Mahogany Care – Holyport is a domiciliary care agency. It provides personal and nursing care to people living in their own houses and flats. It provides a service to older people, younger adults, people living with dementia and people with physical disabilities. Not everyone using Mahogany Care receives the regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, which is help with tasks related to personal hygiene and eating. Where they do receive the regulated activity ‘personal care’, we also take into account any wider social care provided. At the time of the inspection the service was providing personal care and support to two people.

The service had a registered manager as required. 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 registered manager was present and assisted us during the inspection.

At our last inspection, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good:

People received support that was safe. Staff were knowledgeable in how to safeguard and protect people. People were supported with medicines and received them safely when they were required. Risks to people were assessed and actions taken to minimise risks without restricting their freedom. A robust recruitment procedure was in place to ensure as far as possible only suitable staff were employed. Appropriate personal protective equipment was supplied and used to prevent the spread of infection.

People continued to receive effective support from staff who were trained and had the necessary skills to fulfil their role. Staff were well supported by the registered manager and had an appraisal of their work annually. People were supported with maintaining a balanced diet and adequate hydration when this was part of their care plan. People’s healthcare needs were monitored and advice was sought from healthcare professionals when necessary. 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 supported this practice.

The service remained caring. Relatives told us people thought staff were kind and patient and they had formed trusting relationships with them. People’s privacy and dignity were protected; relatives told us staff treated people with respect. People and when appropriate relatives were fully involved in making decisions about their care. Staff encouraged people to maintain as much independence as possible.

The service remained responsive to people’s individual needs. Staff knew people very well and paid attention to finding out about their personal preferences. This enabled care and support to be focused to achieve people’s desired outcomes. Individual care plans were person-centred; they considered the diverse needs of each person, taking into account any protected characteristics. The service provided flexible support, embracing people’s individual wishes. People and their relatives knew how to raise concerns or make a complaint; they felt confident they would be listened to if concerns were raised. The service was working to the accessible information standard.

The service was well-led, with strong leadership from the registered manager. Records were relevant, complete and reviewed regularly to reflect current information.

Mahogany Care – Holyport provides both personal and nursing care in people’s own homes. The office of the service is located in a residential area of Holyport, not far from Maidenhead in Berkshire. The service is bespoke and unique due to the size and the nature of the care. At the time of the inspection, there were two people who used the service.

At the time of the inspection, there was 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.

The location was last inspected under the Health and Social Care Act (Regulated Activities) Regulations 2010. On 20 December 2013 we found one outcome; “records” was not compliant. We had also found at the previous inspection of the service on 18 April 2013 that the same outcome was not compliant. The provider had submitted an action plan to us after the prior inspections to document how they would improve their process of record-keeping. Since these inspections, the regulations have been changed. However at this inspection, we have found that the failure to comply with the “records” outcome has been resolved and is therefore compliant.

People received safe care from the service. The staff knew what abuse was, how to safeguard people in the event of suspected abuse and what organisations needed to be contacts. People had risk assessments, care plans and regular evaluation of their care to ensure their safety. Staffing deployment was satisfactory as the registered manager and one support worker provided the personal and nursing care to two people. People were assisted with medicines out of pre-packaged blister packs from the local pharmacy. The registered manager had a good working relationship with the local pharmacist and ensured that medication dispensed was correct.

The service was effective in the care it provided to people. The registered manager and support worker attended necessary training to ensure they could provide the best personal and nursing care for people. The support worker received regular supervision with the registered manager and was able to set and achieve their own employment goals. Recruitment and selection of any staff member was robust and ensured safety for people who used the service. Consent was always gained from people before care was commenced and people’s right to refuse care was respected.

We found the support worker and registered manager were kind and generous. A relative and person who used the service agreed when we spoke with them, and supported the findings from our inspection. The staff told us they respected people’s privacy and dignity, and ensured that life in their homes was as close as possible to being independent. People were able to say how they liked their care, and the service would accommodate their requests.

The service was responsive to people’s needs. People and relatives had the ability to share their compliments, concerns and complaints in an open and transparent manner by communicating directly with the staff. One person and one relative we spoke with had no concerns about the service, and we had received examples of positive feedback from the general public.

The person who used the service and a relative commented that the service was well-led. They felt that the support worker and registered manager took time to listen and would often make an extra effort for them. The registered manager provided nursing and personal care, and so was known to both people who used the service. We found that the management conducted a range checks to assess the standard of care. This included auditing care documentation to ensure safety, accuracy and opportunity for improvements, if needed.

During this inspection we followed up on concerns identified from our last inspection from 18 April 2013. We spoke with the manager and a staff member. We did not speak to people who use the service as part of this inspection.

Staff were provided with information on safeguarding vulnerable adults. The provider implemented a policy to aid staff awareness about safeguarding and how to identify abuse.

Staff were provided with training by the manager with support from external trainers. There was a system for staff supervision and induction.

Care plans were person centred and updated frequently. They contained detailed information about people's health and social care needs. They provided information on consultations with other services involved in meeting people's care needs. Some documentation related to the management of the service was unsuitable or unavailable.

The people who used this service had difficulties communicating or found it difficult to use the phone, therefore we spoke with their relatives. They told us the service met people's care needs and the manager worked with external health and social care professionals. They said this meant the service ensured people had access to appropriate care and treatment.

Relatives told us people were involved in the planning of their own care, or if they were unable to participate in care planning, a relative was involved. Relatives told us spot checks were undertaken on care workers by the manager to ensure they were competent and that they delivered appropriate care.

A care worker told us they were given a practical induction and provided with some training. However they were not provided with all training relevant to the needs of people who use this service. We found there was no system for identifying or delivering training. The manager had not provided staff with appropriate knowledge or policies regarding safeguarding vulnerable adults or whistleblowing.

The care records we looked at contained detailed information on people's care needs. However they lacked written risk assessments. Some records related to the management of the service were unavailable.