Masterstaff Healthcare (Preston) provides domiciliary care to people in their own homes. The service supports people with a wide range of needs including older people, dementia, mental health, physical disability and sensory impairment and children. The service operates from an office base in the docklands area of Preston.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

We spoke with nine people supported by the service. They told us staff who visited them were polite, friendly and caring. They told us they received patient and safe care and they liked the staff who supported them. Comments received included, “I am very happy with the service and find the staff are very reliable and helpful.” And, “I have the same group of staff visiting me and they are all brilliant. I am never rushed and allowed to go at my own speed. I have a laugh with them.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

When we last inspected this service recruitment procedures required improvement. This was because we made a recommendation that the provider reviewed the recording of information received in relation to recruitment checks. We found there was not a clear audit trail confirming checks had been completed before new employees commenced working for the service. During this inspection records seen confirmed staff had been recruited safely and recruitment is now rated as good.

We found staff had been appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Staff retention was good and people told us they were supported by the same group of carers. They told us staff who supported them knew and consistently met their needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked at how the service was staffed. Five staff members spoken with said they were happy with how their visits were managed. They told us they were allocated sufficient time to be able to provide support people required. People supported by the service told us staff were reliable and never let them down with late or missed visits.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at the times they needed them.

Staff had received infection control training and were provided with appropriate personal protective clothing such as disposable gloves and aprons. This meant staff were protected from potential infection when delivering personal care.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff supported people to have a nutritious dietary and fluid intake. Assistance was provided in preparation of food and drinks as people needed.

People were supported to have access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems or required assistance to attend healthcare appointments.

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

People’s care and support was planned with them. People told us they had been consulted and listened to about how their care would be delivered.

The service had provided people with information with regards to support from an external advocate should this be required by them.

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Regular reviews and discussions helped to ensure support plans and risk assessments met the changing needs of individuals.

People using the service provided positive feedback about the support they received. Comments included; “We go through the plan to see if it is alright. I can raise anything. I let them know if I am going away. I am satisfied.” And “It is going very well. I am more than happy.”

Staff training, policies, procedures and good practice helped to keep people safe and free from abuse.

The recruitment process helped to ensure only suitable staff were employed. People using the service and their relatives spoke favourably of the staff team. We were told; “I couldn’t get nicer people.” “The staff are all lovely. I couldn’t fault them. I don’t know what I would do without them.” And “Absolutely brilliant. Full marks.”

There were good systems in place to assess and monitor the quality of the service people received.

We spoke with seven people who use the service, two relatives and four members of staff. The feedback that we received from all of these sources was extremely positive.

The people we spoke with said that staff were "friendly”, "thoughtful” and “considerate". They told us that their care was delivered as agreed in their care plan. They said they saw the same people regularly which helped them as the care staff got to know their strengths and preferences.

Staff reported that they were happy working for the provider. They reported that their training and supervision was good and that they received management support to deliver the agreed care plans. They knew how to get help and advice if the person's needs changed.

We reviewed the provider's policies, procedures and reporting and feedback systems. These were appropriate for the types of care given. Feedback reports tallied with the feedback from people we interviewed and were very positive about the service and staff.

We spoke with ten people who use the service, three relatives and three members of staff. The feedback we received from these sources was extremely positive.

Without exception the people we spoke to said that staff were always polite and respectful. Staff were described as;”Very nice people,” “Fantastic,” “Extremely competent,” and “Really nice.”

People also told us that there is good consistency of staff support, with the same care worker, or for people who need two staff or several visits each day, the same small team of care workers being allocated.

It was clear that staff have built up good relationships with people they support and that these relationships are highly valued and bring pleasure to service users. One person told us how much they look forward to the staff member coming to their home, saying; “I love her to bits, she is fantastic.”

The staff we spoke to told us that training is very good and is regularly updated, qualification training is provided and that the manager and senior staff are all very approachable and supportive.

Surveys are regularly distributed, giving opportunity for the service user or their representative to give feedback about the quality of the service. People who use the service told us that they are visited by senior staff or contacted by telephone and asked if they are happy with the support they get.

Masterstaff is a limited company providing domiciliary care throughout the country. Masterstaff (Preston) is a local branch based in the docklands area of Preston, near the city centre. The agency provides personal care services to support people to live independently in the community. At the time of our inspection there were 130 people using the service and 70 care workers appointed.

We last inspected this location on 21st November 2013, when we found the service to be compliant with the regulations we assessed at that time. This inspection was conducted on 12th March 2015 and 13th March 2015. The provider was given 48 hours notice of our planned visit. This meant someone would be available to provide us with the records and documents we requested.

The registered manager was available at the agency office at the time of 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 recruitment practices were not sufficiently robust, because the recording of information did not reflect a clear audit trail, to show necessary details and checks had been received before people started to provide care and support to those in the community. New employees were provided with an in-depth induction programme and were supported to gain confidence and the ability to deliver the care people needed.

Records showed that staff had completed training in safeguarding adults. The staff team were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who used the service.

A variety of assessments were conducted within a risk management framework. This helped to protect those who used the service from harm. Emergency plans were in place, which provided staff with clear guidance about action they needed to take in the event of a critical situation.

The staff team were provided with a range of learning modules. This helped to ensure they were trained to meet people’s health and social care needs. Records demonstrated that formal supervision for staff was regular and appraisals were conducted every year. This promoted a well supported staff team.

Staff were kind and caring towards those they supported and people were helped to maintain their independence with their dignity being respected at all times. Plans of care were, in general person centred and people who lived in the community received care and support in a consistent way.

The plans of care were, in general person centred documents. However, some areas could have been a little more informative, so that staff were provided with a clearer picture of the people they supported.

When asked about the service provided people’s comments varied. One person said, “They (the agency) are ok. Mum has used them for a few years. They (the staff) call four times a day. They help her get up and washed and dressed and they help with some food.” Another commented, “They are excellent. They are very good and I’d recommend them.” “When they help me to shower it’s all done well and with dignity. They use gloves and an apron. They have uniforms. It’s the same people each time.”