The inspection took place on 16 January 2017. FirstCol Services Ltd is a home care service providing care and support to 35 people living in their own homes who are in receipt of the regulated activity of personal care. The service supports older people and people who are living with dementia or other conditions, to enable them to continue living in their own homes. Some people privately funded their care whilst others had their care funded by the local authority. The service is based in Worthing, West Sussex.

At the time of the inspection there was a new manager in post who had applied to become the 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. Since the inspection took place the new manager had become registered with the CQC.

Some people were supported by staff to have their medicines. Some people were prescribed PRN medicines. PRN medicines are given 'when required' and should be administered when symptoms are exhibited. There was no specific guidance for staff regarding when and how to use such medicine, what the expected effect would be and the maximum dose and duration of use. This meant that people were at risk of not being given PRN medicines consistently and in accordance with prescribed instructions. Medication Administration Records (MAR) were used to record and monitor the administration of people’s medicines. We found that there were some gaps in recording on the MAR charts. The provider’s system for monitoring recording had identified that there were gaps, but it was not clear what actions had been taken as a result. The manager had introduced a new system for monitoring MAR charts, but this was not yet fully embedded. We have identified this as an area of practice that needs to improve.

People told us the service was reliable and helped them to feel safe living at home. One person said, “They do make me feel safe, very much so, they are all very good.” Risks to people had been identified and were managed effectively. People were supported by staff who had a clear understanding of their responsibilities with regard to keeping people safe from avoidable harm and reporting any safeguarding concerns. The provider had robust recruitment procedures in place to ensure that staff were suitable to work with people. There were enough staff to provide care safely and people told us that they received their visits on time and that staff stayed for the expected duration of the visit.

Staff received the training and support they needed to carry out their roles effectively. People told us they had confidence in the staff. One relative said, “They have helped my husband to be able to walk again, their perseverance and encouragement has contributed to his recovery.” Staff had a good understanding of their responsibilities with regard to the Mental Capacity Act 2005. They asked people for their consent before providing care. Where people lacked capacity, best interest decisions were documented in line with the legislation.

People were supported to have enough to eat and drink. Where risks and nutritional needs were identified staff monitored their food and drinks and checked their weight regularly to manage the risks. Staff told us they offered people a choice depending upon what food they had available. People told us that staff supported them to access health care services if they needed to. One relative said, “They have been excellent, the physiotherapist showed the carers what to do and they encourage (person’s name) to move. They pick up on little things and bring it to my attention in case I need to speak to the doctor.”

People spoke very highly of the care they received. One person said, “You can’t run peop