About the service: Nationwide Care Services (Dudley) Ltd provides personal care to people living in their own homes. At the time of the inspection, 112 people received personal care from the service.

People’s experience of using this service:

People were supported by staff who knew how to report concerns of abuse and manage risks to keep people safe. People received support from a regular team of staff and there were systems in place to ensure visits were made on time. People’s medication was managed in a safe way.

People received support from staff who had training relevant to their role. People’s dietary needs were met and people had access to healthcare services where required. People’s rights were upheld in line with the Mental Capacity Act.

People told us that staff were kind and caring to them. People’s dignity, privacy and independence were encouraged. People’s diverse needs had been respected.

People were supported by staff who knew them well. Staff knew peoples preferences with regards to their care. Complaints made had been investigated and resolved.

People spoke positively about the leadership at the service. People were given opportunity to feedback on their experience of the service. This feedback was acted on. There were systems in place to monitor the quality of the service.

Rating at last inspection: Requires Improvement (Report Published 18 May 2017)

Why we inspected: This was a planned inspection based on the rating on the last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This announced inspection took place at the provider’s office on 15 and 16 January 2018 with phone calls undertaken to people with experience of the service on 16 and 18 January 2018. The provider was given a short notice period that we would be undertaking an inspection. At our previous inspection in March 2017, the provider was rated as ‘Requires Improvement’ in the key questions of Safe, Responsive and Well Led. The provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Well Led to at least good. At this inspection, we found the provider had made sufficient improvements to meet the regulations but further improvements were required in the way the quality of the service was monitored, the detail provided in people’s records and in relation to the out of hours service provided to people.

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 older adults. They also provide a service to people who have been discharged from hospital and who receive a re-enablement service. At the time of our inspection 92 people were receiving personal care from the provider.

The service had a registered manager but they were not based full time at this service. The service was managed on a daily basis by a branch manager who advised they were supported by the registered manager. The branch manager had applied to become the registered manager and her interview to become registered was planned after our inspection. The branch and registered manager were present during our 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.

Although some improvements had been made, people and relatives continued to experience some inconsistencies in the way the service was provided. People and relatives told us support was not always provided by the same staff that arrived at the expected time. This at times made people feel unsafe as they did not always know the staff member supporting them. Recruitment practices ensured only suitable staff were employed to work with people. Staff knew how to meet people’s need and were aware of any risks associated with supporting them despite the lack of detail in people’s care records.

People told us their health and well-being needs were assessed when they first started using the service. Staff had received training to enable them to have the skills and knowledge required to support people effectively, and staff told us they felt supported in their role. People’s consent was sought before staff supported or provided them with any assistance. People received appropriate support to ensure they ate and drank adequately. Referrals to relevant healthcare services were made as required when changes to health or wellbeing were identified.

People’s preferences were taken into account to ensure their dignity was maintained. People and relatives made positive comments about the staff that supported them describing them as kind, caring and gentle. People were provided with suitable information about the service and were supported with their individual communication needs.

People and relatives knew a complaints procedure was in place and they told us any concerns raised with staff or the branch manager had been responded to. Records showed that complaints were investigated and outcomes and actions recorded where required so lessons could be learnt .

There had been some improvements in the way the service was managed and mo

This inspection took place on 14 March 2017 and was announced. The service had been registered with us previously and was rated as Requires Improvement. There has been a change to the provider’s legal entity and this was the first inspection since this service was re-registered in July 2016.

Nationwide Care Services Ltd (Dudley) is a domiciliary care service registered to provide personal care to people within their own homes. They provide support to people on a long term basis and to people who have been discharged from hospital and who receive a re-enablement service. At the time of our inspection 80 people were using the service.

The service had a registered manager but they were not based full time at this location. The service was managed on a daily basis by a branch manager who advised they were supported by the registered manager. The branch manager was present during our 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.

The provision of medicines was not monitored effectively within the service to ensure people received their medicines when they needed them. People did not always receive a reliable and consistent service as they had experienced late and missed calls.

Staff had received training and were aware of the types of abuse people may be at risk of and knew the actions to take if they suspected someone was at risk of harm. Recruitment processes were in place to reduce the risk of unsuitable staff being employed by the service.

Staff received an induction and on-going training to ensure they had the skills and knowledge for their role. People were supported with meals where required and staff had some knowledge of people’s dietary requirements. People and relatives told us that staff sought consent before providing their care. Staff monitored the health and wellbeing of people and knew the action to take if someone became unwell.

People and their relatives told us that staff were kind and treated them with respect. Most people felt staff ensured their dignity was prompted when providing personal care. Care records contained information about people's abilities, preferences and support needs, but these were not reviewed in a timely manner.

A complaints system was in place but complaints were not always recorded or responded to in a timely manner. Although feedback was sought from people, and their relatives the action recorded to address the shortfalls had not been effective in ensuring improvements were made.

The provider failed to provide evidence that they had a clear oversight of the service through regular auditing and effective quality assurance systems.

You can see what action we told the provider to take at the back of the full version of the report.