This inspection took place on 14 November 2016 and was announced. We gave the manager prior notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office.

Home Angels Healthcare Services Ltd is a domiciliary care agency providing care and support to mostly older people who live in the community. At the time of our inspection there were 45 people using the service and receiving personal care.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 supported us during the inspection.

People felt safe while supported by the staff and relatives agreed their family member were safe. Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

People were supported by sufficient staff to meet their individual needs. However, some people told us they were not always informed about the changes to and timings of the visit. Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.

People were treated with respect and their privacy and dignity was promoted. People said their support workers were good and supported them in the way they wanted most of the time. Staff were responsive to the needs of the people they supported and enabled them to improve and/or maintain their independence with personal care. Risks to people’s personal safety were assessed and plans were in place to minimise those risks. There were safe medicines administration systems in place and people received their medicines when required. People's health and wellbeing was monitored and appropriate action was taken when required.

Staff training records indicated which training was considered mandatory by the provider. Most of the staff were up to date with their mandatory training. The registered manager had planned and booked training when necessary to ensure all staff had the appropriate knowledge to support people. Staff received supervision and appraisals to discuss various matters and review their performance.

People received support that was individualised to their specific needs. Their needs were monitored and support plans were kept under review and amended as changes occurred. People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure people's rights were promoted.

Staff felt they worked well together and supported each other, which benefitted people. Staff felt management worked with them as a team most of the time though the communication could be improved at times. The registered manager was aware of the concerns and action was being taken to address this.

Quality assurance systems were in place to monitor the running of the service and the quality of the service being delivered. The registered manager continuously looked at ways to improve the service. They praised the staff team for their dedication and hard work and appreciated their contribution to ensure people received the best care and support.

On the day of our visit 32 people were using the service. They were supported by seventeen care staff plus the registered manager, the deputy manager, and two care co-ordinators. The service also employed a finance officer.

We spoke with five people who use the service, five staff: the registered manager and the deputy manager. The focus of the inspection was to answer five key questions:

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?

The service was safe. People who use the service told us they felt safe. Staff had received safeguarding training and knew how to recognise and deal with cases of suspected and actual abuse.

People’s care plans had included full needs and risk assessments to ensure they were treated in a way that did not put them at risk of receiving inappropriate care.

All information and records relating to the service were kept either on a secure shared computer drive or in locked drawers. Only designated members of staff had access to specific types of information.

Is the service effective?

The service was effective. People told us they felt properly cared for and that staff were properly trained and competent to carry out their duties. Each person had a fully completed and up to date care plan which was tailored to their specific needs.

People’s views were taken into account, for example through the use of regular satisfaction surveys, and staff also had the opportunity to give their feedback.

There were sufficient numbers of staff to provide an appropriate level of care to people. Care staff had either completed, or were in the process of completing, appropriate qualifications in health and social care.

Is the service caring?

The service was caring. People we spoke with were positive about the service they received. One person said: “I’m very happy with my angel (staff).” and another said they thought the service was “not bad” and that “they do what I want them to do”. A third person said they thought the service was “pretty good”. All the people we spoke with thought the staff were kind and friendly.

Care staff had a good awareness of people’s needs. They were able to constantly monitor people’s health and wellbeing and where necessary make amendments to a person’s care plan.

Is the service responsive?

We found issues relating to punctuality of care staff’s visits to people who use the service. All the people we spoke with said that staff had been late, sometimes on a regular basis, and often they were not informed about this. However, none of the people we spoke with said that a visit had ever been cancelled so they were always able to receive the care they needed.

Care plans were regularly updated to reflect changes in people’s needs.

Is the service well led?

We found that the service was well led. The service had a registered manager. The provider regularly met with all staff to seek their views and to share any issues with them that might affect the service.

There were systems in place to monitor and assess the quality of the service on a regular basis. These included satisfaction surveys and a range of service audits.

We spoke with seven people who used the service, the manager and three staff.

We found that people’s needs were assessed and care was delivered in the way people wanted it to be. People told us that they were ''always treated with great respect and dignity’’. People told us they ‘’always feel safe in staff hands, including when I’m being hoisted’’.

We saw that the agency worked with other services for the benefit of those they offered care to. People said the agency ''keep us informed about our care package and tell us who to contact if we have any concerns about our future care’’.

We found that the agency completed checks on new staff to make sure they were ‘fit’ to work with vulnerable people. Staff were supported to offer good quality care to people. People described care staff as, ''very good staff who know exactly what they’re doing’’.

The service had ways of checking that they maintained and improved the quality of care they offered. People said they had ''never had to make a complaint but would be confident to do so, if necessary’’.

We found that the agency did not keep all the records that they should. Some records that they did keep were not accurate.

We found that some plans of care did not contain detailed information about people’s preferences and choices. Some did not clearly describe how staff were to give people care. However, people told us that they always received care in the way they preferred. People told us that they were always treated with respect and that their dignity was maintained. One person said ''there is no question that I am always treated with respect.’’ Care was delivered safely and people told us that they were ‘’very happy’’ with the quality of care they received. The service knew how to protect people from all forms of abuse. People told us that they ‘trusted staff’ and ‘’felt safe’’ with them in their homes. Staff were supported and trained to ensure they were able to give good care. People told us that staff were well trained and ‘’knew exactly how to help them.’’ Most of the people we spoke with told us that they had no concerns or complaints about the service.