The inspection took place on 19 and 21 December 2017. This inspection was announced.

This service is a domiciliary care agency based at an office in Strood. It provides personal care to people living in their own homes. This included older people, younger adults and people with complex health needs such as epilepsy, diabetes and physical disabilities. There were 84 people using the service at the time of our inspection.

The registered manager was employed at 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.

At the last Care Quality Commission (CQC) inspection on 21 October 2015, the service was rated as Good in all of the domains and had an overall Good rating.

At this inspection we found the registered manager and provider had consistently monitored the quality of their service to maintain a rating of Good.

Independent Care and Support offered an inclusive service. The staff followed policies about Equality, Diversity and Human Rights.

The registered manager was consistent in measuring the quality of people’s experiences and continued to work at putting people at the heart of the service.

The quality outcomes promoted in the providers policies and procedures were monitored by the registered manager. There continued to be multiple audits undertaken based on cause and effect learning analysis, to improve quality. Staff understood their roles in meeting the expected quality levels and staff were empowered to challenge poor practice.

The registered manager consistently understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA).

People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face or by telephone.

There continued to be enough staff deployed to meet people’s physical and social needs. Emergency backup systems continued to be operated to allow care to continue at all times.

The registered manager checked staff’s suitability to deliver personal care during the recruitment process. People’s medicines were managed and administered safely.

The registered manager continued to train staff so that they understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns. Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in their care plans.

People were consistently supported to eat and drink according to their assessed needs. Staff supported people to maintain a balanced diet and monitor their nutritional health.

Staff continually received training that matched people’s needs effectively and staff were supported with supervision and with maintaining their skills.

Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and carried personal protective equipment like disposable gloves and apron’s.

During this inspection, the inspector focused on answering five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and what the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. During our inspection people who used the service told us that staff delivered the care recorded in their care plans.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. Staff had access to support and advice at all times from a manager.

The manager ensured that staff underwent checks before starting work at the service. For example they checked a person’s character by carrying out Disclosure and Barring Service checks (DBS). This was formally known as a Criminal Records check. The manager operated robust recruitment process.

Staff had been trained in safeguarding people from abuse and staff understood their responsibilities to protect vulnerable people.

The manager had systems in place to check if staff were delivering care safely. .People who used the service told us staff were competent in their roles and that they were supported safely.

Is the service effective?

People had an individual care plan which set out their care needs. We saw that people had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. People who used the service told us that staff were reliable and that they were happy with the service they received.

The manager of the service carried out checks on staff whilst they were delivering care and support. People who used the service had been asked their views about the standard of service they had received.

Is the service caring?

We found that people were treated with respect and their dignity was maintained. People we talked with told us that they were relaxed and comfortable with the staff that supported them. People told us that they had positive relationships with staff, both those that delivered care and support and those in the office. People who used the service told us that staff were friendly and caring. People said “Before the staff leave they always make sure I have snacks and drinks within my reach”. Another person said, “Staff always make sure I have my community emergency alarm with me before they leave.” Other people told us that staff were “Always cheerful” and that “Staff spent time chatting to me which is good”. One person told us how staff made sure that they were comfortable and safe after they had hoisted them into bed and before staff left the call. For example, staff ensured that the person had the television remote, the bed control and their home telephone to hand.

Is the service responsive?

The service reviewed people’s care plans to ensure they were up to date. The manager of the service was available for people to contact. People who used the service told us that they did not have any concerns, but that they knew how to raise complaints.

There were policies and systems in place which ensured that the provider could learn from incidents that occurred to prevent them from occurring again.

Is the service well-led?

The provider continually monitored areas of risk at the service and made checks on quality. This included visiting people who used the service to ask what their views were of the service provided.

The manager ensured that people’s care was planned. Staff understood people’s needs because they followed people’s assessments and care plans. Systems were in place to monitor quality and safety. The manager ensured that staff were recruited with the right skills and experience for the service users they cared for. Staff received an induction when they started with the organisation. Staff received on –going training and were supervised by the manager. The manager gave staff the opportunity to develop their skills and knowledge in line with their job description and responsibilities.

This inspection took place on 21 and 28 October 2015 and was announced.

Independent Care and Support provides care services to people in their own homes mainly in the Medway area. The care they provided was tailored to people’s needs so that people could maintain or regain their independence. This included older people who had been discharged from hospital who needed help with day to day tasks like cooking, shopping, washing and dressing and help to maintain their health and wellbeing. There were 96 people using the service at the time of our inspection. There were six people with higher dependency levels using the service, with the remaining people assessed as low risk in terms of the care they needed.

There was a registered manager employed at 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.

People spoke about the staff in a positive light regarding their feelings of being safe and well cared for. They thought that staff were caring and compassionate. Staff were trusted and well thought of by the people they cared for.

The registered manager assessed people’s needs and planned people’s care to maintain their safety, health and wellbeing. Risks were assessed by staff to protect people. There were systems in place to monitor incidents and accidents.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse. Procedures for reporting any concerns were in place. The registered manager knew how and when they should escalate concerns following the local authorities safeguarding protocols.

The registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

Staff were recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding. Recruitment policies were in place that had been followed. Safe recruitment practices included background and criminal records checks prior to staff starting work.

Some people needed more than one member of staff to provide support to them. The registered manager ensured that they could provide a workforce who could adapt and be flexible to meet people’s needs and when more staff were needed to deliver care they were provided.

People felt that staff were well trained and understood their needs. They told us that staff looked at their care plans and followed the care as required. People told us that staff discussed their care with them so that they could decide how it would be delivered.

Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well.

The registered manager gave staff guidance about supporting people to eat and drink enough. People were pleased that staff encouraged them to keep healthy through eating a balanced diet and drinking enough fluids. Care plans were kept reviewed and updated.

There were policies in place which ensured people would be listened to and treated fairly if they complained. The registered manager ensured that people’s care met their most up to date needs and any issues raised were dealt with to people’s satisfaction.

People were happy with the leadership and approachability of the service’s registered manager. Staff felt well supported by registered managers. Audits were effective and risks were monitored by manager to keep people safe.