Jemcare provides care and support to people in their own homes in the Copeland and Allerdale areas. At the time of our visit they were supporting around 280 people. Call times varied with some people having minimal visits a few times a week to other people having support for longer periods from two members of staff. The service was offered to older people, people with a learning disability and to those people living with complex healthcare needs.

At the last inspection 15 July 2016 the service was rated overall as Good. However, we found that the way staff were recruited had not always been safe. We asked the provider to take action to make improvements in staff recruitment, and this action has been completed.

The service was managed by the provider who was the registered person for Jemcare. 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 staff were friendly, kind and caring and people valued the service they received. Their privacy and dignity were respected and promoted by the care staff.

People told us that they felt safe when receiving care and support from staff. Staff knew how to recognise and report potential safeguarding issues and they received appropriate training in this area.

There was a robust and detailed recruitment programme in place that helped to ensure people received good standards of care from a skilled staff team. Staffing levels were sufficient to ensure people received standards of care that enhanced their welfare, safety and day to day living.

Staff training, support and development was given a high priority. The care staff were well trained and supported to be able to provide the care people needed. Specialist training was given to staff to meet people’s individual support needs.

Staff received comprehensive induction when they first started work at the service and received on-going supervision and an annual appraisal of their performance. Staff spoke of opportunities for development and were enthusiastic about gaining skills and qualifications in order to support people.

Thorough risk assessments were in place to protect people from risks but also enabled them to take positive risks. Risk assessments and care plans were person centred and up to date.

People were included in planning and agreeing to the care they received. People could ask for changes to their planned care and the service agreed to these where possible.

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 support this practice.

The service had developed good links with healthcare and social care professionals to support people with their health and well-being. Medicines were handled safely and people received support with their medicines as they needed. People received the support they needed to prepare meals and drinks.

The registered provider and senior team set high standards and monitored the quality of the service to check these were maintained. Where issues had been highlighted by people we saw the provider had taken action to address these.

Jemcare provides care and support to people in their own homes in the Copeland and Allerdale areas. At the time of our visit they were supporting around a hundred people. Call times varied with some people having minimal visits a few times a week to other people having support for longer periods from two members of staff.

The service was managed by the provider who was the registered person for Jemcare. 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 who were supported by Jemcare told us that they felt safe because the staff team understood their responsibilities in keeping people safe

The service was suitably staffed with enough members of the team to allow for suitable care delivery. In the main staff were recruited appropriately but we discovered that some staff had visited service users prior to all checks being completed.

This was a breach of Regulation 19: Fit and proper persons employed. We made a compliance action about this matter.

All staff received an appropriate induction. The service had a disciplinary process that was used if there were any issues of poor practice.

Medicines were managed appropriately by the staff team.

Staff understood how to control infections while working in people's homes.

Staff received suitable levels of training and support to allow for each person to develop in their role.

Staff supported people to have suitable levels of nutrition and hydration.

Health professionals were called on when necessary. Staff were careful to monitor people's health care needs.

People told us that the staff team were kind and caring and that they treated them with dignity and respect.

Assessments and care plans were suitably detailed and up to date. Staff and service users confirmed that these were kept in people's home and updated when needs changed.

People were supported to pursue interests and go out into the community if this was part of their care and support package.

People told us that they were confident that any complaints would be dealt with appropriately. The service had a suitable complaints procedure in place.

We had evidence to show that the team worked well with other professionals when people received care and support from a number of agencies.

Staff and people who used the service said that the provider was accessible and easy to talk to. Staff felt that the leadership was fair and that the service was well organised.

The service had a quality monitoring system in place. We had evidence to show that people were consulted about the care delivery and that changes were made based on quality assurance outcomes.

Our expert by experience spoke to around fourteen people by telephone and people were generally very positive about the care and support they received. People were asked about the way care was delivered and about the attitude and aptitude of the carers who came to their homes. Here are some of the comments we received:

"They’re great."

"They never let us down."

"We’re relaxed with them."

"They’re kindness itself."

"They’re very polite and very helpful."

We spoke to some relatives during these calls and this is what they told us:

"[My relative] is quite happy with the carers."

"The carers have a laugh with my [relative]."

We also asked people about how they were supported to be given good levels of nutrition. The people we spoke to were satisfied with how staff prepared meals and drinks.

We looked at how staff supported people to take their medication. People told us that they were satisfied with the way this was done. We found some problems with the way this was assessed and recorded and we made a compliance action about this.

We checked on the facilities in the office and found these to be secure and well equipped. We also looked at the way care was recorded and this was generally done very well. Records were kept confidential and were suitably stored in the office. Everyone we spoke to told us that they had a care plan in their home and that staff made records of each visit. They were happy with the content of records.

On this occasion we did not visit people who use the service but we contacted a small random selection of people by phone.

Generally people were satisfied with their care:

"I can only give them a good name...quite satisfied ...if I wasn't I would soon get another agency...but had them for a number of years and no problems."

"The staff are very nice...and they treat me and my home properly. I am satisfied..."

"Have had them for a good few years and they have improved a hell of a lot...much better staff now"

People told us that they were consulted by their social worker and by the staff of Jemcare so that they only received care that they had consented to.

"They always explain what they need to do...and never force me."

We saw good evidence to show that care was carefully planned in consultation with the person and with other professionals. Care plans were suitably detailed so that staff could give consistent care. People we spoke with said that they were happy with the service.

"My care is wonderful...the service is beyond reproach!"

"It is like having another family of girls who look after me...it stops me being a burden on my own family."

People who were cared for by this service were protected from harm and abuse. The manager had suitable systems in place to report any concerns in an appropriate way.

Staff in the service had good levels of training and support to enable them to care for people. One team member said:

"We get plenty of training. I am one of the trainers for manual handling and I induct new staff. I make sure no one goes out on their own until they are competent."

The manager and the provider had worked on their quality monitoring systems since we last visited and they had good systems in place. They monitored the way staff worked and contacted service users regularly to give people the opportunity to comment on the quality of care.

One person said:

"I have been visited twice by management who checked I was happy with the service."