We inspected Mushkil Aasaan on 14 January 2019. This was an announced inspection. The provider was given 48 hours’ notice because this is a domiciliary care service. The registered manager and staff are often out in the community during the day; we needed to be sure that someone would be in.

Mushkil Aasaan is a domiciliary care service providing care and support to people in their own homes. At the time of the inspection there were approximately 140 people using the service.

At the last comprehensive inspection which took place on 04 May 2016 the service was rated Good. 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.

There was a registered manager at the service. 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.

The service continued to provide a good service that met the diverse needs of people using the service. People said their cultural needs were met by the provider and there was a matching process that was based on geographical, appropriate skills set, language and cultural needs. This matching process helped to build trusting relationships between people and their care workers. The close relationships that people had with their care workers was continuously highlighted as a positive aspect of the service.

Care workers demonstrated that they understood people’s support needs well. They were also aware of people’s individual preferences and how they liked their care to be delivered. People told us that they were treated well and personal care was delivered to them in a sensitive manner that promoted their dignity and privacy.

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.

People were confident that they would be listened to if they raised any concerns or formal complaints. The provider maintained a complaints record which showed that when complaints were made, they took action to try and resolve it to the satisfaction of the complainant.

Staff told us they enjoyed working at the service. They said that all their training needs were met and they felt empowered to do their jobs. They said the office staff, including the care co-ordinator and the registered manager were always open to feedback and they felt well supported. Records showed that staff received regular training, including a comprehensive inspection.

Care co-ordinators carried out regular supervision, both office based and ‘in the field’ which helped to ensure that people continued to receive a good service.

Thorough assessments were completed which helped to ensure that care plans were appropriate for the needs of people using the service. These included an assessment of risk to people and identifying their support needs. Care plans reflected the assessments that were in place. Care plans were reviewed on a regular basis which helped to ensure they were fit for purpose.

People’s needs in relation to their personal care, medicines, general health and nutrition were being met by the provider.

This inspection took place on 29 March 2017 and was announced.

At our previous inspection on 4 May 2016 a breach of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to notifications.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found.

Mushkil Aasaan is a domiciliary care service providing care and support to people in their own homes. At the time of the inspection there were approximately 120 people using the service.

There was a registered manager at the service. 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.

At our previous inspection we found that the provider did not always notify the CQC of notifiable incidents.

At this inspection, we found that improvements had been made.

The provider was aware of the type of incidents that they were required to notify the Care Quality Commission (CQC) of and kept a record of the events that had been reported to CQC and the local authority.

This inspection took place on 4 May 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. At our previous inspection on 9 September 2014 we found the provider was meeting the regulations we inspected.

Mushkil Aasaan is a domiciliary care service providing care and support to people in their own homes. At the time of the inspection there were approximately 120 people using the service.

There was a registered manager at the service. 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 and their relatives told us that care workers were caring and supported them in an appropriate manner. They told us they were offered choices and care workers asked for their consent before supporting them. They also said their privacy and dignity was respected. They told us they felt safe in the presence of care workers and they were competent when supporting them with hoisting.

We found there had been some incidents that required a formal CQC notification of which we were not notified.

The provider had robust recruitment checks in place which helped to ensure care workers were safe to work with people. These included checks on eligibility to work, written references and background checks including criminal record checks. Care workers completed an induction programme based on the Care Certificate over a period of six weeks. This helped to ensure they had the appropriate training to meet the needs of people using the service.

There were enough staff to meet people’s needs. People and their relatives told us that care workers attended on time and if they were running late, they were always notified by the provider. This was backed up by a log of visits that was kept by the provider which showed a high level of visits that were attended on time.

Although care workers told us they felt supported, there was lack of formal one to one supervisions. This was not in line with the providers own supervision policy of four supervisions in a year.

The provider completed an assessment of people’s support needs when they first started to use the service, this helped to ensure people received the care that they wanted. Risk assessments and care plans were written and a copy was kept in people’s homes for care workers to refer to if needed.

The provider had recently changed the way care plans were written so that they were more person centred. Not all of the care plans had been transferred to the new style.

Feedback was sought from people as part of the provider’s quality assurance monitoring. We reviewed this and found that people had good things to say about the service they received. Other audits, such as unannounced spot checks took place. People told us that when they raised concerns, the provider listened and acted upon them. We reviewed complaints that had been received within the past year and saw that the provider documented and investigated these in a timely manner.

We found a breach of regulation in relation to notifications. You can see what action we have told the provider to take at the back of the full version of this report.

During our previous inspection which took place on 19 December 2013 we found that formal staff supervision records were not always up to date. We asked the provider to take appropriate action to achieve compliance with the regulations. Following the inspection, the provider sent us an action plan addressing how they would action the area of non-compliance within an agreed timescale.

During this inspection we spoke with seven care workers and two managers. Staff told us they felt well supported by the management team and that their training needs were met. Some of the comments included, "I have always had good support and help", "they (the managers) are very helpful" and "they (the managers) do ask me what training I need."

Care workers told us, and records confirmed that they were regularly spot checked and supervised. They told us, "I have had managers come to observe me" and "they check if I am doing my job properly."

During this inspection we found that the provider had established a robust way to records the supervision and appraisal that care workers received.

People we spoke with and their relatives felt that care workers were understanding of their needs. One person using the service told us that their care worker was “fully aware of my cultural practices and helps me with what I tell her”. One relative said that staff "inform him what is going to be done". Staff demonstrated a good understanding of consent in terms of delivering personal care to people. One care worker said "I use signs or expressions to help them understand"; another care worker said "I have worked with him a long time, I understand his moods".

People using the service were given a copy of their care plan to keep at home. A family member said “since they are regular carers, I assume there is no need to look at the care plan when they arrive". Another relative told us “the carers do read the care plan and also fill the arrival sheet and I sign them".

Although staff attended training, there was a lack of staff supervision.

People told us they would contact the provider if there were any problems. A family member said, “I had to call office on two occasions of carers not turning up and the office responded well". Unannounced spot checks were carried out once or twice a year. These checks were to observe the care workers at work and also speak to people using the service about their care.

During our visit we were unable to speak directly with people who use the service or care workers. We randomly chose people using the service, relatives and staff members to interview by telephone.

A relative we spoke with commented "the staff are very nice, kind and punctual" and confirmed the service called if there was a change in care worker. A staff member we spoke with said "I had training with a senior care worker when I started".

We saw that the service provided information for people receiving care and support on who to contact if there was a concern or complaint and there was a user charter explaining the rights of the person using the service.

A person who uses the service we spoke with said "the carer doesn't judge me and never makes me feel rubbish".

Most people told us that they feel they get a good service which meets their needs. However, some people said that they do not get the service they need.

Some of the people we spoke to said that when they have raised issues about the service they have not felt listened to, and ‘’nothing changes’’. One person said, ‘’complaining is useless as they don’t listen to me’’.

Most people said they are happy with the service they receive. However, some people said that their care worker was ‘’rude’’ and disrespectful towards them.

Most people said that their care worker arrived on time, though some people said that their care worker can be up to an hour late, and they are not notified by the agency that there would be a delay.

The majority of people said that the care workers who visited them were appropriately trained to give them the support they wanted.