This was an announced inspection, carried out on 09 & 15 November 2016. We gave 48 hours’ notice of the inspection because we needed to be sure that the registered manager or someone who could act on their behalf would be available to support our inspection.

N-able Support Services is a domiciliary care agency, providing personal care and support to people living in their own homes. The service operates from an office based in the City of Liverpool. At the time of the inspection two people were using the service.

The service is managed by the registered provider who has registered with the Care Quality Commission to manage the service. 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 last inspection of N-able Support Services was carried out in July 2014 and we found that the service was not meeting all the regulations that were assessed. We asked the registered provider to take action to make improvements, which included safeguarding people, safe recruitment and records. The registered provider sent us an action plan following the inspection in July 2014 detailing how and when they intended to make the improvements. During this inspection we found that the required improvements had been made.

We have made a recommendation about records. Although we found improvements had been made with some records, we found further improvements were required. Care plans and medication administration records (MARs) for one person lacked information about their care and support needs. This meant people were at risk of not receiving the right care and support. In addition records had not been maintained following some checks carried out on the service people received. Following our inspection we were provided with confirmation that the required records had been put in place.

Since the last inspection improvements had been made in relation to safeguarding people from abuse. Staff had completed safeguarding training and they had access to all the relevant information to help protect people and keep people safe. People indicated that they felt safe using the service and that staff treated them well. Staff were confident about recognising abuse and reporting any concerns they had about people’s safety.

Since the last inspection improvements had been made in relation to the recruitment of staff. Although no new staff had been recruited since our last inspection records including photographic evidence of staff’s identify had been obtained and placed in their recruitment files along with references. There was a recruitment and selection policy and procedure in place which outlined a safe process for recruiting new staff.

Staff said they felt well supported by the registered provider and that they were given sufficient opportunities to discuss their work and training and development needs. For example, they attended weekly meetings and met regularly with the registered provider on a one to one basis to discuss their work and the people supported.

People received support by the right amount of suitably, skilled and experienced staff. Staff arrived at people’s homes on time and stayed for the full duration of the contracted call. People received care and support from the same staff who had worked at the service for a number of years. Staff knew people well and had formed positive relationships with them.

People indicated that the staff were kind, caring and that they enjoyed their company. Staff took time to get to know people and they engaged people in their chosen hobbies and interests. One member of staff developed skills to enable them to communicate with a person using a second language.

People’s healthcare needs were understood and met by staff. People were supported as required to attend heath care appointments. Staff liaised with other health professionals for advice and support regarding people’s healt

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

As part of this inspection we spoke with a person who used the service, the registered provider (who managed the service) and three care staff. We also reviewed records relating to the management of the service. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We asked a person who used the service if they would feel confident to raise any concerns with staff or the manager and they told us they would.

At the time of our inspection the agency was only supporting one person. We found that the care and support they received was individualised and staff were aware of the person's needs and any risks associated with their needs.

Procedures were in place for reporting suspected abuse but staff had not been provided with training in safeguarding people from abuse. The provider therefore had not made suitable arrangements to ensure people were safeguarded against the risk of abuse. A compliance action has been set for this and the provider must tell us how they plan to improve.

Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the provider could not demonstrate that the staff employed to work at the service were suitable and had the skills and experience they needed. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

Personalised care and support was provided to the person who used the service. Staff told us they knew the needs of the person they supported well and we found that care and support was 'person centred' or based on their individual needs .

Staff were able to tell us how the person they supported was listened to and included in day to day decision making. Staff spoke about ‘encouraging’ and ‘supporting’ the person to use their independent living skills and to use their local community.

Is the service caring?

We asked the person who used the service if staff were caring and respectful and they told us they were. We saw that staff interacted with warmth and familiarity when supporting the person who used the service.

Staff told us they were clear about their roles and responsibilities to promote people’s independence and to respect their privacy and dignity.

Is the service responsive?

Personalised care and support was provided and the service was flexible to meet the changing needs of the person supported.

The person who used the service had been supported to see health professionals as appropriate to their needs.

Is the service well-led?

The provider had an informal system in place for assessing and monitoring the quality of the service. The provider told us they carried out regular visits to the person who used the service to check on the quality of their support but there were no records kept about these visits and the type of checks involved.

The provider was not able to demonstrate, through records, that the person who used the service was receiving appropriate care and support that met their needs. The provider was also not able to demonstrate through records that staff had been recruited appropriately and were suitably skilled and experienced. A compliance action has been set for this and the provider must tell us how they plan to improve.