This inspection took place on 21 December 2017 and was announced. We gave the registered manager 48 hours’ notice of our inspection. This was so that staff and people would be available to talk with us. At the last inspection on August 2016, people’s rights were not upheld in accordance with the Mental Capacity Act 2005. At this inspection, we found that suitable action had been taken and people’s rights were being fully upheld in accordance with the Mental Capacity Act 2005.

Medacs provides domiciliary care and support to around 200 people living in Bristol and the surrounding area. There were around 200 people receiving personal care when we carried out the inspection. Medacs is a national company that delivers care to people in many areas of the United Kingdom. The services provided at this location included support with personal care such as assistance with bathing and dressing. It also included support with eating and drinking, medicines and home help covering all aspects of day to day housework, this part of the service is not registered by CQC.

There was a registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered managers, they are ‘registered persons’. Registered person 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 who needed support with their medicines were supported by staff to receive them safely. This was because the staff had completed training in safe handling and administration of medicines. There were safe systems and processes in place to help to protect people from the risk of harm. For example, new staff were only recruited after an in depth recruitment procedure was completed. When taking on new staff the agency placed an emphasis on the potential new employee’s caring approach. This was to help them try to recruit staff that were suitable to work with people who used the service.

People felt safe and the staff knew what the different types of abuse were and what constituted poor practice. Staff were aware of the correct actions they should follow if they thought someone was at risk of harm or abuse was suspected. Risks to people were being properly managed. Care records contained up to date guidance as well as detailed risk assessments. These were updated regularly when people's needs changed. Accidents and incidents were closely monitored. If actions were required, after an incident these were discussed with staff and the people involved.

People received care and support that met their needs. The staff were led by an experienced registered manager. The team were committed to the values of the organisation they worked for. These included trying to ensure each person had a good quality of life, and were supported to stay independent.

People told us staff were kind and caring and understood how to provide the care and support they needed. People and their relatives were positive about the caring attitude and approach of the staff. Some people told us recently some visits had been very late and on occasions they had not happened at all. The registered manager was in the process of putting in place an action plan to respond to these concerns. Visits plans were being reviewed to ensure that where there was an increase in traffic that was impacting on times then more travel time was given.

The staff knew the people they supported well. People were involved in planning how they were cared for and supported. Care records were person centred and written to meet people's individual needs. Care plans were reviewed regularly with the involvement of the person concerned.

The staff felt they had access to the information they needed to meet people's needs, including receiving regular up to date information. Changes in people's needs were identified and their care packages were updated to meet their

We undertook an inspection on 2 and 3 August 2016. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. The last full inspection took place on 17 and 18 June 2015. We found one breach of the regulations of the Health and Social Care Act 2008 relating to consent. We also found one breach of the CQC (Registration) Regulations 2009 relating to their statutory duty to notify CQC of incidents. These breaches were followed up as part of our inspection.

Medacs provides personal care to people living in their own homes in the Bristol and North Somerset area. At the time of our inspection the service was providing personal care and support to approximately 250 people.

A registered manager was not in post at the time of 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. A manager has been appointed and they have sent their registered manager’s application to CQC for consideration.

In June 2015 we found that people’s rights were not being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions for themselves. We found insufficient improvements had been made.

In June 2015 the provider did not notify CQC of all relevant incidents that affect the health, safety and welfare of people who use the service, as required. We found sufficient improvements had been made.

The service used the CM2000 system which is a database that allows the service to electronically monitor calls. Between the period of 4 July and 31 July 2016 the service made 9864 calls which represented 100% of their planned calls. 92.92% of calls were made within 30 minutes of the planned time. This meant the service were covering their expected calls and people were in the main receiving their calls at the correct time.

The provider operated safe recruitment procedures and ensured all pre-employment requirements were completed. Staff had received appropriate training to identify and respond to suspected abuse.

Staff received training to enable them to carry out their roles. An induction process was completed by staff newly employed at the service. Staff received supervision, in some cases they needed to be up-dated in line with their supervision policy.

People in the main felt they received good care from staff and that staff were confident and knowledgeable when providing their care. Some concerns were expressed regarding the timeliness of calls and the lack of communication from the office staff.

Records showed that staff liaised with other healthcare professionals when it was appropriate to do so. This helped to ensure that there was good communication and sharing of information about the person’s care needs.

People generally spoke positively about the staff and told us they were caring.

People told us the service was in the main responsive to their needs. Before people commenced a care package with the agency, a full assessment of their needs was carried out by a Service Quality Assessor. This included gathering full information about the person’s needs and their views on the kind of support they wished to receive.

There were systems in place to respond to complaints and this was set out in a written policy. We saw that the concerns outlined in the complaints had been responded to comprehensively and with openness and transparency, with apologies made where appropriate when the service had not performed as expected.

There were systems in place to monitor the quality of the service provided by the agency. This included a sy

The purpose of this inspection was to follow up areas of non compliance found during our last inspection in May 2013 with supporting workers. We did not speak with people who use the service this was because we were looking at the training records and systems to support the care staff.

During this inspection we found the agency had made improvements to the training and support mechanisms that were in place.

People could be confident that staff supporting them, had received annual training and that their skills and knowledge were kept under review. This was because staff were receiving regular supervision and spot checks were carried out on their work.

We did not talk to people using the service during this visit.

Care staff told us that they help a number of people to take their medicines. Each person has a medicines assessment to assess how much support they need with taking their medicines. These assessments were kept with people's care plans.

The 12 people we spoke with told us they felt very happy with the service and were always asked for their opinions and preferences. They also told us they felt care was provided that respected their privacy and dignity and enabled them to be as independent as possible. The told us “The staff are very good and I feel comfortable with them”.

People we spoke with and their relatives told us staff always put the people who used the service at the centre of their care and sought to respond to the individual's needs and wishes. People told us "They provide a good service. They do everything I want and always ask how I feel". “They always send me the same one and that’s good when it’s so personal what they do”.

Relatives we spoke with told us they had been provided with plenty of information about the service.

The seven staff we spoke with had a good knowledge of the individual people to whom they provided care. They told us they had a “mostly consistent” group of people to whom they provided care. They told us they would see other people who use the service to cover sickness and holidays, and these would usually be people they had visited before. Both staff and people who used the service told us that it is very unusual for a carer to visit a person only once.

We undertook an inspection on the 17 June 2015 and called people who used the service and relatives the following day. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. When the service was last inspected in September 2013 there were no breaches of the legal requirements identified.

Medacs provides personal care to people living in their own homes in the Bristol and North Somerset area. At the time of our inspection the service was providing personal care and support to 198 people.

A registered manager was not in post at the time of 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.

People’s rights were not being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. There was a lack of documentation related to a service user’s capacity to make decisions and how to support a service user when there was evidence that they lacked, or had variable capacity to make informed decisions.

Records showed that consent had been obtained by people or their representative regarding the support they received from the agency. In some cases consent forms were signed by their next of kin however, nothing had been recorded as to why this decision had been made, such as having the power of attorney over the person’s care and welfare. Being a person’s next of kin does not give them the automatic right to give consent on the person’s behalf.

The provider did not notify CQC of all incidents that affect the health, safety and welfare of people who use the service as required. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

Support plans were in place to guide staff in meeting people’s needs. These were regularly reviewed to ensure they were current and amended when a person’s needs changed.

Staff members did not consistently receive on-going or periodic supervisions in their role to ensure their competence level was maintained. However, staff received on-going training to enable them to carry out their roles. Staff spoke positively about the training they received and felt they were able to provide good care as a result of the training.

There were sufficient staff available to meet people’s needs. Staff told us that staffing levels were sufficient and told us they had time to meet people’s needs.

People told us they felt safe when staff visited them and provided their care. A range of checks were carried out on staff to confirm they were suitable for the work. The recruitment process was thorough to ensure people were protected.

Staff knew the people they cared for well and met people’s assessed needs when they visited. One relative commented that the staff were knowledgeable and told us; “They’re very knowledgeable, our two regulars are absolutely brilliant.” People told us that staff were caring and their privacy and dignity was respected and they had a positive relationship with the staff. One person commented, “I feel protected. They are always careful to keep me covered up.”

People were supported to see healthcare professionals when required and records showed that staff responded promptly to peoples changing needs. The service had appropriate systems that ensured referrals to healthcare professionals were made.

There were arrangements in place for obtaining people’s feedback about the service. People who had raised concerns felt they had been listened to and thought the manager was approachable. One person commented, “I wanted some changes to be made so I wrote a letter. They responded immediately and things changed to how I wanted them.”

Since the appointment of the new manager staff told us they felt supported and were kept up to date with any developments.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.