Everyday Recruitment Agency is domiciliary care service that provides support to people in their own homes. The service operates in West Sussex, including in Bognor Regis, Chichester, Selsey and The Witterings. At the time of our visit the service was supporting 134 people.

The service did not have a registered manager. Although the person responsible for the day to day management of the agency had applied to be registered with the Care Quality Commission (CQC) and had just undertaken an interview. They were now awaiting approval to be registered. A registered manager is a person who has registered with the 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.

At our last inspection to the service in April 2016 we found one breach of regulations. People were not always protected because risks to their health and safety had not been fully assessed. Where risks were known there was limited written guidance for staff on how to minimise them. We asked the provider to take action and the provider sent us an action plan In June 2016 which told us what action they would be taking. At this inspection we found that improvements had been made and the regulations were now met.

We also made one recommendation that the registered manager and provider review their quality assurance system to ensure that all aspects of the service were monitored and to ensure compliance with the regulations. At this visit we found that quality assurance systems were appropriate.

People received a safe service and risks to people were assessed and reviewed. We saw that care plans contained risk assessments for individuals and the risk assessment contained information on how risks could be minimised. There were also environmental assessments for people’s homes so staff knew any risks and what they should do to keep people and themselves safe.

People told us they were satisfied with the service and the support they received and felt safe with the people who supported them. There were policies and procedures regarding the safeguarding of adults. Staff were aware of the action to take if they considered anyone was being mistreated. . People received their medicines safely. There were sufficient numbers of staff employed to meet people’s needs. Recruitment processes were thorough to help ensure only suitable staff were employed to support people.

Each person had a care plan and a copy was kept in their home. Care plans gave guidance to staff on the support people needed at each visit. Staff received training to enable them to deliver the care people needed. Staff said there was suitable training and support provided so they could support people effectively.

Staff told us they had a good induction, including shadowing experienced staff before they started to provide support to people. They were supported in their roles and professional development by a system of supervision.

The manager and staff understood people’s rights to be involved in decisions about their care. People were involved in decisions about their care and support and were able to express their views. The manager and staff had received training in the Mental Capacity Act (MCA)) 2005 and associated legislation and knew what action to take if they thought a person lacked capacity to consent.

People were supported to eat and drink in line with their individual needs and this was recorded in their care plan. People’s healthcare needs were monitored by staff and the agency supported people to access healthcare professionals when needed.

People were supported by kind caring staff. People said they were encouraged to be independent as possible and that staff treated them with dignity and respect. People and relatives were involved in planning the care and suppo

The inspection took place on 26 and 29 April 2016 and was announced.

Everyday Recruitment Agency Limited, also known as ‘ERA’, is a domiciliary care service that provides support to people in West Sussex, including in Bognor Regis, Chichester, Selsey and The Witterings. At the time of our visit the service was supporting 155 people with personal care. This included 14 children between the ages of 4 and 18 years old.

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 may not have been protected from harm because risks to their health and safety had not always been assessed. Where risks were known there was often a lack of guidance for staff on how to minimise them and monitoring of risks was not always effective.

People received their medicines safely but in a few cases specific guidance on individual support needs was missing.

Staff understood local safeguarding procedures and reported any concerns promptly.

People had confidence in the staff who supported them. There were enough staff employed and the rotas were managed effectively. Staff received training to enable them to deliver effective care. They were supported in their roles and professional development by a system of supervision. Staff understood how consent should be considered in line with the Mental Capacity Act 2005. People and/or their representatives were involved in planning the care that they received. During our visit the registered manager modified the assessment form to ensure that the level of people’s involvement and consent was clearly recorded. Staff supported people to prepare meals and to eat and drink if required.

People spoke highly of the staff and told us that they treated them with dignity and respect. In our survey sent out prior to the inspection, 100 percent of respondents said that staff were caring and kind. A relative wrote a letter of thanks to the provider which read, ‘As you know I am very happy with so much about ERA but it is particularly the carers that make ERA so successful’.

People’s care needs and their satisfaction with the service was regularly reviewed. Staff responded quickly to changes in people’s needs and made referrals to other healthcare professionals such as the GP, district nurses or occupational therapist when additional support was required.

People felt able to contact the registered manager or staff if they had concerns and said that they received a quick response. People told us that they understood how to make a complaint.

The registered manager used feedback from people and staff to monitor the quality of the service and to identify improvements. Suggestions had been acted upon. Although there was a system of quality assurance by senior care workers in the community we found that some care plans were missing information and that checks on daily notes and medication records had failed to identify some issues. We have made a recommendation that the registered manager and provider review their quality audits to ensure that all areas of the service are checked.

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

We looked at the procedures and records held by the provider relating to prescribed medicines and their administration. The records we sampled were in the main complete, accurate and followed the procedures the provider was using.

We spoke to a number of people who used the service by telephone and they told us that they were all very happy with the support they got with their medicines. Comments included, "You cannot beat what we get", "The girls are brilliant" and "The staff in the office are very helpful when you ring them".

Therefore, people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

At the time of this inspection the agency was providing personal care to 74 people. We spoke to 13 of these people, or their relatives, and three care workers. Everyone expressed satisfaction with the care they received and the main care workers who visited them. For example, one person said, "I've got three lovely carers who come regularly. They help me get out of bed, make me a cup of tea and help me shower. I'm very happy with the service". Some people that we spoke with told us that of a weekend the delivery of care could be inconsistent. People expressed the view that this was due to changes in the care workers who visited them.

People also told us that they had been involved in making decisions about the service they wanted. For example, one person said, "They listen to you, check you agree with the help they are offering. This makes you feel like they really care". People also told us that they had been asked for their views about how the agency operated. Also that if they raised issues these were usually resolved.

Despite everyone expressing satisfaction with the service they received we found that the agency was not maintaining accurate medication records and was unable to demonstrate that medicines had been taken as prescribed. This placed people at potential risk.

We spoke to five people who received a service from Everyday Recruitment Agency Limited. They told us about the care and support they had received and confirmed they were involved and satisfied. They also told us that they found staff to be capable, friendly and reliable. We also spoke with a relative. They told us that the care worker who visited their family member was, “Very very good, I wouldn’t change her for the world”.

We spoke with five members of staff. They said that they had sufficient time on visits to provide a quality service but mentioned that travelling time was not included in the schedule. This meant that sometimes they had to start a few minutes early, be very efficient on the calls or finish late. One member of staff said of the agency, “They are good as an employer, I can ring them up and ask any questions I want”.

Despite everyone expressing satisfaction with the service they received we found that the agency was not maintaining accurate records and that this put people at risk of receiving unsafe or inappropriate care. This was a particular concern in the area of medicines where a new policy had recently been introduced but was not being followed. The manager was unable to demonstrate that support with medicine had been given at the appropriate level or that medicine had been taken as prescribed.

The majority of people told us that they received the same staff on a regular basis and that this had helped them to build up a relationship of trust with their care workers.

Everyone we spoke with said that care workers were friendly and helpful.

Everyone told us that they had been consulted about the times of their visits. They said that care workers were very rarely late. If this occurred they always received a telephone call beforehand to inform them of this and giving an expected arrival time.

People told us they had copies of their care plans in their home and that they had agreed the contents. They also told us that the agency checked that the care they received was what they wanted.

Some people that we spoke to said that formal reviews of their care packages did not take place. They did however say that they could always contact the agency and any necessary changes were made.

Everyone apart from one person told us that they were happy with the care they received.

People told us that they felt safe and care workers treated them well.

People expressed satisfaction with the care workers who visited them.