Milford Del is a domiciliary care agency. It provides care and support services to people living in their own homes in the community. Not everyone using Milford Del received a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At the time of the inspection, Milford Dell were providing the regulated activity of personal care to eight people. Our inspection was based on the care and support provided to these eight people, each of whom received a variety of care hours from the agency depending on their level of need. Some people had a learning disability or autism and were living in individual supported living flats; they required support to enable them to retain a level of independence. Other people had spinal injuries and required 24/7 support with personal care; they were cared for by the agency’s ‘spinal team’.

This inspection was conducted between 23 and 27 July 2018 and was announced. We gave the provider two working days’ notice of our inspection as we needed to be sure key staff members would be available.

We last inspected the service in March 2017 when we did not identify any breaches of regulation, but rated the service as ‘Requires improvement’. Following that inspection, the registered manager wrote to us detailing the improvements they planned to make. At this inspection, we found improvements had been made and a new registered manager had been appointed.

There were enough staff available to complete all care and support visits and action was being taken to notify people of any changes to the rotas.

Robust recruitment procedures had been put in place to help ensure that only suitable staff were employed. Individual and environmental risks to people were managed effectively.

Where staff supported people to take their medicines, we found this was usually done in a safe way. Staff followed infection control procedures and used personal protective equipment when needed.

Staff understood their safeguarding responsibilities and knew how to identify, prevent and report abuse. The registered manager reported incidents appropriately to the local safeguarding authority and conducted thorough investigations.

People were complementary about the competence of staff and the quality of care they received. New staff completed an effective induction into their role and experienced staff received regular refresher training in all key subjects. Staff were appropriately supported in their role by managers.

Staff followed legislation to protect people’s rights and sought consent before providing care or support to people.

Managers conducted assessments of people’s needs before agreeing a package of care; where necessary, they put additional resources in place before the person started receiving the service. Care plans were informative, up to date and reviewed regularly.

People received personalised care from staff who understood their individual needs well. Staff were flexible and adaptable when people’s needs or wishes changed.

Where staff were responsible for meeting people’s nutritional needs, they encouraged people to maintain a healthy, balanced diet based on their individual needs and preferences.

Staff monitored people’s health and supported them to access healthcare services where needed.

Staff were caring and compassionate. They built positive relationships with people, encouraged them to be as independent as possible and involved them in decisions about their care.

Staff treated people with dignity and respect and protected their privacy during personal care.

Staff were committed to supporting people to receive compassionate end of life care and were working with a healthcare professional to develop end of life plans for people.

People had confidence in the service and felt it was managed effectively. They knew how to rais

Milford Del provides care and support services to people living at home. Although they provide support to over 40 people in total, they only provide personal care to nine people. Our inspection was based on the care and support provided to these nine people, each of whom received a variety of care hours from the agency depending on their level of need. Some people had a learning disability or autism and were living in individual supported living flats; they required support to enable them to retain a level of independence. Other people had spinal injuries and required 24/7 support with personal care; they were cared for by the agency’s ‘spinal team’.

The inspection was conducted between 1 and 10 March 2017 and was announced. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

There was a registered manager in place. 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 were not always protected from the risks associated with unsuitable staff being employed. Pre-employment checks and references were not always completed before staff started supporting people in their homes. However, the registered manager amended their procedures to address this concern during the course of the inspection.

There were enough staff deployed to meet people’s needs. People receiving care from the agency’s spinal team received care and support from consistent staff. However, this was not always the case for people living in the supported living flats; this caused anxiety to some people, particularly those with a diagnosis of autism.

Staff sought consent from people before providing support. However, at the care planning stage, managers did not follow legislation designed to protect people’s rights. They had made decisions on behalf of people but could not confirm that these were necessary or in the best interests of people.

People received individualised personal care that met their individual needs. However, staff did not always support them in a consistent way that promoted their independence. There was a lack of information in people’s care plans about how staff should help people to develop additional skills.

Not everyone had confidence in the service and staff had mixed views about the way it was run. Some were critical of the way their duties were planned and others did not feel communication was always effective between the staff team working with people in the supported living flats.

The registered manager was addressing staff concerns by introducing a more structured rota and making themselves more available to staff.

A new quality assurance process was being introduced. This led to some improvements; however, it needed further time to become fully effective and embedded in practice.

Staff treated people in a caring and compassionate way. They built positive relationships with people and supported them to maintain relationships that were important to them.

People’s privacy and dignity were protected, particularly when personal care was being delivered. Staff took care to be as discreet and unobtrusive as possible and gave people time alone when they needed it.

People and their relatives told us they felt safe and trusted the staff from Milford Del who supported them in their homes. Staff knew how to identify, prevent and report incidents of abuse.

People were protected from individual risks in a way that supported them and respected their independence. Risk assessments had been completed and measures put in place to reduce the likelihood of harm. Medicines were managed safely and people received their medicines as prescribed.

Staff compl