to meet the needs of people using the service.

We saw and were told by people who used the service that the staff had developed good relationships; they were kind and respectful and communicated with people in a way they understood.

The staff had received training on how to recognise signs of abuse and possible harm, and they knew what to do if they had any concerns.

People using the service were encouraged to retain their independence and decided how to spend their time. People agreed to the level of support they wanted and how they wanted to be assisted. Where people’s needs changed, the provider responded and reviewed the care provided to ensure people were safe. People were involved with the development of their support plan and could tell the staff how they wanted their care delivered.

People told us that staff were kind and courteous and delivered their care in the way they wanted. Where personal needs changed, we saw support plans were reviewed and staff were alerted to any changes.

The staffing was managed flexibly to ensure people received their agreed care. Where people had healthcare appointments or personal commitments people could request the support was changed.

We looked at how medication was administered, recorded and managed. We found suitable systems were in place, but improvements needed to be made with the recording of information.

The provider was responsive to individual circumstances and support required and there were enough staff to provide the agreed care. Where additional support was identified this was only agreed when the provider could deliver the additional staff support.

People using the service were consulted about the management of the service which meant they could influence the service delivery.

We found that systems were in place in the office to monitor the time people received their support visit and how long staff provided this support. Rotas allowed for travelling time between calls. However the care records did not always offer information regarding the day, time or duration of the call. This meant care records were not up to date.

People using the service told us they were provided with useful information about the service. People were involved in the discussions and decisions made about their care and support. One person told us, “They listen to what I want and have been out and asked me if everything is as I like it. I only have to let them know if I want any changes.”

The support was provided by staff who knew the needs of people well and what to do to assist them. People said they had no concerns about the service and knew how to raise concerns should they need to. One person told us, “We have information about who to speak to if we are not happy, but I’ve never had to use this.”

The staff received training that was appropriate for their individual needs and provided them with the information they needed to care for the people living in their own home.

The care records did not always contain accurate personal information about the care people needed.

Quality monitoring systems were in place which confirmed the quality of the care was reviewed and monitored.

We did not speak to people using the service for this follow up review.

We found that the provider had taken appropriate action following our last inspection regarding the arrangements for the management of medicines. This meant that people using the service were protected against the risks associated with medicines.

We did not speak to people using the service for this follow up review.

We found that the provider had taken appropriate action following our last inspection to ensure that risk assessments were regularly reviewed. This meant that changes in people's needs were identified and met.

We found that there were discrepancies and gaps in medication records. This meant that people were at risk because the provider did not have suitable arrangements in place for the management of medication.

We spoke to 11 people by telephone about the care and support they received; if they were unable to speak directly to us we spoke to a family representative instead.

People told us they were mostly satisfied with the service provided. They said that staff usually came at the time agreed and stayed for the expected length of time at each visit. Two people said their morning visit was not always at the time agreed and that this disrupted their preferred daily routines.

People were positive about the staff who visited them. They told us "they’re very nice, very kind", "they’re bright and cheerful", and "they do a good job – I couldn’t ask for more".