This announced inspection took place on 5, 7 and 12 September 2017. We last inspected Ginger Homecare in January 2016. At the inspection in January 2016 we rated the service as ‘Good’ overall and for all the individual domains of ‘Safe’, ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well-led’.

Ginger Homecare Limited is a privately owned domiciliary care agency providing practical and personal care to people living in the local community. The agency operates from an office base in Farrington, Lancashire.

At the time of our inspection there were approximately 120 people receiving a service from the agency which equated to approximately 1000 hours per week. The vast majority of people using the service had their hours commissioned by the Local Authority.

The Registered Manager was present during the inspection of the registered premises and was cooperative throughout the inspection process. 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. The Deputy Manager was also present throughout the inspection and was also cooperative. Both had worked at the agency for over 20 years.

People who received a service from Ginger Homecare told us they felt safe when staff from the agency visited them in their own home.

People we spoke with told us they were supported well to take their medicines on time by a competent staff team. We did however see some examples within care plans were people’s current needs were not reflected in this area and we have made a recommendation about this.

People’s needs were risk assessed prior to receiving a service from the agency. As with medicines management risk assessments, we found some examples where people’s current needs, were not consistent with the information within their care plan. We have made a recommendation about this.

People told us the staff that came to provide care and support were well presented and wore personal protective equipment (PPE) when assisting them with personal care. Staff confirmed with us that they had enough PPE to carry out their duties effectively.

We spoke with staff and asked them if they were supported to carry out their role effectively. All the staff we spoke with told us they felt supported by management and peers.

We saw evidence that staff received a thorough induction when they first started work with the agency and that they received a variety of training once they were established. Staff also received three monthly supervisions and an annual appraisal.

We found some conflicting information with regards to how people gave their consent. The agency had introduced a new system and paperwork to resolve this issue prior to the inspection process finishing.

People we spoke with told us they were happy with the care and support they received and that staff were caring and considerate in their approach. People and relatives we spoke with raised no issues with respect to dignity, privacy or confidentiality.

Improvements had been made to care plans in terms of the detail within them and how they related to individuals. This had been an issue raised at the previous inspection. Whilst some work was still needed, to ensure care plans were fully reflective of people and their current needs, we could see that a lot of work had gone into this aspect of the service. People told us they were involved in the review of their care if they wished to be.

The agency had an up to date complaints policy in place and we saw that complaints were responded to and investigated in line with their published procedures. People we spoke with told us they knew how to raise complaints.

People, relatives and staff we spoke with talked positively about the management of the service and told us they cons

This inspection was conducted on 27 January 2016 by the lead Adult Social Care Inspector for the service. We made phone calls to people using the service and relatives of people using the service on 3 and 4 February 2016.The provider had been given 48 hours’ notice of our planned visit, in accordance with our inspection methodologies of Domiciliary Care services to ensure that the Registered Manager was available to speak with. 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.

We last Ginger Homecare Limited on 20 August 2013 and the service was judged to be fully compliant with the previous regulatory standards.

Ginger Homecare Limited is a privately owned domiciliary care agency providing practical and personal care to people living in the local community. The agency operates from an office base in Farrington. Parking is provided outside the office building.

At the time of our inspection there were 80 service users receiving a service from the agency which equated to approximately 900 hours per week. Approximately 95% of people using the service were funded by the Local Authority.

The Registered manager, Deputy Manager and owner of the agency were present during our visit to the office, all of whom had worked at the agency for over 20 years.

The service had procedures in place for dealing with allegations of abuse.

Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Staff members spoken with said they would not hesitate to report any concerns they had about care practices.

We looked at the systems for medicines management. We saw clear audits were regularly conducted and detailed policies and procedures were in place. Each person’s care plan contained a medication risk assessment and a signed medication consent form was found in each care plan permitting care workers to prompt people to take their medication.

We discussed staffing levels with the registered manager. They told us that recruitment was an ongoing process but that staffing levels were sufficient to meet the needs of the people using the service.

Staff told us they felt supported in their role and that they received a thorough induction prior to them starting work. However we found little in the way of evidence that formal, recorded ‘face to face’ supervisions took place either within staff files or when speaking with staff.

We saw that staff attended regular training via the staff training matrix in the office and found staff to be knowledgeable about their caring role. We found evidence also within staff files of training undertaken such as safeguarding, moving and handling, medication, infection control and food hygiene.

People we spoke with told us they were happy with the care they received from the service and that the approach of staff was caring and compassionate.

We spoke with staff on issues such as confidentiality, privacy, dignity and how they ensured that people retained as much independence as possible whilst being supported.

People we spoke with and their relatives told us they knew how to raise issues or make a complaint and that communication with the service was good. They also told us they felt confident that any issues raised would be listened to and addressed.

We looked in detail at five people’s care plans. The content of each person’s care plan contained some good information and was up to date. However some of the information within care plans was task orientated and not personalised to the individual and in places lacked detail.

People we spoke with talked positively about the service they received, as did relatives we spoke with. People spoke positively about the management of the service and the communication within the service.

A range of quality audits and risk assessments had been con

People using the service were given sufficient information to enable them to give consent to their care plans. One person said, “It’s the first time we’ve had carers. They came to ask us what time we wanted them and what we wanted them to do and it’s all written down”.

Care plans were in place and these were followed in practice. However, we found that care plans were task focused and did not give information about how people wanted their care to be provided. Risk management plans were not always in place when risks had been identified. The manager took immediate steps to address these issues.

We found that people usually had the same team of carers and they arrived on time for their visits. We spoke with five people about their care. They were all very complimentary. One person said, “I depend on them for everything and I wouldn’t do without them. They are part of my life”. Another person said, “You can rely on them for anything. I couldn’t wish for better care”.

We found that safe and effective recruitment processes were in place and that the service had a staff team that was appropriately qualified and experienced. A staff member said, “We get loads of training and we aren’t asked to do anything we don’t feel able to do”.

People who used the service and staff were able to give their views about the service. Systems were in place to assess and monitor the quality of the service that people received. An effective complaints system was in place.

People who received support from Ginger Homecare told us they had been fully involved in the assessment of their support needs. They told us the care they received was provided in a way they wanted and when they wanted. One person said, “The staff are brilliant. They know the way I like to do things”.

People said they were always involved in any changes to the care they received or times they received this. They said Ginger Homecare was providing a reliable, flexible service that was meeting their needs. One person said, “The staff are kind and patient and always do what I ask them to.” Another person said, “The staff are sensitive to our needs.”

All staff had structured, frequent, training in care so that staff had up to date skills and knowledge. A person supported by the agency told us, “The staff know how to support us well. They are well trained at Ginger Homecare”.

Senior staff regularly spoke with and visited people to check they were satisfied with the care they received. They also visited staff without notice to supervise and monitor the care provided.

People using the service told us they were satisfied with the care and support provided by the agency. People said they shared a good relationship with the staff who they described as “caring” and “helpful”. One person said “They help me in every way; all the carers are kind and very understanding”.

People had signed their care plans to indicate their agreement and participation. However, the care plans seen were brief and did not provide information about how people wanted their tasks carried out. We also noted one person’s plan contained out of date information. This meant staff had limited information about people’s current needs and preferences.

People felt the manager and the staff team were approachable and accessible and they could talk to them at any time if they had any concerns or queries. People were given the opportunity to complete a customer satisfaction questionnaire from both social services and the agency. This meant people were able to express their views and opinions about the service.