This inspection visit took place on 03 July 2018 and was announced.

Complete Care Services (Preston) is a domiciliary care agency providing practical and personal care to people living in their own homes in the Preston and surrounding areas. The agency includes supports for older people, dementia, mental health, physical disability and younger adults. In addition the agency provides support for people who misuse drugs and alcohol, learning disabilities and people detained under the mental health act. The agency is part of a private company that has three branches in the north west. Parking is provided outside the office building.

At our last inspection on 28 September 2017 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to their lack of auditing systems to identify and act on any issues. The service was rated Good overall during the inspection. At this inspection we found the provider had made improvements to ensure they met legal requirements. We found their auditing systems had improved to ensure the service was monitored in a timely manner and improvements made when required. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was not registered manager in place. 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. However, they were in the process of recruiting a suitable candidate as the previous registered manager had only recently left the service approximately two months ago.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People we spoke with and visited told us the service they received was provided by caring, polite and respectful staff. For example positive comments we received included, “Love the staff I have to say they are caring and nothing is too much trouble.” Also, “The carers close the blinds because I’m at the front of the house.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and confirmed this when we spoke with them.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified care and support people required to suit their individual needs. We found they were informative about care people had received. They had been regularly reviewed and changes made when required so they were up to date. Staff had the right information to reflect people’s changing needs and tasks required when visiting people in their own home.

The service had the same good systems for recruiting staff in place from the previous inspection.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the polici

The inspection visit at Complete Care Services (Preston) took place on 08, 09 and 10 August 2017 and was announced. The provider was given 48 hours’ notice because the service delivered domiciliary care to people living in the community. We needed to be sure people in the office and people the service supported would be available to speak to us.

Complete Care Services (Preston) is a domiciliary care agency providing personal care to people in the Preston and surrounding areas, living in their own homes. The agency covers a wide range of dependency needs including older people with a physical or learning disability and older people living with dementia or mental health problems. The agency's office is located on Preston’s Dockland, Riversway. At the time of our inspection there were 140 people receiving a service from Complete Care Services (Preston).

The service had a registered manager in place. 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 on 23, 24, 27,28,30 April & 01May 2015, we asked the provider to take action to make improvements related to consent, the administration of medicines and training. We requested there was a registered manager in post and all incidents requiring notification to commission were completed. We noted all these actions had been completed.

At this inspection, we noted auditing systems in use did not identify when staff had failed to document the care and support delivered.

This was a breach of Regulation 17 HSCA (RA) Regulations 2014 (Good governance).

Staff had received safeguarding from abuse training. They understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure. One staff member told us, “We did safeguarding training, it was very detailed.”

The provider had procedures around recruitment and selection to minimise the risk of unsuitable employees working with vulnerable people. Required checks had been completed prior to any staff commencing work at the service. This was confirmed during discussions with staff.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service. The number of people being supported and their individual needs determined staffing levels. Staff members we spoke with said they were allocated sufficient time to be able to provide the support people required.

Staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. Documentation indicated people were supported to meet their care requirements in relation to medicines.

Staff members received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. One staff member told us, “We get quite a lot of training.”

People and their representatives told us they were involved in their care and had discussed and consented to their care packages. We found staff had an understanding of the Mental Capacity Act 2005 (MCA).

When required, people were supported to maintain a balanced diet to prevent the risk of malnutrition and dehydration. This included staff preparing snacks and drinks for people in their own homes.

The registered provider worked with other health care services to meet people’s health needs. Care records contained information about the individual’s ongoing care requirements.

People spoke about care staff who visited in a warm, compassionate manner. They told us they were treated

We considered our inspection findings to answer questions we always ask: -

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People and their relatives told us they felt safe and comfortable when they received support from Complete Care Services. One relative told us, “I feel my husband is very safe in their hands. I have absolutely no worries about that”.

Our discussions with staff confirmed they were trained in the use of equipment utilised to support people in their care. This meant the provider had protected people from unsafe care by ensuring staff were adequately trained.

We saw evidence that people were supported with their medication appropriately. One relative told us, “I am satisfied the carers are well-trained and know what they’re doing with mum’s medication”. This showed people were protected against the risks of unsafe management of medicines because appropriate protocols were in place.

Records we reviewed confirmed staff were recruited safely. One person told us, “I am confident that the company recruits and trains staff properly. A new worker started this week and she was very good”. This meant the provider had ensured people were protected against unsafe care because staff were properly recruited and trained.

Is the service effective?

We observed that staff respected people and enabled them to make decisions about their care. One relative told us, “They have involved us in my husband’s care plan. We agreed and discussed some changes around his reduced mobility”. This meant people were safeguarded against inappropriate care because the service was effective in consulting people about their changing needs.

People told us where their needs had changed the agency was effective in acquiring appropriate equipment to support them. People’s social, health and support needs were assessed and regularly reviewed. Support plans were individualised and risk assessments were in place. This meant people were protected against ineffective care provision because people’s changing needs were monitored.

Is the service caring?

We spoke with people and their relatives to gain an understanding of their experiences of the support they received. Their response was very positive. One person explained, “The carers are like my angels. I wouldn’t want to change a thing”. A relative told us, “They’re very polite and they advise rather than take over. They treat mum as an individual”.

Staff explained that they worked in a caring and friendly manner. They described being respectful to and working with people to understand their needs. One staff member told us, “The company are fantastic at keeping us up-to-date with training. It adds to my experience and understanding, especially in the specialist care we provide for people”. This showed people were safeguarded against inappropriate care provision because staff understood people’s individual needs.

Is the service responsive?

People’s needs were properly assessed, monitored and reviewed. This meant the provider had continuously assessed whether the service was able to maintain people’s care levels. One staff member told us, “We look at people’s changing needs with our supervisors, who will then amend the care plan”.

People told us they were involved in the review of their care. One person said, “They have involved us in my husband’s care plan. The manager saw us recently and we agreed some changes around his reduced mobility”. This demonstrated the provider had minimised the risks of unsafe care because the service had responded to people’s changing needs.

Is the service well-led?

Complete Care Services had a range of quality audits in place. Other regular processes underpinned this, such as staff supervision and team meetings. People who accessed the service were given the opportunity to feedback about the service. This meant people were protected against inappropriate care because the manager had systems to check the quality of care.

One staff member told us, “Managers will regularly contact service users directly to check how I’m doing and the care they’ve received. I get feedback from my manager, which is very useful in my work”. This showed the manager ensured people received appropriate care because their views were actively sought and acted upon.

People using the service were given sufficient information to enable them to make informed decisions and give consent to their care and support plans. One person said, “I’m highly involved with my mum’s care. They consult with me and mum all the time. The office staff check how things are going as well. They’ll do anything we ask. She couldn’t get any better anywhere”.

Care assessments and care plans were in place and these were followed in practice. We found that people usually had the same team of carers and they arrived on time for their visits. One person said, “My mum has four visits a day, seven days a week and she has the same team of carers. It seldom changes, only for holidays and illness”.

We found that safe and effective recruitment processes were in place and that the service had a staff team that was appropriately qualified and experienced to provide a safe and effective service. A staff member said, “The training is fine and its always being updated. We aren’t asked to do anything we don’t feel able to do”.

People who used the service were able to give their views about the service. Systems were in place to assess and monitor the quality of the service that people received. An effective complaints system was in place.

We spoke with the manager, staff, relatives of clients, and people who use the service. We asked people who use the service about the way they were treated by staff and the agency in general. Comments were positive and included,

"All the people are polite and caring."

"The staff are always on time and know exactly what to do when they get here. They provide me a lifeline."

"I need a lot of help to get washed and dressed, they never get impatient with me and treat me with respect and dignity."

"We have had one or two agencies but these are definitely the best. The carers are well presented, competent and the manager always checks up with me to see if everything is ok."

One person we spoke with told us they were satisfied with the level of care and support they receive from the agency. Comments included, "The staff went through everything with me."

We spoke with five people who use the service, about their experiences being supported by the agency. They told us the staff and management provided sensitive and flexible personal care support and they felt cared for.

This inspection took place across six dates; 23,24,27,28,30 April & 01 May 2015 and was unannounced.

The last inspection of Complete Care Services took place on 07 November 2014. At that time we found care was not planned and delivered in a way to meet people’s needs. Staff were not arriving on time or staying for the allotted time period to provide care and support to people who used the service. The provider was found to be in breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The provider took appropriate action and responded to people’s concerns. Systems, such as call monitoring and spot inspections by the manager have improved call times and during this inspection we received feedback from people who used the service that confirmed improvements had been made. We found the provider to be compliant with the new regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014, Person Centred Care.

Complete Care Services (Preston) is a domiciliary care agency providing practical and personal care to people in the Preston and surrounding areas. At the time of the inspection there were 110 people who accessed the service.

Complete Care Services (Preston) as a condition of its registration should have a registered manager in place. 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 service had not had a registered manager in place since February 2015. The current manager was recruited in February 2015. However at the time of our inspection she had not commenced the application process to become a registered manager with the Care Quality Commission.

We found that the service provides a good standard of person centred care. Feedback from service users was positive in regards to being involved in plans around their care, support from staff and people told us that they felt safe and well cared for.

The manager had started to implement robust monitoring systems and at the time of our inspection the provider was updating and amending the service policies and procedures in line with requirements stipulated by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our findings demonstrated that the registered person did not consistently protect people against abuse and improper treatment. We found that staff did not always follow escalation procedures to ensure that the manager could appropriately assess and monitor safeguarding concerns. We also found that the manager was not fully aware of requirements to notify the Care Quality Commission when safeguarding incidents had been reported.

We looked at staff recruitment and training files. Recruitment and induction processes were found to be supportive of staff development needs. However, we found gaps in training and supervision records. The provider did not have a comprehensive training policy to highlight expected training outcomes for staff and time scales for training refresher courses.

People who used the service told us they felt involved in care decisions and we saw that service users and, or their relatives had signed care plan agreements. However, we found that the provider did not have processes in place to consider people’s ability to consent, in line with the Mental Capacity Act 2005.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safeguarding service users from abuse and improper treatment, staffing and need for consent.

We also identified breaches of the Health and Social Care Act 2008 itself as well as the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.