This inspection took place on 5 and 7 September 2018.

At our last inspection of Options Care Limited which took place over December 2016 and January 2017 we found the provider to be in breach of three regulations of the Health and Social Care Act (Regulated Activities) 2014. These were in relation to good governance; fit and proper persons being employed and sufficient staff being deployed. At this inspection we found the provider had taken the appropriate actions to address each shortfall and was no longer in breach.

Options Care Limited is a domiciliary care agency that provides care and support to people with

varying needs in their homes. At the time of our inspection Options Care Limited was providing support to 10 older adults and two people with a learning disability. All of the people receiving a service lived in the London Borough of Sutton.

The service had a registered manager. 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’s care was delivered at the agreed times and for the agreed durations by staff who were safe and suitable to provide support. Staff were recruited through a rigorous and consistently applied process. People were protected by the infection prevention and control practices of staff and received their medicines in line with the provider’s instructions.

The care and support people received was delivered by staff who were trained and supported. The registered manager supervised and appraised staff. People participated in their needs assessments and were supported to access healthcare services. People’s assessed nutritional needs were met and staff delivered care with people’s consent.

Staff were kind, caring and compassionate. People and staff shared positive relationships. People had their privacy respected and staff treated them with dignity. Staff promoted people’s independence and supported their cultural needs.

The care people received was personalised and based upon their individual needs. People were involved in the development of their care plans. Where people received funding so to do they were supported to engage in activities to counter the risk of social isolation. The registered manager addressed people’s complaints in line with the provider’s policy.

The registered manager used feedback from people, their relatives and from staff to shape and improve the service. Quality assurance processes were in place and the provider gathered feedback from people, relatives and staff about the care being delivered. People benefited from the provider’s partnership working approach in which the service liaised with external organisations and professionals.

This inspection took place on 20 December 2016 and 16 January 2017.

The provider was given 48 hours’ notice of the first inspection date because the service provides domiciliary care and we needed to be sure the registered manager was available. The visit in January 2017 was unannounced in response to allegations made by some members of staff.

The previous inspection took place on 1 September 2014 and the service met the regulations we inspected.

Options Care Limited is a care agency that provides care and support to approximately 18 adults with varying needs in their homes.

The service had a registered manager. 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.

There were not always sufficient numbers of suitable staff available to meet people’s needs. Staff did not go through an appropriate recruitment process before being employed.

Staff received initial training. Training included an induction process for new members of staff. Refresher training for existing staff was available through media accessed training. However, staff were not appropriately trained and assessed as competent to provide safe and appropriate care and support.

People told us they felt safe with this service. Staff had completed safeguarding training which meant they were aware of the different types of abuse that could take place and new how to raise any concerns. Risk assessments reflected people’s needs and supported staff to provide safe and appropriate care and support. People’s medicines were managed safely where required.

Staff were supported with regular supervision meetings and appraisals where any training and development was identified. The service was working within the principles of the Mental Capacity Act. People consented to their care and support. The service was meeting people’s nutrition, hydration and healthcare needs.

People and relatives told us staff were caring and treated them with dignity and respect. The service supported people to express their views and to be involved in planning their care and support. Staff respected people’s dignity and privacy and encouraged people to be as independent as they wanted to be. Staff supported people to make choices and respected people’s preferences.

People’s needs were assessed before the service started providing care and support. Care and support plans were person centred and identified needs, goals and preferences. The service encouraged feedback from people and their representatives about their experiences of the service. The service generally managed complaints appropriately.

The service had systems to assess, monitor and improve the quality and safety of services provided, but these were not always effective in identifying problems and concerns. The provider did not ensure records relating to the provision of the regulated activity were accurate, up to date and fit for purpose.

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

An inspector carried out a planned inspection and gathered evidence against the outcomes we looked at to help answer our five key questions; is the service safe, caring, effective, responsive and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found sufficient staff were available to deliver people’s care and support needs and they received the training required to provide safe, appropriate care and support. Appropriate checks had been carried out before staff started working with people to ensure they had the appropriate knowledge, skills and experience to meet people’s care and support needs.

People were protected from the potential for abuse and neglect as the provider had taken reasonable steps to ensure staff recognised the signs of abuse. Staff we spoke demonstrated their knowledge in recognising signs and symptoms of abuse and how to report concerns. The registered manager demonstrated how concerns were investigated with necessary actions identified, taken and followed up.

The provider had an effective system in place to analyse any incidents that occurred when providing care and support for people in their homes. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

Is the service caring?

People told us they were treated with respect and dignity by the staff. We found people were supported appropriately and sensitively by kind and considerate staff. We spoke with staff who told us about how they provided care and support. People we spoke with were positive about the caring nature of staff members supporting them. They told us they felt safe with their care workers. A relative of a person using the service told us, "(my relative) speaks very highly of the carers. They are well cared for and looked after."

Is the service effective?

People’s health and care needs were assessed with them. We saw evidence to show people and their relatives or advocates had been involved in writing and agreeing their care plans. Specialist dietary and healthcare needs had been identified in care plans where required. People we spoke with told us they received the support needed. People’s care was subject to review so staff could ensure their needs were being met effectively.

Is the service responsive?

Staff we spoke with demonstrated they would report any concerns to the registered manager and were confident these would be addressed. This was confirmed by a staff member we spoke with who told us, “we are regularly encouraged and supported to the manager to report any concerns we may have or if there have been any changes. The manager is very good at sorting things out.” A relative of a person using the service told us, "they always keep me updated if something changes. I've never had to complain but I'm certain it would be dealt with if I did." We saw there was an effective complaints procedure in place.

Is the service well led?

People we spoke with, staff and relatives were positive about the management of the service. Staff told us they felt supported by the registered manager.

We found monitoring and reviews of the service were carried out regularly and highlighted actions were completed in a timely manner.

The registered manager told us they were currently providing care and support to one person.

We spoke to the person using the service. They said they had a care plan and staff carried out the tasks recorded in their care plan. We spoke to their relative. They said they were very happy with the care and support their relative was receiving. They said “The agency talked with me and my relative about my relative’s needs, they went through everything with us and they have always been very helpful”. They said the agency gave them information about making complaints. They said they would contact the registered manager if they had to make a complaint.

The project manager from a local self-advocacy group run by and for people with learning disabilities said they provided the registered manager with an easy to read version of the agencies service user guide. They said the registered manager was keen to make information easy for people to understand. They also provided the agency with training on learning disability awareness.

We spoke to the care manager of the person using the service. They said the agency offered a good service to their client and they had no concerns about the quality of care and support they provided.

We spoke to one person who uses the service. They told us they had been consulted about what was included their care plan. They told us staff carried out the tasks recorded in their care plans. They told us they knew how to make a complaint if they needed to.

We spoke to a relative of another person who uses the service. They told us the agency was "very good and very helpful" and they were very satisfied with the care their relative was receiving. They told us they were involved in developing their relative's care plan. A copy of the care plan was kept at home and another copy was kept at the agency office. They told us staff turned up on time and carried out the tasks recorded in the care plan. They told us they were given a copy of the Service Users Guide and the agency’s complaints procedure.

We spoke to the care manager of one of the people who use the service. They told us the agency was professional in their approach in terms of meeting with them and the person using the service, carrying out assessments and developing and delivering a care package. They told us they were impressed that the agency had matched the complex needs of the person using the service with a member of staff who had the skills and experience to meet their needs.