This inspection took place on 23 August and 13, 24 and 27 September 2018. On 23 August and 13 September 2018, the visits were announced. On 24 and 27 September we made telephone calls to people who used the service, relatives and staff.

At the last inspection in August 2017 we rated the service as Requires improvement. At that inspection we found the provider was in breach of Regulation 19, Fit and proper persons employed, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-led to at least good. During this inspection we found improvements had been made and recruitment was now managed safely; with systems in place to monitor this.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. On the first day of our inspection, there were 31 people using the service. On the second day there were 25 people.

There was a registered manager in post. 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.

People told us they felt safe with staff and the care they were provided with. They said they received a good standard of care. There were enough staff to support people safely. Staff had received appropriate safeguarding training and risk assessments had been developed when needed to reduce the risk of harm occurring. We did however find that some risk assessment records needed to be strengthened.

Systems for managing medicines safely were overall, effective. The registered manager responded swiftly to some issues we identified with the records of medicines support to ensure safe medicines management. Staff understood their role and responsibilities for maintaining good standards of cleanliness and hygiene.

Training records showed staff had completed a range of training and staff spoke highly of the training they received. Staff told us they received support, supervision and appraisal to help them understand how to deliver good care and records we looked at confirmed this.

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 supported this practice. However, we recommended the provider reviewed the records of capacity assessments and decisions made in people’s best interests to ensure people’s rights were fully upheld. Staff understood their roles and responsibilities to seek people's consent prior to care and support being provided.

People received support from health care professionals where they needed this to keep well. Where needed, people who used the service received support from staff to ensure their nutritional needs were met. Staff were trained to respond to emergencies and said they felt confident to do so. There were systems in place to make sure managers and staff learnt from any accidents and incidents.

People spoke positively about the caring nature of staff and the support they received. People told us they were treated very well. Staff showed a good knowledge of the people they supported and understood how to maintain people’s privacy and dignity. It was clear they had developed positive relationships with people and encouraged their independence.

Peoples care and support needs were reviewed regularly. However, some people's care plans did not always contain sufficient detail about their needs. The registered manager took action at the time of the inspection to rectify this.

This was an announced inspection carried out on the 7, 10 and 17 July 2017. This was the first inspection of the service since they became a newly registered service, due to a change of address in May 2016.

ILS24Health Care Limited is registered to provide personal care to people in their own home.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

The registered provider did not always take appropriate action to follow safe recruitment practices. We found appropriate checks had not always been carried out before employing workers.

We identified some potential risks with how medicines were being managed and the registered manager responded swiftly and took action to make sure appropriate arrangements were put in place.

Some risk management plans lacked detail and did not give full guidance on how risks were to be managed. We recommend risk management plans are reviewed to ensure full guidance is available to staff on how to minimise risks to people.

Relatives of people who used the service told us they were happy with the support their family members received from the service. They said they felt their family members were safe, received a good standard of care and they would recommend the service to others.

Staff showed a good understanding of promoting choice and gaining consent from people. The registered manager and staff we spoke with had an understanding of the principles and their responsibilities in accordance with the Mental Capacity Act (MCA) 2005.

Arrangements were in place to make sure any dietary requirements were met and a range of other professionals were involved to help make sure people stayed healthy.

There were sufficient numbers of staff to meet people’s needs and keep them safe. People’s relatives told us staff arrived on time and they had a regular team of familiar staff to provide the care and support. We saw people were provided with care and support by staff who had the appropriate knowledge and training to effectively meet their needs. Staff told us they felt well supported and received regular supervision.

People who used the service and their relatives were involved in planning the care and support received. They told us they felt fully involved and listened to when discussing care needs. People’s relatives told us they felt theirs and their family member’s views on how care was to be delivered were fully respected.

Care records did at times lack detailed guidance for staff to follow which meant there was a risk people’s needs would be missed or overlooked. However, staff were very knowledgeable on people’s care and support needs. It was clear they had built positive relationships with people and could describe people’s individual needs well.

There were systems in place to monitor and improve the quality of the service provided. However, these were not always robust enough; our concerns regarding recruitment had not been identified through the checks in place.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.