We inspected this service on the 7 and 10 November 2017. The first day of the inspection was unannounced which meant the service were not expecting us on the first date of the inspection.

HICA Homecare Chorley is a domiciliary care agency registered to provide personal care for people in their own homes. The agency provides care and support services as the preferred provider for three extra care schemes, the 'Buckshaw Retirement Village' in Chorley, 'Brookside' in Ormskirk and ‘Heyswood’ in St Helens. The service was not providing domiciliary care for anyone within the wider community at the time of our inspection. Across the three schemes, at the time of our inspection, just over 1300 hours support per week were being delivered

Not everyone using HICA Homecare receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We last inspected the service in March 2016 and found two breaches of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. These related to; Safe care and treatment and Person centred care. The service was rated as requires improvement overall and requires improvement for two of the key questions; safe and responsive. We rated the home good in the effective, caring and well-led key questions.

At this inspection we found the service had met the previous breaches. Risk assessments were now in place for all people who needed medicines, including those people who self-administered and support plans had been reviewed and reflected people’s needs. We have rated the home as good overall and for each of the five key questions.

Everyone we spoke with old us they felt safe receiving care and support and that staff were kind, caring and professional. We could see that people felt comfortable in the presence of the care staff that assisted them.

Staff we spoke with had a good understanding of the services safeguarding policy and knew how to recognise and report potential safeguarding issues.

People were supported to take their medicines safely and processes were in place to order, store and record people’s medicines. No-one we spoke with raised issues about how their medicines were managed.

The people we spoke with were happy with the consistency, timeliness and ability of the care staff that assisted them. Staffing levels were judges to be appropriate for the assessed needs of the people using the service. Some agency staff were used to cover night time shifts in particular but this usage had reduced at the time of ours inspection and recruitment was underway to fill staffing vacancies.

Staff received an effective induction prior to them working alone with people. Staff then went on to received training, supervision and support to enable them to carry out their role effectively. The service listened to feedback from staff who had undertaken the previous induction programmes and changed how staff were inducted to give them practical experience sooner. This showed that the service listened to its staff and acted upon what they said.

Staff we spoke with understood the Mental Capacity Act 2005 and how this legislation potentially affected people within the service they provided support to. We saw evidence of training in this are taking place.

People told us their privacy and dignity were respected and promoted by the care staff and that staff treated them well. The observations we made throughout our inspection confirmed these views.

We could see that people were involved in decisions about their day to day life and that people’s involvement was in line with their wishes. People were encouraged to take part in the activities that were in place at each scheme but people told us there was no pressure put on them to do so.

People and relatives we spoke with told us they knew how to raise issues or make a c

This inspection took place on the 10 & 11 March 2016, the first day was unannounced.

The manager was present throughout the inspection and was cooperative throughout the inspection process. The manager was part way through the process to become the registered manager for the service. 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.

We last inspected the service in June 2014. We identified a breach of regulation for medicines management. An action plan was received and a pharmacy inspector inspected the service in October 2014 and judged the service to be compliant for medicines management.

HICA Homecare Chorley is a domiciliary care agency registered to provide personal care for people in their own homes. The agency provides care and support services as the preferred provider for two extra care schemes, the 'Buckshaw Retirement Village' in Chorley and 'Brookside' in Ormskirk. The service was also looking to provide domiciliary care within the wider community going forward.

At the time of our inspection the service was delivering approximately 800 hours of care per week across both extra care schemes as well as providing an emergency response service to all the people living within both complexes, whether they had a commissioned service or not.

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 found that a number of people who were assisted with taking their medicines, some on an ad hoc basis, had no risk assessments in place within their care plan. We also found no risk assessments for people who self-administered their medicines within the care plans we reviewed.

We asked people if there were enough staff to meet their needs. We mainly received positive comments however a couple of people raised concerns regarding how much time staff had with them.

We asked staff about the continuity of care for people, i.e. if they visited the same people regularly. They told us that this did happen for the majority of the time unless there was unplanned absence such as short term sickness.

The service had effective recruitment policies and procedures in place which we saw during our inspection.

People we spoke with told us their needs were met in the way they wanted them to be. They spoke highly of the staff that supported them and told us that they believed the staff to be competent, caring and approachable.

We saw that staff attended regular training via the staff training matrix we were given and also found evidence within staff files.

We spoke with staff regarding their understanding of the MCA, the responses we received were good in terms of their understanding of the legislation and staff were very knowledgeable when discussing the issue of consent.

We asked people if they always got enough to eat and drink throughout the day and night. Many people were able to get a drink themselves, but people with less independence told us that they had drinks left for them within reach and we saw evidence of this during our inspection.

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. Staff were knowledgeable in all areas and were able to talk through practical examples with us.

Good information was provided for people who were interested in moving in to the service. The service users’ guide and statement of purpose outlined the services and facilities available, as well as th

We inspected HICA Homecare to review action taken in relation to one area we had found the provider to be non compliant in when we last visited in May 2014.

We found that the service was safe because people were protected against the risks associated with use and management of medicines.

People received their medicines at the times they needed them and in a safe way. Medicines were administered appropriately and, where necessary were kept safely in people’s homes.

People who used the service told us they were happy with the support they received and said they felt safe. One person told us, "I have no problems here, I feel very safe and everyone is very nice to me". Staffing levels were managed well and staff had access to relevant good quality training.

We found that people were very happy with the care workers who visited them and that they were competent in their role. All of the people we spoke to told us they were happy with the care and support they received. One person said, "There is an awful lot of staff and a lot of people. You do get to know some of the staff but I don't mind seeing different people as long as they know what they are doing, which they all do".

People knew how to comment on the service they received and felt comfortable raising any concerns if they felt this necessary. There were adequate quality monitoring tools in place to measure the effectiveness of the service and this linked into the bespoke auditing tool used by HICA.

As part of our inspection we were able to talk to some of the users of the care and support services. The people we spoke to were positive about the care and support that they received. "The staff are so helpful, they always find the time to help me when I ask for it".

The people we spoke to said they felt safe and knew who to approach if they had any concerns.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

People we spoke with told us they felt safe whilst receiving care and support from HICA Homecare and felt able to raise any concerns with care staff or the managers within the service. One person who received a service said, "I feel safe living here and with the carers. I have only ever had one minor issue with a carer and it was dealt with. I don't like reporting people but I know who to go to if I have to". One of the relatives we spoke to told us, "The staff are very approachable and friendly. I would not hesitate to contact the office if there was a problem".

Staff we spoke to told us that they had received appropriate medication training. We saw that medications were stored appropriately within peoples own apartments. We saw that the majority of entries on MAR charts were signed, witnessed and countersigned. However we found a number of issues across a three month period for one service user that showed prescribed medication had run out. This meant that this particular service user did not take their prescribed medication on a number of occasions.

Is the service effective?

The four members of staff we spoke to confirmed that they had regular supervision and annual appraisals that took place every January. We saw evidence of this within staff records. Supervision covered areas, such as, presentation of employee and dress code, attendance, training, concerns, issues discussed, decisions and actions made. Appraisals covered work performance, improvements needed, training, practical assessments for the administration of medication, achievements were recorded as well as challenges, objectives and actions needed.

Is the service caring?

We looked at six people's care plans. All were written in a person centred way and included detailed pre-admission information. People's assessed needs were well recorded and plans were person centred. We spoke with seven people who used the service as well as two family members. All were happy with the care they or their loved ones received. One person told us, "I'm very happy. the staff are helpful in every way and it is a very caring environment here".

Is the service responsive?

We saw that relevant risk assessments were in place within each person's care plan covering a range of topics such as; bathing and showering, moving and handling, medication and environmental.

Is the service well-led?

We were shown the bespoke audit tool that HICA used across all their services, the results of which were sent up to board level on a monthly basis. Examples of audits included medication, infection control, complaints and accidents and incidents. The tool was also used to measure human resources issues such as sickness and staff capability.