The inspection took place on 12 and 13 October 2016 and was announced.

Lillyfields Care provides a domiciliary care service for people living in Petersfield and the surrounding area. At the time of the inspection 60 people were receiving care visits.

Lillyfields Care is not required to have a registered manager in post. This is because the provider is an individual person who acts as a registered manager as well as the registered provider. 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 inspection on 18 September 2014 we found a breach in regulations. We asked the provider to take action to make improvements to the implementation of the principles of the Mental Capacity Act 2005. As a result of the breach, the provider sent us an action plan detailing how they would ensure the regulations were being met. We found this action had been completed fully.

People were asked for their consent before care or treatment was provided. Staff told us they asked people for their consent before providing any care. The provider had taken action to ensure that those people who did not have capacity to consent to their care were identified and that they followed the principles of the Mental Capacity Act 2005 (MCA) when providing care.

People were protected from abuse. Staff had knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. There was a safeguarding policy which was available to staff. This detailed the action staff should take in these events along with contact telephone numbers for the relevant authorities where they could seek advice and report concerns.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. Assessments were carried out before people accessed the service to identify any potential risks to their safety. Care plans were written which addressed the risks so that staff were informed about how to provide care in a way which protected people.

People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. The allocation of staff was carried out part electronically and part manually. The system ensured consistency of staff for people, identifying appropriate travel routes and provided sufficient travel time. The system ensured that any shortfalls in availability of staff could be identified and recruited to. This ensured there were always enough staff available to cover all calls.

Recruitment and induction practices were safe. Relevant checks such as identity checks, obtaining appropriate references and Disclosure and Barring Service (DBS) were being completed for staff. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

There was a system in place to ensure the safe administration of medicines. Some people had their medicines administered by staff. Staff had received training to ensure they were able to administer medicines safely. Information was recorded in people’s care plans which informed staff where medicines were kept in people’s homes and how to administer them.

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as infection control, fire training, moving and handling, food safety and health and safety. Staff told us they had received sufficient training to meet the needs of people. Staff received an induction in line with the Care Certificate.

Staff had regular supervision meetings with management and an annual appraisal. Staff received extra supervision and appraisal during their inducti

At the time of our visit we were told the agency provided personal care and support to approximately 200 people. We attempted to speak with six staff and gained feedback from five members of staff. We also spoke with the provider, the person responsible for human resources, the person responsible for finances and the person responsible for quality. We reviewed the care records of seven people in detail. We received feedback from 12 people who used the agency and seven relatives.

The inspection team was made up of a single inspector and an expert by experience. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

The agency had effective systems in place to monitor and manage any infection control risks. Staff were aware of their responsibilities in this and received training to support their understanding.

Staff understood the importance of respecting people and were able to describe how they did this and supported people’s right to make choices and remain independent. They told us they always checked whether people were happy for them to provide care before they delivered this. We saw that consent was requested before care started. However, when consent had been provided by someone other than the person who received it, the provider was unable to evidence this person had the legal authority to do so. Where people lacked the capacity to provide consent or give permission the provider was not able to demonstrate the principles of the Mental Capacity Act 2005 were applied. Staff we spoke with told us they had not received training in this Act and did not know what a mental capacity assessment was. We have asked the provider to tell us what action they will be taking to ensure they met the requirement of law in relation to consent to care and treatment.

Care plans had been developed for people based on an assessment of needs. These reflected the person’s current needs and the action staff needed to take to meet them. Risks for people had been assessed and support was planned in a way that ensured any risks were minimised. Staff told us risks were clearly identified in care records and they were given the knowledge and guidance to reduce these.

Is the service effective?

The provider ensured all staff were supported appropriately through a system of unannounced spot checks and one to one supervision meetings. Staff felt comfortable to raise any concerns they may have. They told us they felt listened to and supported by the agency.

Is the service caring?

People we spoke with told us they were supported by kind and caring staff. They told us staff respected their privacy and dignity. They told us the care staff listened to them and the management were supportive.

Is the service responsive?

People and staff we spoke with were confident and comfortable to raise any concerns they may have. They told us they were confident the agency would listen and would take action to address any concern promptly. People and staff told us when they had raised concerns these had been addressed immediately.

Is the service well led?

Everyone we talked to spoke highly of the service. All staff told us they were encouraged to provide feedback and were made to feel comfortable in doing so. The provider sought feedback from people who used the service. Learning from incident took place and staff all confirmed the agency always shred this information.

We spoke to two people who received a service from the agency as well as to three relatives of people who received a service. We also spoke to three professionals from community health and social care teams.

People told us the staff treated them well. Relatives said staff always asked their relative what they wanted support with and followed any requests made by people. Relatives said that people received a good standard of care. One relative said, “Care is carried out professionally, with care, and consultation.”

Relatives and people said they received information from the agency in the form of a folder containing their care plan, the complaints procedure and telephone numbers for contacting the service.

Relatives and people said they were consulted about their care needs. Relatives and people said they were aware of their care plan. People also said that staff made a record each time they attended a care appointment.

People and their relatives said the agency provided a reliable service although one relative reported that a staff member had failed to attend a recent appointment.

People and their relatives said staff were skilled in dealing with people’s needs. This included recognition of changing health needs and regular communication with relatives.

People said they had a copy of the complaints procedure and were asked to give their views on the service.

During this inspection we met the providers and owners of Lillyfields Care in their office. We met the management and administrative team and met a group of new staff ho were attending training that day. The office was calm and well organised. We heard staff telephoning in with concerns and the office staff being supportive and responding appropriately.

We spoke to three staff over the telephone after the office visit and to 21 people who use the service and/or their relatives.

People told us hey were happy with the service they got. One said "My carers are lovely, more like friends now." People told us their privacy and dignity was respected. One said "My carer always ensures that the door is shut and curtains closed before she undresses me." We were also told that no staff raised their voices or talked about the other people who used the service.

No one had ever had any concerns about their personal safety. Most people said that they got on really well with their carers. People described carers as kind and caring and would often go over and above what they were asked to do. They all knew who to call if they did have any concerns.

Staff told us it was a good place to work and people received a good, caring service. Staff told us they felt valued and supported and got "Loads of training".

We found that the quality monitoring systems were not robust and consequently care plans were not all regularly reviewed. We also found that spot checks of staff and supervisions had not taken place regularly and this put people at risk of not receiving safe and appropriate care.