This inspection took place on 1 August 2018. We gave the provider 24 hours’ notice of the inspection to make sure the registered manager would be available to speak with us.

At our last inspection on 3 March 2017, we found a breach of regulation relating to guidance available to staff about how to support people safely. We found improvements were needed in a total of three key areas. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question effective to at least good.

At this inspection we found improvements had been made in all key areas, and the provider was meeting the fundamental standards required by regulations.

Enthuse Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It is registered to provide a service to people with a range of social care needs. These include older people, younger adults, and people living with dementia, mental health needs, physical disability and sensory impairment.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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 provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and in line with their agreed care visits. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. There were arrangements in place to protect people from risks associated with the management of medicines and the spread of infection.

Care and support were based on detailed assessments and care plans, which were reviewed and kept up to date. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. Where appropriate, people were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs.

Care workers had developed caring relationships with people they supported. People were supported to take part in decisions about their care and treatment, and their views were listened to. Staff respected people’s independence, privacy, and dignity.

People’s care and support took into account people’s abilities, needs and preferences, and reflected their physical, emotional and social needs. The provider arranged events for people at their office which kept them in touch with the wider community. People were kept aware of the provider’s complaints procedure, and complaints were managed in a professional manner.

The provider had a clear vision and strategy, which was shared with staff. Systems were in place to make sure the service was managed efficiently and to monitor, assess, sustain and improve the quality of service provided.

This inspection took place on 03, 09 and 13 March 2017 and was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be available in the office.

This service is a domiciliary care agency. It provides personal care to people living in their own homes and flats in the community. At the time of our inspection the service was providing personal care to 105 older people with a variety of care needs, including people living with physical frailty or memory loss due to the progression of age.

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.

People and their families told us they felt safe and secure when receiving care. However, we found that the risks assessments relating to people’s health and wellbeing were not always in place. These did not include information about people’s health conditions such as diabetes and were not always adequate to support people appropriately.

Relevant recruitment checks were conducted before staff started working at Enthuse Care to make sure staff were of good character and had the necessary skills. However, there were unexplained gaps in staff employment histories.

People’s medicines records were not always completed appropriately and information on where to apply medicated creams was not always clear.

People and their relatives expressed mixed views about the leadership of the service. They raised concerns over not being able to speak to management at the office and not being provided with a weekly rota to inform them which staff would be visiting their home to provide care.

People felt the service did not always respect people’s preferences in respect of the gender of staff who supported them with personal care.

Staff received training in safeguarding adults. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction designed to ensure staff understood their new role before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development. There were sufficient numbers of staff to maintain the schedule of care visits to meet people’s needs.

People who used the service felt they were treated with kindness and said their privacy was respected. Staff had an understanding of legislation designed to protect people’s rights and were clear that people had the right to make their own choices.

Staff knew what was important to people and encouraged them to be as independent as possible.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans were regularly reviewed to ensure people received personalised care. A complaints procedure was in place.

Staff felt supported by the manager and could visit the office to discuss any concerns. Procedures were in place to investigate complaints and learn from any accidents or incidents.

We identified one breach of regulations. You can see what action we have told the provider to take at the back of this report.