Mears Care Old Stratford provides domiciliary care services. It provides support and personal care to a range of people living in their own houses in the community. At the time of our inspection 113 people were receiving personal care from the service .

At our last inspection in June 2016 we rated the service. 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.

Staff received safeguarding training so they knew how to recognise the signs and symptoms of abuse and how to report any concerns of abuse. Risk management plans were in place to protect and promote people’s safety. The staffing arrangements were suitable to keep people safe. The staff recruitment practices ensured staff were suitable to work with people. Staff followed infection control procedures to reduce the risks of spreading infection or illness.

The provider understood their responsibility to comply with the Accessible Information Standard (AIS), which came into force in August 2016.

Staff received induction training when they first started work at the service. On-going refresher training ensured staff were able to provide care and support for people following current practice.

Where the provider took on the responsibility, staff supported people to eat and drink sufficient amounts to maintain a varied and balanced diet. The staff supported people to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

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.

People had their diverse needs assessed, they had positive relationships with staff and received care in line best practice meeting people’s personal preferences. Staff consistently provided people with respectful and compassionate care.

The service had a positive ethos and an open culture. The registered manager was a visible role model in the service. People, their relatives and other professionals told us that they had confidence in the manager’s ability to provide consistently high quality managerial oversight and leadership.

This inspection took place on 02 June 2016, with an announced visit to the service. In addition, phone calls were made to people and their family members on 03 and 06 June 2016.

Mears Care - Old Stratford provides people with personal care in their own homes in Milton Keynes and Northamptonshire. They provide care to older people, as well as people with physical or learning disabilities. When we inspected they were providing care to 90 people.

The service did not have a registered manager in post, as they had recently left the service and de-registered. A new manager had been appointed and was in the process of registering. 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.

People felt safe when they received care from the service and staff worked to protect them from harm or abuse. There were systems to identify potential risks to people, and to put steps in place to help staff manage those risks effectively. Staffing levels were consistent and sufficient to meet people's needs without the need for agency staff. Background checks and references were completed for all staff members to ensure they were of good character and suitable for their roles.

Staff were given the training and support they needed to equip them with the skills and knowledge required to meet people's needs. Staff received regular supervision and were able to discuss any concerns they had. People's consent to their care and support was sought and there were systems in place to help make best interests' decisions if people lacked mental capacity. Staff supported people to maintain a health and balanced diet and helped them to see healthcare professionals if necessary.

People were treated with kindness and compassion by staff members. Staff worked to build strong relationships with people and their family members, which helped them to deliver people's care in the way they wanted. Information about people's care and the service was available to them and their family members and they were involved in planning their own care. Staff members treated people with respect and made sure their privacy and dignity was upheld.

Person-centred care was given, which ensured people received care and support which took their specific needs and preferences into account. Initial assessments were carried out to identify people's needs and care plans were updated on a regular basis to ensure they were accurate. Feedback from people was encouraged, as were compliments and complaints, to help the provider develop the service.

There was a positive and open culture at the service. People were happy with the care they received from members of staff and felt that there had been positive developments at the service. Staff were aware of their roles and responsibilities and were motivated to work with people and meet their needs. The manager had been newly appointed and was positive about the service and the direction they wanted to take it in. They were aware of their statutory requirements and had systems in place to oversee the service and identify areas for development.

This inspection took place on 05 July 2015 and was announced.

Mears Care – Old Stratford is registered to provide personal care for people in their own homes. This domiciliary care agency provides personal care support to people who want to continue living independently in their own home. The agency provides a range of domiciliary support services to people living in the Northampton and Milton Keynes area. At the time of our inspection the service was providing domiciliary care for 119 people.

At our previous inspection on 12 February 2015, we found that one regulation relating to care and welfare and records were not being met. We found that the registered person did not take appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity. This was a breach of regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we looked at these areas to see whether or not improvements had been made. We found that the provider was now meeting this regulation.

The service did not have a registered manager in place, however a new manager had been appointed and they had started the process of registering with the Care Quality Commission. 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.

Staffing levels were sufficient to meet people’s needs. Improvements had been made to the way staffing was scheduled and allocated and systems had been put in place to oversee staffing.

This inspection took place on 12 February 2015 and was announced.

Mears Care – Old Stratford is registered to provide personal care for people in their own homes. This domiciliary care agency provides personal care support to people who want to continue living independently in their own home. The agency provides a range of domiciliary support services to people living in the Northampton and Milton Keynes area. At the time of our inspection the service was providing domiciliary care for 128 people.

At our previous inspections on 02 October 2014 we found that regulations relating to care and welfare and records were not being met. We found that care and treatment was not always consistently planned and delivered in a way that was intended to ensure people's safety and welfare which was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We also found that people were at risk as the provider did not maintain accurate and appropriate records, this was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to provide us with an action plan to address this and to inform us when this was complete. During this inspection we looked at these areas to see whether or not improvements had been made. We found that the provider was now meeting these regulations.

The service had a registered manager in post. 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 people were protected from abuse and felt safe.

Staff were knowledgeable about risks of abuse and there were suitable systems in place for recording, reporting and investigating incidents.

Staffing levels were not always sufficient to meet people’s needs. This was in breach of regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Staff had been recruited using effective recruitment processes so that people were kept safe and free from harm.

Where needed, people’s medications were managed so that they received them safely.

We found that staff were well trained and had good understanding of their role and key legislation. Staff were regularly supervised by senior staff and management.

Staff were trained in the Mental Capacity Act (MCA) 2005 however its use was not a regular occurrence, due to the levels of capacity of current residents. Policies for the MCA and Deprivation of Liberty Safeguards (DoLS) were in place.

Care was delivered in a person-centred way which promoted their independence, privacy and dignity.

People could make choices about their food and drink and were provided with support when required to prepare meals.

People were supported to make and attend health appointments when required.

Staff were caring and ensured that people’s privacy and dignity was respected at all times.

People and their relatives were involved in making decisions and planning their care, and their views were listened to and acted upon.

Staff were knowledgeable about the needs of individual people they supported. People were supported to make choices around their care and daily lives.

We found that the service listened to what people said about the care they received and took active steps to encourage feedback from each person and their families.

Management systems were in place and the registered manager had taken significant steps since coming to post to make improvements to the service. Some systems were not sufficient to meet the needs of people using the service but others had been effective.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

During our inspection of Mears Care – Old Stratford we set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found.

Is the service safe?

People we spoke with told us they felt safe being cared for by staff from the service and felt confident to raise concerns with staff. Staff had received training in safeguarding and were clear about how to identify, prevent and report abuse.

There was one occasion when seven people did not receive a care visit on the same day, when a member of staff went off sick and the visits had not been reallocated. We were informed that as soon as the service had identified the missed calls, they called each individual and offered to provide them with a care worker. We saw records that demonstrated the service had notified the local safeguarding team and the Care Quality Commission. This meant that the service was transparent by ensuring that local safeguarding protocols were being followed.

The service followed safe recruitment practices. This meant only staff who were suitable to work with vulnerable people were employed by the service.

Is the service effective?

People told us that they sometimes experienced late care visits and three people added that they were not advised of the delays. However, eight of the ten people we spoke with stated that they received all their care, felt their needs were met and were happy with their regular care workers.

Records we looked at were varying and inconsistent. People’s medication needs were not detailed in care plans and people’s Medication Administration Records (MAR) contained numerous omissions. Electronic records of staff providing care did not correspond with hand written records. This meant that people using the service were not protected from the risk of unsafe care and treatment because records were not accurate or fit for purpose.

Is the service caring?

Three people said they did not always receive care from a consistent group of care workers who knew and understood their needs. However they confirmed that they were happy with their regular care workers and said their care needs were always met.

Care workers we spoke with were aware of people’s care needs and spoke kindly about the people they cared for. We also heard office staff talking about people fondly and knowledgably.

Is the service responsive?

We saw four examples of individual complaints in relation to inappropriate timings of peoples care visits. Although these had been responded to individually, we received feedback from people that their care visits were sometimes late.

People were encouraged to make their views known about the care and support they received. We observed 26 feedback forms recently completed by people using the service. These were overall positive and 14 people rated the service as ‘very good’ and five as ‘excellent’.

Is the service well-led?

We were made aware that there had been changes to the management of the service. A new manager had been appointed and was receiving additional support from the organisations operation manager.

Staff spoken with said that the new manager had brought in lots of changes to improve on the care provided. A staff member said, “The manager and trainer work hands on to ensure that care is provided to an appropriate standard.”

During our inspection of Mears Care we set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Below is a summary of what we found.

Is the service safe?

In the first six months since Mears Care managed their domiciliary service from their new office in Old Stratford there had been concerns about the number of missed or late calls being reported. This meant that some people had not always received safe care. This was because some people had their needs neglected because staff had not always managed to provide the agreed number of visits some people required throughout the day. We found that, for example, although assessed as necessary, some people had not always received two staff to support them with their personal care needs. This was due to a combination of factors including, for example, problems with staff recruitment which meant staffing levels were sometimes inadequate to ensure people consistently received the care they needed. We also saw that previously the day-to-day scheduling of staff had not always been effectively coordinated and communicated to staff. This had meant some people had not always received their care at the time or interval agreed with them.

We found that although there had been improvements made to increase the reliability of the service so that people received safe care, some further improvements were still needed to ensure this was consistently sustained. The improvements already implemented when we inspected included the recruitment of more staff, the appointment of a new manager, and better communication between the office staff, the staff scheduled to provide people’s care, and the people who received that care. We saw, for example, that the provider had introduced a new telephone system that required staff to ‘log’ in and out of their scheduled visit. This had reduced the risk of a call being missed and provided the manager with information about times of arrival and departure from people’s home.

Is the service effective?

The issues already highlighted above had meant that in the months previous to this first inspection of the service located at Old Stratford the service had not always been effective.

We saw from the eight care files that we looked at that individualised care plans and risk assessments were in place that gave staff the information they needed to provide effective support. It was clear from speaking with staff that they had a good understanding of the individual care and support needs that people required.

We saw that communication between staff had improved which has had a positive impact upon the day-to-day effectiveness of the service. The six people we visited at home all said they had received the agreed service they needed. One person said, “The carers are not as bad at time keeping as they once were. There has been a lot of improvement. I have no complaints at all about the carers.” Another person said, “The carers have always had to rush to get things done although I am not unhappy with what they do for me. I get the help I need, but I still think the staff are under a lot of pressure to get things done in the time they have.”

Is the service caring?

The six people we visited at home all said the staff that visited them were friendly, caring, and treated them respectfully. This was the experience of the additional ten people we telephoned and was also reflected in previous surveys carried out by the provider. One person said, “I have no worries about the way the carers treat me. I think they are marvellous. A few times though when I have had to phone the office they did not ring me back even after saying they would. I think that could be better. It gives the wrong impression.”

Is the service responsive?

We found that in the eight care files we looked at the assessments had included identifying any risks to people and detailing how staff should care for people to support their safety and wellbeing. Previously some people had not always experienced a responsive service. This was because the provider had not always been aware that scheduled calls had been missed or that staff had arrived late at people’s homes. We saw that improvements had been made to the scheduling of day-to-day visits to people’s homes. This meant that the risk of people not receiving the care they needed, when they needed it, had been reduced.

New office staff had been appointed to co-ordinate the service more efficiently. This meant that staff were in a position to respond appropriately and in a timely way to unforeseen problems that had an effect on the reliability of the service, such as traffic delays causing staff to run late, or staff sickness requiring last minute changes to the visit schedules. This meant that people were better informed about unavoidable delays to their service.

Prior to our inspection people were unhappy that they rarely knew who had been allocated to visit them at home. Although people had been sent a weekly schedule it was often sent incomplete. We saw that this had improved, with complete weekly schedules posted out to people so that they were not left wondering if anyone had been scheduled to visit them.

Is the service well led?

We saw that a new manager had been appointed and recently registered with the Care Quality Commission (CQC) in July 2014. The five staff we spoke with individually confirmed that the manager is approachable, supportive, and committed to sustaining the improvements already implemented prior to our inspection. This meant that people were assured of receiving a service from staff that were enabled to do their job with the managerial support and guidance they needed.