This inspection was carried out on the 31 May 2017 and was announced.

Mitchells Domiciliary Care Services provides a supported living service for older people and people with a learning disability, autistic spectrum disorder, physical disability and younger adults. People receive personal care and support in their own properties. At the time of our inspection the service provided personal care to 22 people.

There was a registered manager in post and present at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

The registered manager had systems in place which monitored health and safety and the quality of people’s support. However the systems were not always responsive and had not always led to changes being made. We have made recommendations around this. However people, relatives and staff were happy with the management support they received.

People told us they felt safe using the service. Relatives felt that their family members were safe with staff. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. There were sufficient staff at the service to provide care and support to people. Appropriate recruitment checks were undertaken before staff started work.

Staff understood the risks to people and ensured that people were kept safe. Staff encouraged and supported people to lead their lives as independently as possible. People’s medicines were managed in a safe way and staff were competency assessed to ensure that they were competent in the administration of medicines.

People received support from staff that knew them well, and who had the knowledge and skills to meet their needs. Training was provided to staff that was specific to the needs of people including challenging behaviour and epilepsy. Staff received supervision to provide effective care to people and staff felt supported.

People had care plans in place which provided guidance for staff about how people liked their care provided. People and relatives were involved in the care planning.

Staff understood the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Relatives were involved in making decisions where appropriate. Where people were being deprived of their liberty this was done in their best interest.

Staff supported people with their nutritional and hydration needs. Health care professionals were involved in people’s care and staff ensured that they followed guidance provided by them.

Complaints and concerns were taken seriously and used as an opportunity to improve the service. People and relatives said they knew how to make a complaint if they needed to.

The registered manager had informed the CQC of significant events. Records were accurate, well maintained and kept securely.

Mitchells Domiciliary Care Services provides a supported living service for older people and people with a learning disability, autistic spectrum disorder, physical disability and younger adults. People receive personal care and support in their own properties. The service was supporting 46 people in 12 supported living properties, some of which are shared with other people.

The inspection was announced. We told the provider three days before our visit that we would be coming. This was to ensure that the people we needed to talk to would be available.

There was a registered manager in place who was present on the day of the 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.

Effective systems were not always in place to monitor the quality of the service that people received. Audits were not routinely undertaken and surveys were not always used to improve the quality of care.

Complaints were not always responded to in an appropriate way.

People did not always feel involved in their care planning. Relatives also said that they did not always feel consulted however other relatives said that they were.

Care plans and records were not written in a dignified and respectful way. However people did say that staff treated them with dignity and respect. Relatives confirmed this. People’s independence was promoted. In the event of an emergency, such as bad weather, there was a service contingency plan which detailed what staff needed to do to protect people and make them safe.

There were sufficient numbers of skilled and experienced staff to support the people who used the service. People and their relatives told us they were supported by regular staff who knew their needs and preferences well.

Training was provided to staff in relation to the needs of people who received care. Staff had their competencies assessed through regular one to one supervisions and appraisals.

People were cared for by kind, respectful staff. People told us they looked forward to staff coming to support them.

Systems were in place to ensure that people were protected from the risk of abuse. Staff were aware of procedures to follow to safeguard people from abuse. Risk assessments were detailed and staff were provided with guidance on to reduce the risk of things happening. There were assurances that before staff started work appropriate recruitment checks had been undertaken on all care staff however not all administrative staff who came into contact with people had undergone these checks.

People were supported at mealtimes to have food and drink of their choice and supported to make healthy choices about their food. People were supported to have access to health care as they needed it.

People’s right were being upheld as required by the Mental Capacity Act (MCA) 2005. This is a law that provides a framework to protect people who do not have mental capacity to give their consent or make certain decisions for themselves. Staff were aware of their responsibilities through appropriate training in regards to the Mental Capacity Act 2005.

Medicines were safely administered and people received their medicines in the way that had been prescribed for them. Each care file had clear instructions to care staff stating whether the person was to be administered medication as part of the care plan.

The registered manager had ensured that the Care Quality Commission (CQC) were informed of important events that happened in the service.

During our inspection we found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have also made recommendations in relation to regulations.

Our inspection of this domiciliary care service helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, a random telephone survey of people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe with

the staff. One person who was a regular visitor to a person who uses the service told us they visited on several occasions during the day and had never witnessed poor practice from the staff.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The provider reported safeguarding alerts to the local authority and notified CQC. This reduced the risks to people and helped the service to continually improve.

The registered manager sets the staff rotas, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Relatives that we spoke with confirmed they had been involved in the care planning when their relative were first started to receive care from the service. They also told us that the reviews held by the service reflected their current needs. Relatives that we spoke with confirmed that although they were not always informed formally when the care plans changed staff always spoke to them and would notify them immediately of any changes.

Is the service caring?

People told us that they were supported by kind and attentive staff.

Comments received from relatives included "Staff are kind and caring and were always willing to go a bit more to help”.

"When my family members health deteriorated it was the staff who spent a long time

sitting and encouraging them to eat and drink to avoid a hospital admission".

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People told us they knew how to make a complaint if they were unhappy. We looked at the complaints record and found there had been no complaints made to the provider. We were told that the complaints policy was displayed at the various locations where the service provided care. The complaints policy we looked at had been designed, written and developed to be user friendly in an easy read pictorial format. Relatives confirmed that they had not needed to make a complaint. People could be assured that if a complaint had been received there was a system in place which would ensure investigation and action.

Is the service well-led?

The service worked well with the local authorities that had placed people with the domiciliary care agency. This ensured people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and that quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We undertook a random telephone survey of the people who used the service. Three of these calls included talking to the person's relative.

People who used the service told us that they were treated with respect by the staff. They told us that staff always respected their privacy and dignity. One person told us, "Staff always make sure that my doors are closed and curtains pulled when they help to wash

me." Another person told us, "The staff were very pleasant and they always respect me." People also told us that they made decisions about their care, treatment and support, for example, one person told us, "I can ask for things to be done differently and staff would do

it." Another person told us, "Staff let me do as much as I can for myself, I like to be independent."

People told us that they had an assessment of their needs undertaken and they had a care plan at their homes. They told us that they always felt safe with the staff who attended to them. People also told us that a member of staff from the office comes to do spot

checks to make sure the staff were confidently carrying out their duties.

Relatives we spoke to told us that they were involved in the assessment and care planning process and they knew how to raise concerns and make complaints about the service their relative received.

We were told by the people who used the service and their relatives they had just completed a Quality Questionnaire about the how they felt about Mitchells Domicilliary Care.

The majority of people who use this service live in group supported living service it was therefore not possible to talk directly to them. We therefore spoke with representatives of the people who use the service. The representatives we spoke to all spoke positively about the service their relatives received from Mitchells Domiciliary Care Services. People made comments such as "their relative was consulted about their care needs", "the people from the office came at first to make up a care plan which suited the needs of their relative", they continued to say that the care plan was fully discussed with their relative them and asked if they were happy with it before it was put into place". A family member of a person who receives care from the service said that "the care staff were willing to help them and offered the right levels of support and have made excellent recommendations to assist and improve the care of their relative".

The service had completed a Quality Assurance (QA) audit during April 2012 we were therefore able to use some comments made by some of the people who used the service. One person stated that, " the staff team who are involved in my care are very caring and supportive". Another person said that they "were happy and cool with the staff who look after me".

All the people who spoke with us felt that their relatives were safe and at appeared at ease with the carers that visit them. They knew who and to whom they should contact if they were unhappy with the service or felt unsure or worried.

The service was told in advance of our review in order to ensure that we could have access to appropriate records and contact details of staff and people who use the service.

People who use the service told us they felt that staff respected their privacy and chosen lifestyle. A person told us that they were supported by staff to make important decisions about their life.

People who use the service said that they had discussed their support and preferred routines with staff and these were respected. A person said that they had agreed their care plan and were therefore aware of its contents. People generally said that they received the help they needed and that they were encouraged to do things for themselves whenever possible.

People who use the service told us that they felt safe. They said they could talk to the staff if they had any concerns. One person told us that if they had any concerns they felt confident that the staff would take it seriously and act quickly to resolve it. Another person told us “that staff are never unkind and are always courteous”.

A carer told us about a relative’s personal items that had gone missing. They felt that little had been done to ensure that their relative was not vulnerable to further loss.

A person who uses the service told us that the service has supported them to get the equipment to keep them safe and maintain their independence.

A person told us that staff have the time to support them in the way that they preferred. People described staff as “great” “really nice and “friendly”. Their comments included: “I get a mixture of different carers, but generally they are ok” and “I can talk to staff and get advice”. A carer gave us examples of where staff did not always turn up on time, or make up the time lost when supporting their relative. Another carer told us that the service took time to introduce any new member of staff to their relative to ensure that they were suitable.

People and carers told us about the opportunities to feedback their views on the services and facilities being provided to them.