This inspection visit took place on 10 January 2018 and was announced. The registered provider was given 48 hours’ notice as we needed to be sure people in the office and people the service supported would be available to speak to us. Holywell care services is a domiciliary care agency. It provides personal care to 24 people living in their own houses and flats in the community. It provides a service to older adults and people with a learning disability.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. “Registering the Right Support CQC policy.

There was a registered manager in place. 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.

At the last inspection in October 2015, the service was rated ‘Good’. At this inspection, we found the service met the required fundamental standards and remained ‘Good’.

During this inspection, we found staff had received training to safeguard people from abuse. They understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of adults who may be vulnerable. Staff we spoke with told us they were aware of the safeguarding procedure.

Staff members received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There was an appropriate skill mix of staff to ensure the needs of people who used the service were met. New staff worked alongside experienced staff members whilst they learnt their role. One staff member told us, “I had two days training it was in Preston it did help. I have just completed my care certificate they [registered provider] signed me up to NVQ3. They are on top of everything.”

The registered provider planned visits to allow carers enough time to reach people and complete all tasks required. People told us staff respected their privacy and dignity during their visits.

Care plans were organised and had identified the care and support people required. We found they were personalised and informative about the care people received. They had been kept under review and updated when necessary. They reflected any risks and people’s changing needs.

Staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. The registered provider completed spot checks on staff to observe their work practices were appropriate and people were safe.

Staff were provided with personal protective equipment to protect people and themselves from the spread of infection.

The registered provider had procedures around recruitment and selection to minimise the risk of unsuitable employees working with people who may be vulnerable. Required checks had been completed before any staff started work at the service. This was confirmed during discussions with staff.

The registered provider had regularly completed a range of audits to maintain people’s safety and welfare.

Staff told us they received regular formal and informal support from the management team.

People and their representatives told us they were involved in their care and had discussed and consented to their care packages. We found staff had an understanding of the Mental Capacity Act 2005 (MCA).

When appropriate, meals and drinks were prepared for people. This ensured people received adequate nutrition and hydra

This inspection visit took place on 09 September 2015 and was announced. We told the provider one day before our visit that we would be coming. We did this to ensure we had access to the main office and the management team were available.

Holywell Home Care offers domiciliary care and support to a range of people in their own homes. The range of support provided includes assistance with personal care, domestic duties, laundry tasks, shopping, and meal preparation. At the time of our inspection visit we were informed Holywell Care Services provided services for 18 people.

There was a registered manager in place. 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.

At the last full inspection on 16 July 2013 the service was not meeting all the requirements of the regulations that were inspected at that time. There was a shortfall in one area ‘Care and Welfare’. However a follow up inspection on 20 February 2014 the service was meeting the requirements of the regulations that were inspected at that time.

People were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. One staff member said, “The service runs well we have enough staff to cover clients.” Staff were able to accommodate last minute changes to appointments as requested by the person who used the service or their relatives.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People told us they liked the staff and looked forward to the staff coming to their homes. One person who received a service said, “I could not manage without them they provide a lifeline for me.”

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.

People were supported to eat and drink where needed. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

We found a number of audits were in place to monitor quality assurance. The registered manager and provider had systems in place to obtain the views of people who lived at the home and their relatives.

At our previous inspection visit in July 2013 we found people did not always receive the support they required, to ensure they were always protected against the risks of receiving inappropriate or unsafe care and support.

As part of this responsive follow up inspection we spoke with the senior care coordinator, training officer, care staff, clients and their carers. We also visited people who received a service in their own home. We did this to take account of the views of people who used the agency and staff who worked there.

Staff we spoke with told us things had changed for the better, in that people’s needs had been reviewed and risk assessments put in place in the home of people who used the agency. Comments from staff included, “I know the care plan and risk assessment was updated and in the homes of the clients I visit.”

We visited a person in their own home to see what changes had been made. We found care plan records in place but not reviewed. This could potentially put people at risk of not receiving appropriate up to date care and support. We spoke with the senior staff member responsible who said it was an oversight and since the previous inspection, care and risk assessment records had been updated.

We spoke with the commissioning authority who had been monitoring the service since September 2013. They had found improvements in the care and support the agency provided.

People being supported and their relatives spoke positively about the qualities of the staff team. We were told that staff were always polite, kind and caring. Staff were described as, “Very good” and “Excellent”. One person said, “Cannot complain about the carers they are all very good”.

In the main people were also pleased about the quality of care delivered. However a relative we spoke with expressed some concerns that a particular member of staff did not always ask his mother want she wanted. We were told that this member of staff presumed what the client wanted.

People also told us that generally there was a good consistency of staff support, with the same care worker or small team of care workers visiting each day. It was clear that support staff had built up good relationships with the people they supported and that these relationships were valued. One relative said, “My husband can speak good English but it is nice for him when the carers speak to him in his own language”.

Staff told us that a range of training was taking place, qualification training was available and that the manager was approachable and supportive. We were told that surveys had recently been distributed to capture the views of people using the service. People also told us that they were visited by senior staff giving opportunity to give feedback about the quality of the service. However we noted that record keeping in people’s home’s needed to be improved in order to keep people safe.

We spoke with a range of people about the agency. They included the owner, manager, staff, relatives and people who received a service. We also had responses from external agencies including social services. This helped us to gain a balanced overview of what people experienced using Hollywell Care Services.

People who use the service told us the agency provided a good service. Comments included, “We are really glad we have Hollywell the staff are tremendous.” Also, “No complaints they are very reliable, competent and polite when they come and visit us.”

People told us they had received a visit from the owner of the agency before the service commenced. They told us their needs had been discussed and they had agreed to the support to be provided. They told us their carers provided sensitive and flexible personal care support and they felt well cared for. One person said, “The manager always keeps in touch to see everything is ok I like the personal touch the agency has.”

We found that there was enough skilled and experienced staff so that people had their care delivered at the right time, usually by the same people and in ways they wanted. One person said, "They do try and stick to the same carers which helps."

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe with the care staff and said they would report any concerns to a manager.

Without exception the service users we spoke with and their relatives all spoke very highly of the agency and of the staff team that supported them. We were told that staff were always polite, cheerful and respectful and that people’s privacy, dignity and independence were always well respected.

We spoke with the relative of a person who had fairly recently started using the service. This relative confirmed that, “Somebody from the agency visits from time to time to see how things are and to ask if we are happy with the service, and we are very happy.” This same person stated how pleased she was that the support staff that visited actually talked to her daughter and listened to what she had to say, and then took into account her decisions on how she wanted the care to be delivered.

Another user of the service described how staff asked her what her preferences were on a daily basis for assistance with personal care such as bathing, showering or just an all over wash. We were told, “They ask me all the time, I know what they are going to do each day but we decide on the day how I want it done.” Another person said, “The lady in charge visits regularly and asks if everything is going alright, they are a concerned bunch.”

People were clearly happy with the service provided and spoke very highly of the support staff describing them as, “Wonderful", “Caring”, “Fantastic”, “Some wonderful girls. We are very satisfied; I just wish we had had them earlier”.

People told us that there was good consistency of staff support, with the same care worker visiting most days. For people who needed two staff or several visits a day, the same small team of support workers was allocated. We were told, “****** is a lot happier with these carers, they always talk to ***** and ask her what she wants. It helps that there are the same people coming so they get to know each other.”

It was clear that staff had built up good relationships with the people they supported and their close family members and that these relationships were valued. One person told us how much she looked forward to the support worker visiting her at home and said that, “If I am down the carers cheer me up.”

We were repeatedly told that staff treated people with care and respect and protected them from harm. People said that they felt comfortable and safe using the service and knew who they would speak with if they did have any concerns. The people spoken with were however very clear in telling us that they had no concerns about the agency or the staff team that supported them.

Contact details of the agency, plus details of how to make a complaint had been given to each person to be kept in their home, alongside other information such as their care plan.

Members of staff spoken with told us that a thorough recruitment process had taken place prior to them being offered employment at Holywell Care Services.

People told us that they had confidence in the staff team, that staff were competent in supporting them in the way they preferred and that they were very satisfied that their needs were understood.

We received a lot of positive comments about the staff group with people saying that staff were polite, courteous, friendly, respectful, very caring and appeared to have a good understanding and skills for the job. We spoke with some relatives who also spoke highly of the staff.

Staff told us that they had received good training and that they felt very well supported. One person said, “The door is always open for any advice or support, I am very well supported.” Another member of staff said, “They are big on health and safety. This is a very caring agency, we see the person not the disability, we think we are good.”

A user of the service and the relatives we spoke with all told us that they were regularly contacted or visited, so that the agency could assess the quality of the service and the competence of the member of staff. People also told us that they were very satisfied with the level of care and support provided.