Home Angels Chorley is a domiciliary care agency registered to provide personal care for people in their own homes. The agency specialises in the provision of care and support for people with dementia and also specialises in end of life care. The agency operates from an office situated in a business park close to Chorley town centre which was registered with the Care Quality Commission on 18 December 2015. Previous to this the agency operated from other premises all in the Chorley area.

This inspection took place on the 28 April and 3 May 2017 and was announced to ensure that the Registered Manager and appropriate staff were available to speak with.

The Registered Manager was present during the visit to the registered premises and was cooperative throughout the inspection process. The Registered Manager is also the registered provider and Nominated Individual 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.

The service was registered with the Care Quality Commission in December 2015. We last inspected Home Angels Chorley in April and May 2016. At the inspection in 2016 we found the service was not meeting one of the regulations we assessed and we asked the provider to take action to make improvements. This was in relation to people’s safe care and treatment. The service as a consequence was rated as Requires Improvement overall and also for the domains of ‘safe’, and ‘responsive’.

We issued one requirement notice and asked the registered provider to tell us how they were going to make the improvements required. At this inspection we found that the registered provider and registered manager had made the changes and improvements needed to meet the requirement notice issued from the previous inspection.

People we spoke with told us they felt safe receiving care and support and that carers respected them and their home environment.

The service had safeguarding and whistleblowing policies in place which staff understood clearly.

Staffing levels were seen to be in place to meet the assessed needs of people receiving care and support from Home Angels Chorley. People who used the service, relatives and staff raised no issues with regard to staffing levels.

People and their relatives spoke highly of the staff that supported them and they told us that they believed care staff to be competent, caring and approachable.

Staff received an appropriate induction prior to them working alone and received on-going training and support in order to carry out their role effectively.

The service was working within the principles of the Mental Capacity Act 2005 and staff spoken with were aware of how the legislation affected, or could potentially affect the people they cared for. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People who were assisted with their nutritional and hydration needs told us they had no concerns in this area and were supported to eat and drink a healthy diet.

The service provided end of life care to support people to remain at home during their final days of life. Trained staff using training resources designed by NHS England, were also available, as needed. Staff spoke passionately about their role in keeping people at home at the end of their life.

Care plans were seen to contain good detail and were regularly reviewed. People we spoke with told us they were involved in the design of their care, if they wanted to be. Staff told us that they felt care plans had improved since our last inspection and that appropriate guidance was in place for them to deliver an e

This inspection took place on the 27 April and 4 May 2016, the first day was unannounced and the second day was spent talking to people and relatives via telephone conversations.

The Registered Manager was present during the visit to 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 Registered Manager was also the owner and nominated individual for Home Angels Chorley.

We last inspected the service in April 2014 and the service was judged to be fully compliant against the regulations looked at under the previous Health and Social Care Act regulations.

Home Angels Chorley is a domiciliary care agency registered to provide personal care for people in their own homes. The agency specialises in the provision of care and support for people with dementia and also specialise in end of life care. The agency operates from an office situated in a business park close to Chorley town centre which was registered with the Care Quality Commission on 18 December 2015. Previous to this the agency operated from other premises all in the Chorley area.

At the time of our inspection the service was delivering approximately 300 hours of care per week to 19 people. There were 16 members of care staff employed by the agency at the time of our inspection.

The service had policies and 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. There had been no medicines errors for the service within the 12 month period prior to our inspection.

However, we found that a number of people who were assisted, via prompts, with taking their medicines, had no risk assessments in place within their care plan or they were very limited in terms of detail.

The service had recruitment policies and procedures in place which we saw during our inspection. However, when looking at some people’s personnel records it was evident that procedures were not always followed. We have made a recommendation about this.

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.

All the staff we spoke with told us they felt supported in their role, both formally and informally and we found evidence to support this.

We checked whether the service was working within the principles of the MCA. 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 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.

We asked people if they were involved in the design of their care plans and if they knew what was in them. All the people we spoke with were aware of the existence of a care plan and confirmed that they had a copy within their home.

There was little evidence in the way of needs assessments carried out by the agency themselves within people’s care plans although due to the nature of the service many care packages did