PCS (Personal Care Services) Limited is a domiciliary care agency that provides care and support to people in their own homes. At the time of the inspection there were approximately 150 people who used the service which meant the agency were providing around 4,500 hours of care per week. The agency provided care to people with a range of care needs, which included older people, people living with dementia, people with physical disabilities and people at the end of life.

This inspection took place on the 14, 16 & 17 March 2017 and was announced to ensure that the Registered Manager and appropriate staff were available to support the inspection.

The Registered Manager was present during the visit to the registered premises and was cooperative throughout the inspection process. 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 was registered with the Care Quality Commission in December 2013. We last inspected PCS (Personal Care Services) Limited in March 2015. At the inspection in March 2015 we found the service was not meeting one the regulations that we assessed and we asked the provider to take action to make improvements. This was in relation to the management of people’s medicines. The service as a consequence was rated as Requires Improvement overall and for the domain of ‘safe’. The service was also rated as Requires Improvement within the domains of ‘effective’, ‘responsive’ and ‘well-led’.

We issued one requirement notice and asked the registered provider to tell us how they were going to make the improvements required. At this inspection we found that the registered provider and registered manager had made the changes and improvements needed to meet the requirement notice issues from the previous inspection.

People we spoke with told us they felt safe receiving care in their own home. Family members we spoke with also told us this. We received positive comments about direct care staff and office based staff in this regard.

We spoke with staff about the agency’s safeguarding procedures. They were all aware of the safeguarding policy and how to report any potential allegations of abuse or concerns raised and were aware of the procedures to follow.

Improvements had been made across a number of areas including risk assessments, care planning, auditing and recording. These were areas we had made recommendations for improvement at our previous inspection.

Staffing levels were judged to be of a sufficient level to meet the assessed needs of people using the service. No-one we spoke with had any concerns regarding staff punctuality or with the length of time staff spent with them.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure staff were recruited safely.

We saw staff received a thorough induction that was adapted from the care certificate. We also saw that staff received on-going training and development and received formal support via one to one supervisions. Staff also told us the agency was a good place to work and that they felt there were opportunities for them to advance their career within PCS.

People we spoke with who received assistance with their nutritional and hydration needs told us this was done well. Care plans contained information to support staff to do this and good records were kept to record people’s food and fluid intake as needed.

People, and relatives we spoke with, told us they were happy with the care and support they or their family members received and that staff were caring and compassionate.

The service provided end of life care to people who wished to remain at home during their final days. Training and support was o

PCS (Personal Care Services) Limited is a domiciliary care agency that provides care and support to people in their own homes. At the time of the inspection there were approximately 70 people who used the service. The agency provided support to people with a range of care needs, which included older people, people living with dementia and people with physical disabilities.

This inspection took place on 6th March 2015. The provider was given 48 hours’ notice that the inspection was going to take place. We gave this notice to ensure there would be someone available at the agency’s office to assist us in accessing the information we required during the inspection.

This was the first inspection of the service since its registration in December 2013.

There was a registered manager in place at the service, who was also the provider. 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 majority of feedback we received from people who used the service was very positive. People expressed satisfaction with their care and spoke highly of care workers, office staff and the registered manager. Their comments included, “I would recommend them. I have already told some people about them.” “I think they rate as good to very good.” “I think that we’ve now come to find an excellent carer from them. We used to get different people, but now we’ve got one who is really good. He’s the best.”

We received comments from three community professionals, which were all positive. Each of the professionals expressed satisfaction with the service and told us they found the service professional and reliable.

Where people expressed dissatisfaction, this tended to be in relation to one of two areas – punctuality and consistency. A number of people we spoke with told us their care workers were sometimes late and others felt they received too many different carers. We noted the registered manager had identified these two themes as areas for improvement and had started to take measures to address them. This demonstrated the registered manager listened to feedback from people who used the service and acted upon it.

People felt they received safe and effective care and had confidence in their care workers.

There were processes in place to ensure staff were aware of any risks to people’s safety and wellbeing and individual guidance was in place to assist staff in supporting people in a safe and effective manner.

Arrangements for supporting people with their medicines were not adequate. We identified concerns in relation to risk assessment and care planning for people who required support with their medicines. In addition, medication records were found to be unclear and in some cases, not completed to a satisfactory standard. This meant people were at risk of not receiving their medicines in a safe manner.

Staff were carefully recruited and a number of background checks were carried out, to help ensure they were of suitable character to work with vulnerable people.

In general, a good level of training was provided for care workers. However, people who used the service felt that new staff were not always well equipped and were less confident. In addition those people with more complex needs, felt some care workers, who supported them did not have the additional skills required to support them. The registered manager had taken steps to address these issues however, by improving the induction provided to new staff and putting arrangements in place for staff to receive training from an in-house qualified health professional in more complex health care areas.

People who used the service and staff spoke highly of the management team, describing them as approachable and supportive. People told us they felt able to raise concerns and were generally confident any concerns they did raise would be addressed.

Formal systems for monitoring quality and safety across the service had not been properly implemented at the time of the inspection. This meant that some opportunities to identify potential improvements had been missed, although the registered manager was able to demonstrate that she encouraged and acted upon feedback from people who used the service.

Whilst we found a number of areas which required improvement, the registered manager was able to provide evidence that she had also recognised them, and in most cases was also able to provide evidence that she had started to take action to address them.

We found that the registered person had not protected people against the risk of people receiving their medication in a safe manner. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 12 (1)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.