This inspection took place on 15, 16 and 18 May 2018 and was announced. The provider was given 24 hours' notice because the location provides a service to people in their own homes and we needed to be sure staff would be available at the location to speak with us.

Compassionate Care Ltd is a domiciliary care service. It provides personal care to people living in their own homes in the community. They provide a service to people with dementia, mental health needs, a learning disability or autistic spectrum disorder, physical disability, sensory impairment, older adults and younger adults.

The service also provided support in a ‘supported living’ setting, so that people can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. One location was situated in the Sheffield area for six adults with learning disabilities. The second supported living setting had been recently established for two people in the Macclesfield area who both had mental health needs.

Not everyone using Compassionate Care Ltd receives a regulated activity. The Care Quality Commission 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 the service was providing personal care to 54 people in their own homes in Trafford and Cheshire East.

At the previous inspection in April 2017, the service was rated as ‘Requires Improvement’ overall. This was because, although significant changes and improvements had been made to the service, these had not yet been fully embedded in respect of the requirements of the Mental Capacity Act 2005. During this inspection, we found the improvements had been made.

There was a registered manager at 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 2008 and associated Regulations about how the service is run.

People's human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA). People's nutritional needs were met because staff followed people's support plans to make sure people were eating and drinking enough, and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

Staff knew people's individual needs and abilities. People told us their needs were met by well trained staff. Staff told us they received regular and adequate training and supervision to deliver effective care. People told us staff gave them choices and asked their permission before supporting them. Staff knew people's right to choice.

There were sufficient staff to meet people's needs. People told us staff generally arrived on time and contacted them if they were running late. Staff told us they had sufficient time between care visits.

People's medication was stored in their own home in line with their wishes and choices. A medication assessment was completed with each person and they were required to sign the consent agreement to enable staff to support them with medication needs. People were only supported by staff who were trained by the service and had passed competency assessments.

Staff were recruited safely. We saw that staff were only offered positions in the company once all satisfactory checks had been completed and references had been obtained.

Risk assessments were completed and reviewed every six months or when there was a change in people's needs. Risk assessments were completed for various aspect

We inspected Compassionate Care Ltd on 4, 5, 7 and 10 March 2017. We gave the provider 48 hours' notice that we would be visiting the office to make sure the appropriate people would be there to assist us with our inspection.

Compassionate Care Ltd is a domiciliary care agency providing personal care and companionship in Trafford and Cheshire East. Care workers support the people using the service with a wide range of needs, including assistance with washing and dressing, accessing activities, attending health appointments, cleaning and making meals. Information provided by the registered manager indicated that the service was providing personal care for 58 people in total.

The service also provided support in the in a 24 hour supported accommodation for six adults with learning disabilities. This was located in the Sheffield area.

The service had a registered manager who was also the company's managing director. 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.

At the last inspection we found the provider was not fully adhering to Mental Capacity Act (MCA). At this inspection we found the provider still needed to address this area as we found there was no direct reference to the MCA in people’s care plans. We saw no capacity assessments, records of best interest meetings, or exploration of whether people using the service had devolved decision-making responsibilities to other people such as through a Lasting Power of Attorney.

At the last inspection we found care plans were person-centred, but did not always address people's identified care and support needs. At this inspection we found a number of improvements had been made and care plans now recorded people’s assessed needs.

People told us they felt safe when using the service; their relatives also said they felt people were safe. Staff we spoke with understood about safeguarding vulnerable people, they had received safeguarding training and said they would report any concerns appropriately.

People receiving support and their relatives complimented staff for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able.

The service had enough staff to attend the care visits scheduled. People receiving support and their relatives said care workers arrived on time and stayed for the duration of their allotted visits.

Some people using the service were assisted with their medicines; we saw these were well managed by the service. Care staff administering medicines received training.

The service undertook risk assessments for all aspects of the care and support people received in their homes. Care workers had been trained in infection control and used personal protective equipment when they supported people with personal care.

Staff received the training they needed to care for the people safely. New care workers who had not previously worked in health and social were undertaking the Care Certificate. The care certificate is a nationally recognised set of induction standards for people new to working in care.

Care workers had received regular informal supervision and had a documented annual appraisal. They also attended regular team meetings.

People receiving support and their relatives told us that care workers respected their privacy and dignity and promoted their independence. Care workers we spoke with could provide examples of how they did this.

Care workers could demonstrate that they knew people's likes and dislikes and the service tried to match people with care workers they would get on with.

People receiving support and their relatives (when appropriat

We inspected Compassionate Care Ltd on 15 and 16 February 2016. Due to the nature of the service we contacted the registered manager one working day before the inspection so that we could be sure there would be someone at the office when we arrived on the first day. The company registered with the Care Quality Commission (CQC) in February 2015 and this was their first inspection.

Compassionate Care Ltd is a domiciliary care agency providing personal care and companionship to about 50 people in Trafford and Cheshire East. Care workers support the people using the service with a wide range of needs, including assistance with washing and dressing, accessing activities, attending health appointments, cleaning and making meals.

The service had a registered manager who was also the company’s managing director. 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.

At this inspection we found that not all care workers had not received training on the Mental Capacity Act (MCA). It was not clear from care records which people had relatives with lasting power of attorney to make decisions on their behalf. Some relatives had signed consent forms for people who had not had an assessment to determine whether or not they could make their own decisions.

Care plans were person-centred but did not always address all of people’s identified care and support needs.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

People told us that they felt safe when using the service; their relatives also said they felt people were safe. Staff we spoke with understood about safeguarding vulnerable people, they had received safeguarding training and said they would report any concerns appropriately.

The service had enough staff to attend the care visits scheduled. People and their relatives said that care workers arrived on time and stayed for the duration of their allotted visits.

Some people using the service were assisted with their medicines; we saw that these were well managed by the service. Care staff administering medicines received training.

The service undertook risk assessments for all aspects of the care and support people received in their homes. Care workers had been trained in infection control and used personal protective equipment when they supported people with personal care.

Staff received the training they needed to care for the people safely. New care workers who had not previously worked in health and social were undertaking the Care Certificate. The care certificate is a nationally recognised set of induction standards for people new to working in care.

Care workers had received regular informal supervision and had a documented annual appraisal. They also attended regular team meetings at which the vision and values of the service were discussed.

The people who needed help to buy food or prepare meals were happy with the support they received from care workers. The service also rearranged visit times in order to accompany people to healthcare appointments.

People and their relatives told us that care workers respected their privacy and dignity and promoted their independence. Care workers we spoke with could provide examples of how they did this.

Care workers could demonstrate that they knew people’s likes and dislikes and the service tried to match people with care workers that they would get on with.

People and their relatives (when appropriate) were involved in developing their care plans. They told us that the service was flexible and that they could change their care plans if they want