D.Care is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults, people living with dementia and physical disabilities.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

Not everyone using D.Care received 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.

This inspection was undertaken on 10 and 13 July 2018 and was announced. We gave the provider 48 hours' notice of our inspection as we needed to be sure key staff members would be available. At the time of the inspection 112 people were receiving a regulated activity from D.Care.

A registered manager was 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.

Not all staff had received up to date training, yet people felt the staff to be competent and the provider’s representative was taking action to ensure staff followed their training schedule consistently.

There were sufficient numbers of staff available to attend all calls and the management team were reviewing the allocation processes to ensure they were robust.

Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people in their own homes.

People told us they felt safe. Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. Risks relating to the health and support needs of the people and the environment in which they lived were assessed and managed effectively.

Where staff supported people to take their medicines, we found this was done in a safe way. Staff followed infection control procedures and used personal protective equipment when needed.

Staff completed an induction programme and were appropriately supported in their work by the management team.

Staff followed legislation to protect people’s rights and sought consent before providing care or support to people.

Where staff were responsible for preparing meals, they encouraged people to be involved in making choices about what to eat and supported them to maintain a healthy, balanced diet based on their individual needs and preferences.

Staff had built positive relationships with people, encouraged them to be as independent as possible and involved them in decisions about their care.

Staff treated people with dignity and respect and protected people’s privacy during personal care.

People were also supported to raise complaints should they wish to.

At the time of the inspection no one using the service was receiving end of life care. However, the registered manager assured us that people would be supported to receive a comfortable, dignified and pain-free death.

People had confidence in the service and felt it was managed effectively.

There was an effective quality assurance process in place at the service. The management team sought and acted on feedback from people. Arrangements were in place to share lessons learnt from incidents and inspections and to promote best practice.

There was an open and transparent culture. The registered manager notified CQC of all significant events and policies were in place to encourage staff to raise concerns.

We inspected both the residential and domiciliary care services provided by this provider. An expert by experience, a person with experience of using care services, telephoned 25 people who received a domiciliary care service. People were positive about the service they received. One said “I was asked when I wanted the visits and they fit in with my routine”. Another said “my carers often do extra jobs if they are needed” and a third said “I had to tell the agency that I didn’t want a certain carer again. They listened to my concerns and I haven’t seen her again”. People did comment that they would like to know which care staff would be visiting them each week. One said “I would like to know who is coming in advance”. We also spoke with seven domiciliary care staff who told us they had sufficient time to meet people’s needs and had received a range of training. They told us they were provided with copies of care plans so knew what care people needed.

Within the residential service we spoke with four of the twelve people who used the service, two relatives, and two members of the care staff. We also spoke with the registered manager and a member of the cleaning staff. All the people we spoke with were happy with the level of care they received. One person told us “they can’t do any more than they do”. The two relatives we spoke with were satisfied with the way their relatives were cared for. One said “they give a really good level of care”.

Residential and domiciliary staff demonstrated a good knowledge of people’s needs. However, people’s care plans and risk assessments did not always reflect their most current needs. In the residential home, records relating to people’s care were not up to date and had not been completed in full. This placed people at risk of receiving care that was inappropriate or unsafe.

The home was clean and hygienic. All staff had completed infection control training and were aware of infection risks and action they needed to take.

We found there were appropriate recruitment, induction and staff support procedures. People told us there was a consistent staff team within both the residential and domiciliary care services.

The views of people who use the service, their relatives and health professionals who visited the home were sought by means of an annual survey. A survey had also been completed for people using the domiciliary care service. However, quality assurance systems were lacking and audits were not carried out regularly and issues identified in audits were not addressed with staff. Therefore, the quality of the service did not improve as a result.

To help us to understand people’s experiences of the service we telephoned them, as this is a domiciliary care agency. We spoke to the eight people who use services, their family and six staff who were providing care to them. People said that they were “very happy” with the care and support they were receiving. They commented that the staff were “superb” and “wonderful”. Two people said that that they staff provided “excellent care” and they would continue to use the agency. People told us that they usually had the same staff which meant that there was continuity in their care.

People were assessed prior to receiving care. Following risk assessments, care plans were put in place to reflect the care and support needed. People said that they were treated with respect and the care records contained people’s preferred form of address. There was a robust recruitment procedure that that management followed. We found that all necessary staff’s checks were completed prior to them starting work.

There was an internal audit and people views were sought. People told us that they would approach the agency with any concerns. Information on how to raise concerns were available to them.

We spoke with five people and all the staff who were on duty at the time of our visit. People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They said that the staff supported them and they had choices in relation to when they got up and went to bed. Comments included” you can get up when you are ready and it is not a problem.” One person told us that they were ‘very happy’ with the care that their spouse was receiving. They said that they were involved in their care and the staff supported them.

Some people were unable to tell us about their experiences due to their cognitive problems. To help us to understand the experiences of people. We observed how people spent their time, the support they received from staff and whether they had positive outcomes.

We observed interactions between the staff and people who use the service. People told us that they were treated with respect and that the staff were kind, courteous and supported them as needed. We heard staff talking to one person in a calm manner when they got distressed and stayed with them until they were calm. At different times of the day we saw staff supporting people to move around the home and ensuring they were able to mobilise and their movements were not restricted.

Two people told us that they had choices in relation to the time they got up and went to bed. They also told us that they were offered choices and alternative meals were provided. One person told us that they were ‘mainly vegetarian’ and did not like meat. We observed that they were provided with the main meat dish at lunchtime and they told us that they had not eaten it. The provider told us that there was alternative meal that this person could have received. The staff could not tell us why this had not been offered to this person.

People living at the home told us that they felt safe and they would talk to the staff if they had “any worries”. They told us that the staff were “very good” and they received the care and support they needed. One person told us that the staff had contacted their doctor when they were unwell.

We spoke to six residents as part of this visit. People said that the staff were ‘marvellous’ and someone had been in to see them in hospital prior to moving into the home. One person told us that they had been supported to bring in small items of personal belongings from their home. They said that was very good and ‘lovely to have their belongings around them.'

People told us that they were happy with the care they were receiving. They said that the staff were very supportive. They told us that they had choices as to where and how they spent their day.

They told us that they felt that their dignity and privacy was always respected. One person who was in a shared room told us that the staff always brought in the mobile screen when they received personal care. Another person commented that they chose to share a room as they found that the room was more suited to them.

People said that the food was ‘always very good’ and they had choices. One person told us that they did not like the set meal for that day and had requested an alternative. We noted that this was provided to them.

People said that they would be happy to approach the manager or the provider with any concerns.

The inspection was carried out on the 2, 3 and 7 September 2015. Twenty four hours’ notice of the inspection was given to ensure that the people we needed to speak to were available. Whitley Bank House provides a personal care service to people in their own homes. At the time of our inspection around 100 people were receiving the service.

The service had a registered manager. 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 our last inspection we found care records were not always up to date and accurate. Checks on the quality of the service provided were not thorough. We asked the provider to take action.

People said they felt safe with care staff and their needs were met. Staff had been trained to spot signs of abuse and were confident about what to do if they had concerns. There were sufficient staff to ensure people received the support they needed from a consistent group of care staff.

Risks to people’s health and wellbeing were assessed and action taken to reduce the risk. People received their medicines in a safe manner and were supported to access healthcare if they needed it. Staff employed at the agency were subject to checks on their suitability to work with people receiving care, and had completed training to enable them to carry out their duties competently.

Staff knew asking people for their consent was important and people said they were given choices by staff, and their preferences were respected. People said staff were kind and caring and respected their privacy and dignity when providing care. People were treated as individuals and staff had formed positive and friendly relationships with them.

Staff felt supported by the management team. Staff were involved in the development of the service and were supported by supervision meetings and informal conversations with the management team.

Quality assurance measures were in place which involved getting feedback from people using the service and making improvements based on this. Checks on staff practice, record-keeping and care delivery were carried out regularly.