Independent Living Home Care is a small domiciliary care agency operating in Thirsk and Sowerby. It provides various services to people living in their own houses and flats. The service supports older adults, younger disabled adults and those living with dementia. Not everyone using the service received a regulated activity, CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection four people were receiving a regulated activity.

The service was run by a single provider in day to day control of the service. It was therefore not required to have a registered manager. 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations.

At the last inspection in August 2015, we rated the service 'Good'. At this inspection, we rated the service ‘Requires improvement’. This is the first time the service has been rated Requires Improvement.

We found breaches of two of the fundamental standards of The Health and Social Care Act 2018 (Regulated Activities) Regulations 2014. These related to the systems and processes in place to monitor and improve the quality of the service and not following recruitment procedures to help recruit staff safe for working with vulnerable adults.

The provider had not understood when notifications should be submitted to the Care Quality Commission (CQC). This was a breach of the Care Quality Commission (Registration) Regulations 2009. We directed them to the guidance.

You can see what actions we told the provider to take at the back of the full version of the report.

Record keeping was not consistent and did not give staff clear instructions when people were supported with their medicines. We made a recommendation about the management of medicines.

The Mental Capacity Act (2005) was not consistently understood and applied to ensure people were empowered to make decisions for themselves and consider any risks affecting them. Despite this people told us they were involved in decisions about their care. There were enough staff to provide support and ensure people’s needs were met. People received care at their preferred times and knew which care worker would be visiting them.

Staff received training to give them the knowledge and skills needed for their roles. New members of staff received an induction which was adapted to reflect their levels of experience in working in care. Informal catch- ups and supervisions were arranged to help staff develop their confidence, skills and knowledge in their roles.

People were treated with dignity and respect. Staff knew how to support people in a way that promote their independence whilst recognising their limitations. People were supported to access health services. Emotional support was provided when required, including after hospital appointments, when people needed time to reflect on and come to terms with the information discussed.

People’s preferences and life histories were understood. People valued the attention to detail staff gave, understanding their specific requirements and enabling them to pursue their hobbies. People were supported to access the community, reducing their risk of social isolation.

Staff were flexible when providing care to people. When care needs changed or people declined care at a particular time adjustments were made to enable staff to support people.

The service had a clear focus on wanting to remain a small company. This was appreciated by people, relatives and staff alike. Staff understood their responsibilities and felt supported in their roles. This included having opportunities for professiona

The inspection was carried out on 17 August 2015. We gave the provider 48 hours’ notice of the inspection in order to ensure people we needed to speak with were available. This was the first inspection of this service since it registered with the Care Quality Commission (CQC) on 30 May 2015.

The service was run by a single provider in day to day control of the service and as such was not required to have a registered manager. 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.

Independent Living provides domiciliary care and support in the Thirsk and Sowerby area. It operates from an office located in Sowerby. The service is a small service with the provider, who also provides care and two members of care staff. They provide personal care to nine people.

People and their relatives we spoke with were very satisfied with the care and support they received. People told us they felt safe in the way staff supported them and had confidence in the staff.

Staff had received training in safeguarding adults; they were familiar with what constituted abuse and the procedures to follow if they suspected abuse had occurred.

Care and support was provided to people in their own home on a flexible basis and in accordance with individual needs. Risks to people’s safety and welfare had been assessed and information about how to support people to manage risks was recorded in people's care plan.

Recruitment checks had been completed prior to staff starting work. These checks were undertaken to make sure staff were suitable to work with vulnerable people. Staff received an induction prior to providing support to people; this included a period of shadowing so that the provider could be confident in staffs abilities and skills. Staff were supported in their roles through an ongoing training programme, supervisions and annual appraisal; and regular staff meetings.

Where people needed assistance taking their medication this was administered in a timely way by staff who had been trained to carry out this role.

People's health and care needs were assessed with them, and they were involved in developing their plans of care. People told us they were included in making decisions about how their care and support was provided. People’s plan of care was subject to review to meet their changing needs. Staff told us they felt well informed about people’s needs and how to meet them.

Policies and procedures were in place covering the requirements of the Mental Capacity Act 2005 (MCA), which aims to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People told us they received good care. Staff were described as kind and considerate and people told us that they were treated with dignity and respect.

People said they were confident in raising concerns and had been given copy of the complaints procedures. People using the service, their relatives were given opportunities to provide feedback on the service. This enabled the manager to address any shortfalls or concerns.

The provider had a clear vision for the service. They told us told us they wanted the service to remain small and provide bespoke care and support. The provider monitored the quality of the service through reviewing care packages with people who used the service and their relatives; and through satisfaction surveys. The staff team met regularly to hand over the care and support provided for people and to discuss and evaluate the agency's effectiveness.