This inspection took place on 30 and 31 March 2017 and was announced.

Direct care (Kent) provides care services to people in their own home in Kent and Medway. The care provided was tailored to people’s needs so that people could maintain their health and wellbeing or maintain their independence.

Care was delivered to older people some of whom were living with dementia and younger adults. There were 26 people using the service at the time of our inspection. The care and support people needed ranged from short calls to more intensive support packages requiring two staff.

At the last Care Quality Commission (CQC) inspection in July 2014, the service was rated as Good in all of the domains and had an overall Good rating.

The two providers of the service were also the registered managers. 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 the registered managers had consistently monitored the quality of their service to maintain a rating of Good.

People continued to experience care that was caring and compassionate. Staff were trusted and well thought of by the people using the service.

People continued to have their needs assessed and their care was planned to maintain their safety, health and wellbeing.

Risks were assessed and recorded by staff to protect people. There were systems in place to monitor incidents and accidents.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse.

The provider had updated their policies since we last inspected in line with published guidance and practice in social care.

Procedures for reporting any concerns were in place. The registered managers knew how and when they should escalate concerns following the local authorities safeguarding protocols.

Staff training covered both core training like first aid and more specialised training like catheter care. They also understood the Mental Capacity Act 2005 and how to support people’s best interest if they lacked capacity.

Staff continued to have good levels of support and supervision to enable them to carry out their roles.

Staff continued to be recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding.

Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well.

People were pleased that staff encouraged them to keep healthy through eating a balanced diet and drinking enough fluids. Care plans were kept reviewed and updated.

There were policies in place that ensured people would be listened to and treated fairly if they complained.

The management team and staff were committed to the values of the organisation and ensured they took these into account when delivering care and support.

People were happy with the leadership and approachability of the service’s registered managers.

We visited the offices of the services and spoke with managers and staff. We looked through care records and staff files and called people who used the service to gather their views on the service.

People we spoke with told us they were happy with the care they received. People made comments such as "They're very good", "They always come on time and never let me down" and "They are very good at what they do".

We looked at staff training records and saw that all staff had received training in subjects including health and safety, medication and infection control. We also saw that staff received regular supervision with a more senior member of staff and annual appraisals.

We saw that people and their relatives were sent questionnaires to check the quality of the service they received. People we spoke with told us that they were asked for their opinion on the service.

We looked at the complaints policy and procedure for the service. People we spoke with told us that they were given a copy when they started using the service and knew how to contact the service if they needed to make a complaint.

We looked at care records and staff files and saw that all were kept accurate and updated regularly.

We spoke to people and their relatives to gather their feedback on the care and support they received at the service. We spoke to staff about their roles, the care they provided and the training they had received and reviewed records.

People we spoke with told us that they were very pleased with the service they received. Relatives of people who used the service told us that they were able to be involved in planning their relatives’ care and were kept informed if there were any changes to their health. They told us their views were taken into consideration and one person said “They are very approachable, and they take me seriously”.

Staff said they liked working at the service and were given the training they needed to perform their roles safely. One member of staff said “This is the first job I’ve had that I’ve really enjoyed and felt supported”.

We did not speak directly to people who use the service but viewed some responses to recent quality assurance questionnaires. People who use the service were questioned about the competence, attitude and time keeping of staff. All of the responses received were positive in their comments and rated the staff as either good or excellent.

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 was 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. ‘The provider was given 48 hours’ notice because the location provides a domiciliary care service”. There were 25 people using the service when we inspected and the care and support was delivered to people in their own homes. The agency provided personal care, support with medication and some complex care and support to people with higher dependency levels. For example for people with physical disabilities or people who needed specialist feeding equipment such as PEG care and dementia. (PEG feeding tubes are used where people cannot maintain adequate food and drink intakes in the normal way.)

The agency had two registered managers who were also the owners of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the agency and has the legal responsibility for meeting the requirements of the law; as does the provider.

Managers assessed people’s needs and planned peoples care to maintain their safety, health and wellbeing. Risks were assessed to protect people who received care and for staff providing care. People said, “I feel more than safe, I could not ask for anything better”. And “My regular morning carer is everything a carer should be, genuine and honest”.

Managers ensured that they could continue the service to people in the event of foreseeable emergencies, such as during periods of extreme weather.

People’s rights and safety were protected because staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Managers knew how and when to submit DoLS applications and had ensured that staff received training in relation to protecting people’s rights.

The agency had robust recruitment policies that had been followed. This ensured safe recruitment practices. Staff backgrounds were checked prior to them starting work. The managers told us staffing levels were kept under review and adjusted according to people’s assessed needs.

People told us that staff met their needs. People told us that they received care and support in a timely manner. They said, “I have had a small group of carers for more than five years, everything is in order and I am very satisfied, there are no problems at all”. And “I get the same staff and my routine is identical”.

Staff had received safeguarding training and showed a good understanding of what their responsibilities were in preventing abuse. They knew the procedures for reporting any concerns they may have and had confidence the manager would respond appropriately to any concerns they raised.

People and their families, had been involved in planning their care. Where required, staff supported people to maintain their health ensuring they had adequate food and drink. .

People received care from staff who had been trained to meet their individual needs. People told us that staff were well trained. Managers encouraged staff to develop and provided training to meet the needs of people who received care. Staff said, “I have my NVQ 2 & 3 and have just started a management training course.” (A National Vocational Qualification (NVQ) is a nationally recognised qualification).

People told us that staff were caring. The agency provided guidance and training to staff to ensure they understood how to deliver care with respect and compassion. People gave examples of staff staying with them longer when they needed more time. Others told us about how staff treated them with respect. People said, “Staff always make sure I have a flask of hot drink to last me through to the next call”. Another person said, “I find the carers respectful and responsive”.

Managers encouraged people to get involved in how their care was planned and delivered. They respected people’s right to write their own care plans and direct their own care and support. The agency demonstrated that where appropriate they involved other people who were important to individuals receiving care. This enabled them to build a good picture of who people were, their likes, dislikes, skills and life experiences.

People told us that managers were approachable and listened to their views. Managers provided good leadership and carried out care task themselves when necessary. One person said, “Compared to other community care experiences I have had, this agency is extremely well organised”. Others said, “I have always found that any problems I may have with my care, all I have to do is let them know I have a problem, and it will be sorted fairly and promptly”. Managers demonstrated that they wanted to maintain and improve standards within the agency.