This inspection was carried out between 26 February and 7 March 2018 and was announced. Two days’ notice of the inspection was given because we needed to be sure that people who wanted to speak to us were available during the inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults, older adults, people living with dementia or mental health needs, physically disabled people and people with a learning disability or autistic spectrum disorder. There were 141 people receiving a service from MiHomecare Ramsgate at the time of our inspection. One person told us, “The job staff do, actually enables me to stay in my own home”.

The registered manager had been working at the service since November 2016 and was registered with the Care Quality Commission CQC) shortly before our inspection. 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.

At the last inspection on 25 November 2016, we asked the provider to take action to make improvements to the way they supported staff, assessed and mitigated risks, and ensured that information within care plans reflected people's assessed needs and preferences. At this inspection we found that all the shortfalls had been addressed and the service that people received had improved.

Everyone we spoke with told us the staff were kind, caring and friendly, and treated them with dignity and respect at all times. They told us staff knew them well and provided their care in the way they wanted. People were given privacy. Everyone was supported to be as independent as they wanted to be. People received care in the way they preferred at the end of their life from staff and health professionals.

People’s medicines were well managed. Guidance was available to staff and people received their medicines as their healthcare professional had prescribed. Changes in people’s health were identified quickly and staff supported people to contact their doctor. People were supported to eat and drink enough. Staff followed safe practices to prevent infections.

People received care tailored to them. Assessments of people’s needs and any risks had improved since our last inspection. Guidance was now available to staff about how to keep people safe and provide each person’s care in the way they preferred. Staff supported people to take part in leisure activities they liked.

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. Everyone was able to make decisions for themselves and staff supported them to do this. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS), and had checked to make sure no one was deprived of their liberty.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. People and their representatives told us they were confident to raise any concerns they had with staff and that these would be acted on. Complaints received were investigated and responded to. Action was taken to prevent them occurring again.

Staff arrived at the agreed time and stayed for the required length of time. People told us they knew if staff would be late and who would provide their care. Staff rotas were planned in advance and any gaps were covered. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Checks were completed to make

This inspection took place on 25 and 29 November 2016 and was announced. This meant we gave the provider 48 hours’ notice of our intended inspection so that appropriate staff and managers would be available to facilitate our inspection. MiHomcare Ramsgate is a domiciliary care service which provides personal care and support to people in their own homes. The service was supporting people with various needs including people with age related fragility and people who lived with dementia.

The registered manager had recently left the service and had not yet submitted their application to deregister. The service was being supported by the regional manager and a new manager had recently been appointed and was in the process of registering with CQC. 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 and associated Regulations about how the service is run.

People and their relatives were positive about the approach of staff. People told us they were supported by staff who were kind and compassionate. Staff understood their responsibility to protect people from harm and abuse. They had been trained to recognise and report safeguarding concerns. However some staff had not received refresher training in safeguarding, the regional manager had identified this and was in the process of addressing this as part of the action improvement plan. Systems were in place to ensure people were safeguarded from abuse.

People’s support was varied and tailored to their needs. People’s care plans gave staff basic but adequate information about their preferences and how they wished to be supported. However care plans were not personalised and risk assessments contained mainly tick box answers, again with little personal information to inform staff. People’s risks were assessed and monitored. However these were being reviewed as part of the action improvement plan to make them more personalised and specific. Consent was obtained from people before support was provided.

People were encouraged and supported to have control of their lives and make decisions about the care they received. Arrangements were in place to help to make sure people received their medicines appropriately and safely. Audits had been reintroduced recently as the management team had identified gaps in this area. People’s care plans showed relevant health and social care professionals were involved with people’s care when required.

People were supported by appropriate numbers of staff who mostly arrived on time. Staff stayed for the allocated time to deliver the care and support people required. Systems such as spot checks were in place to monitor the time keeping and the competencies of staff. Effective recruitment systems were in place to help ensure people were supported by staff who were of good character and were suitable to work in people’s individual homes.

Staff received training and refresher training. However this was under review at the time of our inspection as management had identified gaps in staff training. Systems were in place to monitor and check the training and skills of staff. Staff’s abilities and care practices were observed. Most staff had been provided with an appropriate level of training or support to be able to meet the needs of the people in their care; however some staff had not received update training in some subjects. This was being addressed by the new manager at the service. Staff received some supervision although this was irregular. Again this had been identified by the management and plans were in place to address this as part of the action improvement plan.

People were supported to plan and prepare their meals when required. In many cases family members supported people by providing meals and drinks depending on peoples

We spoke with the manager. We looked at twelve support plans and records related to the management of the service. Our inspection team was made up of one inspector. We used the evidence to answer five questions we always ask.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

Is the service safe?

The service was safe. Systems were in place to make sure that managers and staff learned from events such as medication errors.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and they or their representatives were involved in their care plans. Care plans were detailed, relevant and personalised.

Is the service caring?

The service was caring. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The service was responsive. The agency worked well with other agencies and services to make sure people received care in a way that met their needs.

Action had been taken to address the areas of non-compliance raised at the last inspection of February 2014.

Is the service well-led?

The service was well-led. The service operated a quality assurance system which identified and addressed shortcomings.

We visited the office and spoke with the registered manager, two members of the management team and four staff. We later spoke by telephone with 28 people who used the service and five relatives.

People felt they were able to make their own decisions and choices regarding their day to day care and support. People confirmed that they had given their consent and been involved in discussions about their care, sometimes with a family member, when the service had first started. People said: “All of the staff are very obliging, they do anything I ask them to do”.

We found that care plans contained information about the tasks staff needed to undertake, but lacked detail about people's wishes, preferences and abilities to ensure care and support was delivered to promote their independence. People told us that they had regular staff calling who generally arrived on time and stayed the allocated time of the call.

The systems in place to manage the safe administration of medication were not effective to make sure that medicines were given to people in a timely and safe manner.

People were receiving care form staff who had been checked to work with vulnerable people. People told us the service recruited the right calibre staff to meet their needs

People said: “We are pleased with all of the staff, very pleased indeed”. “The staff are very nice and thoughtful”. “I can’t speak highly enough of the staff, I think they are wonderful”. “The staff are very nice, very thoughtful”.

People said they had been asked for their views and feedback on the service provided.

People told us they felt confident that any concerns would be addressed. There were systems in place to monitor the quality of the service.

Records were not always accurate and fit for purpose.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care.

The inspection team was led by a CQC inspector joined by an Expert by Experience, who has experience of using or caring for someone who uses this type of service.

We spoke with the manager, senior staff and two care workers at the time of our visit to the office and also spoke with three care workers over the telephone.

We telephoned 15 people to discuss the care they were receiving from the agency and visited four people in their homes. People spoke positively about their care workers and felt that they fully supported their care needs. All of the people we talked with told us that they were treated with respect and kindness.

People said that all the staff spoke with them in a in a calm and respectful way and respected their privacy and dignity.

People spoken with told us that their care was personalised to their needs and said that staff always asked what they would like to be called. They said they did this when they arrived for the first visit.

Not many of the people were interested in the detail of their care plan, but confirmed they and sometimes their family read the daily notes. They did confirm that they had been involved in discussing and reviewing their care with a supervisor from the agency.

People told us that they thought the staff were trained well and knew what they were doing.

People said they were happy with the service they received but did make comments that care workers travelling time (in between different people they were supporting), sometimes affected the timing of their visits.