This inspection took place on 15 and 22 June 2017. We gave the service short notice of the inspection. This was because we needed to be sure the registered manager would be available throughout the inspection.

New Care Services & Cornerstone is registered to provide personal care to people in their homes for children from four to 18, younger adults, people living with learning disabilities or autistic spectrum disorder, physical disability, sensory impairment, dementia, mental health, people detained under the Mental Health Act and older people. The office is based in the centre of Preston.

The service had registered manager in post. 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 the last inspection on 24 May 2016 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to assessments of people’s mental capacity, risk assessments, safe management of medicines and staff training. During this inspection we found improvements had been made.

Since our last inspection improvements had been made in the records relating to the safe handling of medicines. Staff discussed safe practice when dealing with medicines. Audits were taking place on MAR charts which included actions taken as a result of findings.

We saw evidence of risk assessment in place to maintain people’s safety in their own home along with any risks associated with the care provided by the service.

Staff demonstrated the system in place to allocate staff to people’s visits. We received positive feedback about the timings of the visits people received however not all people confirmed they received the required amount of time for their visits every time.

Staff demonstrated and understanding of how to deal with allegations of abuse. We saw records had been completed as a result of investigations that had been completed.

People who used the service told us they were happy with the skills of the staff delivering their care. There was evidence of completed staff training taking place that would ensure staff had the required knowledge and skills to deliver effective care.

Staff we spoke with understood the basic principles of the Mental Capacity Act 2005 and the importance of ensuring consent was obtained from people. Care files had been updated and the registered manager told us that appropriate assessments would be completed where concerns around capacity were identified.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were positive about the support they received from their regular staff. However some said when alternative staff undertook their visits the support was not as good.

We saw details in people’s care records that reflected their needs, likes, and dislikes choices and wishes and how they liked them to be met. Staff had access to guidance to help them deliver good care.

People told us they were involved in the development of their care plans. We saw care files were up to date and reflected people’s current and individual needs.

The was a policy and procedure in place to guide people on how to deal with complaints. There was a system in place that records investigations into complaints as well as the actions taken as a response. We saw positive feedback about the service as well as evidence of completed investigations. Some people gave mixed feedback about how the service dealt with their concerns.

We saw evidence that the provider sought the views of people who used the service. People confirmed they had been asked for their opinions in surve

This inspection took place on the 24&25 May 2016 and was unannounced.

We last inspected this service in October 2013. At that inspection we found the service was meeting the legal requirements in place at the time.

New Care Services & Cornerstone [Delta Care] is a privately owned domiciliary care agency. They are situated in Preston near the city centre. The agency provides care staff to support people in their own homes. They provide assistance with tasks such as personal care, food preparation, medication administration and household chores. The service supports people around Preston, South Ribble, and surrounding areas. Services are provided to older adults, adults with physical disabilities, adults with memory loss or dementia, adults with complex needs and adults with specific conditions such as strokes.

At the time of our inspection New Care Services & Cornerstone provided services to two hundred people.

The registered manager of the service was present throughout 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.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. People’s views on the service’s reliability were mixed.

People’s medication was not effectively managed. We found a significant number of medication errors. However medication training and audits had been undertaken.

The majority of staff we spoke with told us they were given enough time with people, time for travelling and that visits to people did not overlap. However, some staff told us they had to leave some visits early to get to the next visit in time. This was however not widespread.

We looked at care assessments undertaken for six people. Some risk assessments had been carried out. However, risk assessments for people’s personal care needs had not been done. The service followed safeguarding reporting systems as outlined in its policies and procedures. Allegations of unsafe care had been identified and actions had been taken to investigate and safeguard people.

We found the service had promoted staff development but there were significant shortfalls in training. Training records showed some training had been undertaken. However, some essential training had not been undertaken for areas such as, mental capacity, dignity, and nutrition. Significant shortfalls were found in other areas of training such as fire risk awareness, dementia, diabetes, equality and diversity and managing challenging behaviours. Staff told us they felt well supported by management and we saw evidence that regular supervisions had been undertaken.

We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act [MCA]. People's care records had no evidence of mental capacity assessments. This was a breach of regulation.

Feedback about care staff and the care that people received was positive. However, some people raised concerns around reliability of the service due to care staff not turning up, or not following the rota.

We found the way people's needs were being met was not entirely person centred. Some files had no details about people’s likes and dislikes. People told us care staff were not always introduced to them before providing care. There were assessment processes in place, which helped to ensure staff had a good understanding of people's needs before they started to support them. However care plans drawn from the assessments were basic and did not always contain detailed information about people’s identified care needs and the risk assessments around the identified needs. We made a recommendation about this.

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We visited and spoke to a number of people who use the service and their care staff. One person who uses the service told us, "the staff are very good they treat me well, I have used them for eighteen months and have been very happy with the service."

All of the people we spoke to told us that they were involved in drawing up their care plans.

All of the people we spoke to told us that staff turned up on time. One person told us, "staff turn up on time or as near to the time as can be expected, they are very punctual and offer a very good service."

People told us they had good relationships with their regular staff, when the regular staff are not available, for example on annual leave, the service provides other staff who are competent and able to carry out the tasks as stated in their care plans.

One person told us, "I have a very good carer, If I had a problem with staff, or felt they were not doing what they were supposed to or did not come on time, I would contact the office and tell them, they would sort it out, the office staff are always friendly. I have not really had any problems with the staff and the service has always made sure that I am cared for."

People told us that they knew who to speak to if they had any cause to complain. One

person told us, "I can tell the staff or call the office if I have a complaint and I know they would do something about it, I don't have anything to complain about because they always offer a good service".

Care staff told us they had regular supervision and an annual appraisal, they attended

regular team meetings and had received lots of training. They told us they were very well supported by the managers and they felt very happy to work for the service.

People told us they were involved in arranging their care and support and had agreed to the support. Consent issues were taken seriously and staff were expected to ‘respect the rights of clients, promote anti-discriminatory practices and involve people in all decisions and discussions.’ People told us the care they received was good and that they had care plans which explained their needs and how their support should be provided.

We were told staff were reliable and flexible in their work. They stayed for the right time and were respectful to them and their homes. People said, “They are a fantastic team and they know how to treat me. I have physio support and the carers were trained up to help me. They are very flexible and will always do that bit extra for you. They even wrapped up my Christmas presents for me”. And “They help me have a shower and I have to say they are absolutely first class”.

Staff had been trained to give people the help and support they needed to take their medicines safely.

People were cared for by staff that been recruited properly and were of good character. We were told staff were helpful, reliable and punctual. “I just don’t know how they (Health Care Recruiters) manage it, but every new member of staff they have sent to me has been first class”.

People were consulted about their experience of the service and were confident to exercise their right to make a complaint or comment.