This inspection took place on 25 October 2018, 31 October 2018, 5 November 2018 and 26 November 2018. On 25 October we made calls to people who received care from J and K Care specialists. On 25 October 2018 and 5 November 2018 we visited the office of J and K Care Specialists. On 26 November 2018 we spoke with staff who worked for J and K care specialists. The inspection was announced. We gave 48 hours' notice of our intention to visit J and K Care specialists to make sure people we needed to speak with were available.

J and K Care Specialists is a domiciliary care agency. It is registered to provide personal care and support for people in their own homes in the county of Hampshire. At the time of our inspection J and K Care Specialists were supporting 110 people with personal care.

The did not have 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 service had a manager who had begin the registration application process with us. They were waiting for their application to be approved.

The provider’s systems for safely managing medicines were not always effective. Audits of medicines administrations records (MARs) were not always effective in identifying errors or omissions. Staff recorded missed doses of medicines but reasons for these were not always documented. Handwritten MARs were not always clear or legible. Records of discussions with people’s GPs were not available when they had not taken a medicine for periods of up to 23 days.

The provider’s systems for monitoring quality and safety within the service were not always effective. Audits of MARs were inaccurate and incomplete as they failed to identify omissions and errors.

The provider had suitable arrangements in place to protect people from avoidable harm and abuse. Staff we spoke with were clear about their responsibilities and had received the required safeguarding training. Sufficient numbers of staff were deployed to support people's needs and maintain their safety. Safe recruitment processes ensured the provider only employed staff who were suitable to work in a care setting. Risks to people were assessed and recorded in their care plans. Records showed that these were managed safely.

The provider had an infection control policy in place and people were protected from the risk of acquiring an infection. The registered manager recorded accidents and incidents and supported staff to reflect on these to prevent recurrences.

People’s needs and choices were thoroughly assessed in line with evidence based practice to support them to live as independently as possible.

People received care from suitably skilled staff who had received regular training and supervision to help develop their knowledge.

The provider complied with the requirements of the Mental Capacity Act 2005. Staff were confidently able to describe how they would apply its principles when caring for people.

People were supported to maintain a balanced diet. People were supported to access care from relevant health and social care professionals. Staff had developed respectful, caring relationships with the people they supported. Staff encouraged people to express themselves and promoted their independence, privacy and dignity.

Care plans were individualised and were written in partnership with people and their families where appropriate. These were regularly updated. Complaints and concerns were responded to promptly and investigated thoroughly.

The provider had systems in place for monitoring the quality and safety in the service. These were not always effective in identifying omissions and errors. Actions were captured in the Service Improvement Plan (SIP) which included dates for completion.

Staff

This inspection was announced and took place on 2, 3 and 4 February 2016. J & K Care Specialists provides a domiciliary care service to enable people living in the Basingstoke and the surrounding areas to maintain their independence at home. At the time of our inspection there were 110 people using the service, who had a range of health care needs. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including epilepsy, diabetes, sensory impairments and mental health diagnoses. At the time of the inspection the provider deployed 100 staff to care for people and meet their individual needs.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People told us they were supported by staff they could trust, who made them feel safe. Relatives told us they had no concerns for the safety of their family member because there was good continuity and consistency of care from staff who were committed to the people they supported.

People were protected from abuse because staff were trained and understood the actions required to keep people safe. There had been three incidents since our last inspection, which had been referred to the local safeguarding authority. These incidents had been reported, recorded and investigated in accordance with the provider’s safeguarding policies and local authority guidance. People had been safeguarded against the risk of abuse by staff who took prompt action if they suspected people were at risk of harm.

Risks associated with people’s care and support needs were identified and managed safely to protect them from harm. We observed staff support people safely in accordance with their risk assessments and support plans. Risks affecting people’s health and welfare were understood and managed safely by staff.

Daily staffing needs were analysed by the registered manager to ensure there were always sufficient numbers of staff with the necessary experience and skills to support people safely. Staff told us there were always enough staff to provide the required support, which we observed in practice. Resilience to cover unforeseen absence was provided by office staff who had all completed the provider’s required training and regular bank staff.

Staff had undergone robust pre-employment checks as part of their recruitment. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.

People received their medicines safely, administered by staff who had completed safe management of medicines training and had their competency assessed by the registered manager.

The provider supported staff to meet people’s needs with an effective programme of induction, supervision and appraisal. The provider’s required staff training was up to date and refreshed regularly to ensure staff had retained and updated the skills and knowledge required to support people effectively.

People were supported to make their own decisions and choices. Staff supported people to identify their individual wishes and needs by using their individual and unique methods of communication. People’s human rights were protected by staff who demonstrated clear understanding of guidance and legislation relating to consent and mental capacity.

People were supported to maintain a healthy balanced diet by staff who understood their dietary preferences. We observed people supported appropriately to ensure they received sufficient to eat and drink.

Staff recognised when people were unwell or upset, and took prompt action to promote their health and wellbeing. The registered manager had ensured people were refe

People's needs were assessed. Care and support was planned and delivered to meet their needs safely. People told us that they were involved in the planning of their care. Their wishes and experiences were important to the provider and were respected. They told us their views were taken into account in the way the service was delivered.

People told us that they were happy with the care and support they received. One person said "I am very happy with my care, I am involved with everything." All the people with spoke with said they had no complaints.

There were appropriate arrangements in place to assist people with their medication.

The provider had an effective recruitment and selection process. Appropriate checks were made on staff before they began work.

There were effective processes in place to assess and monitor the quality of the service that people receive.

We spoke with seven people who used the service and they all made very positive comments such as “I have high confidence. They are very, very good”; “the staff are fully trained and very attentive”. Another person told us that “they work very hard to match the carer with the client, I have every faith”. Another said “excellent, very good. We are lucky to have them, they are kind and considerate”

People we spoke with told us their care plans were accurate and were reviewed regularly. They said that staff arrived on time and always stayed for the right amount of time.

The staff we spoke with demonstrated a good understanding of peoples support needs while respecting their privacy and dignity. They were aware of their responsibilities in keeping people safe and reporting any suspected abuse.

Staff told us they felt supported and involved in how the service was provided. The provider asked for the opinions of people who used the service and the staff. Where appropriate they made changes to improve the service provided.