This inspection took place on 11 and 12 January, 2018 and was announced.

Knowsley and Liverpool East Office is a domiciliary care agency. It provides care to people living in their own houses and flats in the community. It provides a service to young and older adults. At the time of the inspection the registered provider was providing support to 18 people.

At the time of the inspection there was no registered manager in post. 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. At the time of the inspection the registered provider was recruiting into the role of registered manager.

At the previous comprehensive inspection which took place in November, 2016 the registered provider was rated ‘Requires Improvement’. We found the registered provider was not meeting legal requirements in relation to ‘Safe Care and Treatment’ and ‘Need for Consent’.

During this inspection we found that a number of improvements had been made and the registered provider was complying with all health and social care regulations.

There were a number of different systems in place to assess and monitor the quality of the care being provided. This meant that people were receiving safe, compassionate and effective care. Such systems included weekly and monthly governance meetings, quality audits, care plan and medication audits as well as annual quality questionnaires.

Care plans and risk assessments which we reviewed were well maintained, regularly reviewed and updated in order to minimise risk and ensure the correct level of support was being provided.

Care plans were individually tailored to each person who was being supported and a person centred approach to care was evident throughout the inspection. Person centred means care which us tailored around the needs of the person, not the organisation. Staff were familiar with the support being provided and people’s wishes, choices and preferences were well known.

Medication management systems were being safely managed. Staff had received the necessary medication training. People had the relevant medication care plan and risk assessments in place which included detailed information about how medication administration needed to be supported.

Recruitment processes were reviewed during the inspection. All staff who were working for the registered provider had suitable references and disclosure and barring system checks (DBS) in place. DBS checks ensure that staff who are employed are suitable to work within a health and social care setting. This enables the registered manager to assess level of suitability for working with vulnerable adults.

Staff received regular supervisions and annual appraisals. Staff expressed how they were fully supported in their roles; all necessary training had been completed and they felt that they were able to fulfil their roles effectively.

There was a system in place to monitor and assess all accidents and incidents. These were recorded on an internal database system, trends were analysed on a weekly and monthly basis which then helped the registered provider to establish trends and risks which needed to be managed.

The day to day support needs of people were well managed by the registered provider. Appropriate referrals were made when needed and the relevant guidance and advice which was provided by professionals was being followed accordingly.

The registered provider was aware of their responsibilities and understood that CQC needed to be notified of events and incidents that occurred in accordance with CQC’s statutory notifications procedures.

We reviewed a range of different policies and procedures which were in place. Policies and procedures were up to date, contained rel

Knowsley and Liverpool East Office is a domiciliary care agency that supports people to remain independent in the comfort of their own home. The services are designed around the people they support and people have the freedom to choose who provides their care, and when they want it. Care is planned around people’s personal needs.

The inspection of this service took place across two dates; 4 and 5 November 2016, this was the first time the service had been inspected under the comprehensive methodology. The service was given 24 hours’ notice prior to the inspection so that we could be sure someone would be available to provide us with the information we required.

The registered manager of the service was present throughout our inspection. 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.

We found that not all assessed risks had a completed risk assessment as per the agencies own procedure. In addition, there was not always information on how to mitigate risks and there was missing information to help guide staff if said risk occurred. This resulted in a breach of Regulation 12 safe care and treatment.

We looked at people’s care plans and found gaps in information regarding people’s medicine regimes. We saw no support plans to guide staff when giving medicines, which could have put people at risk of medication mismanagement. This resulted in a breach of Regulation 12 safe care and treatment.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to ensure safety in the recruitment of staff. Prospective employees were asked to undertake checks prior to employment to ensure they were not a risk to vulnerable people.

We spoke with four staff members who told us they were given enough time with people, were given time for travelling and that visits to people did not overlap. People we spoke to told us that staff stayed for the allocated time.

The service had a whistleblowing procedure. We spoke with staff who told us they were aware of the procedure. They said they would not hesitate to use this if they had any concerns about their colleagues' care practice or conduct.

People told us the service was reliable. People also told us that they saw the same staff unless there was a specific reason for not doing so, such as annual leave or sickness.

Staff told us they knew how to report safeguarding concerns and felt confident in doing so. When we spoke with staff we were reassured by their level of understanding regarding abuse. Staff were confident in reporting concerns to.

We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act 2005 (MCA). We found that the principles of the MCA were not embedded in practice. We found that people’s capacity to consent to care had not been assessed and information was at times conflicting. The service does provide a service to people who may have an impairment of the mind or brain, such as Alzheimer’s. This amounted to a breach of Regulation 11 ‘Need for Consent’

We found that the service promoted staff development and had a rolling programme to ensure that staff received training appropriate to their role and responsibilities. Staff told us they felt well supported by management and we saw evidence that regular supervisions were being held. Supervision notes confirmed that people had the opportunity to discuss their work performance, achievements, strengths, weaknesses and training needs.

We received consistent positive feedback about the staff and about the care that people received. Everyone that we spoke with, without exception told us they were treated with kindness by the care staff that supported