The inspection took place on 15 February and 3 March 2017 and was announced. Q Care - Ross on Wye is registered to provide personal care to people living in their own homes. There were 89 people using the service at the time of our inspection.

A registered manager was in post and 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. At the time of inspection the registered manager had applied to deregister as a manager with CQC. A new branch manager was in post and present during the inspection. They had applied to become a registered manager with CQC.

At the last inspection the provider had not displayed their most recent CQC rating at their registered premises, in order that this was accessible to the people who used the service. The provider was now displaying the ratings clearly.

There were quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. However the provider had not always identified issues that affected the quality of support provided.

Staff did not always feel listened to and supported with concerns that they had raised with the provider.

People felt staff provided support in a safe and caring way. Staff understood how to recognise and protect people from abuse and received regular training around how to keep people safe.

Staff were not recruited until checks had been made to make sure they were suitable to work with the people that used the service.

People were confident that staff had the knowledge, skills and experience to provide effective care and support. Staff had training relevant to their roles.

People’s care records contained the right information for staff to follow to meet people’s health needs and manage risks appropriately.

People’s consent was always gained before any care and support was given. Staff understood that care could only be given if the person consented.

People had the support they needed to ensure that they had adequate food and drink.

Staff had knowledge of people’s individual needs and how to meet them.

The management team promoted an open culture within the service. Staff knew what to do if they suspected abuse and were aware of when to whistle blow.

The inspection took place on 20 and 21 July 2016 and was announced. Q Care - Ross on Wye is registered to provide personal care to people living in their own homes. There were 72 people using the service at the time of our inspection.

A registered manager was in post and 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 provider had not displayed their most recent CQC rating at their registered premises, in order that this was accessible to the people who used the service. The provider had not informed the Care Quality Commission about two allegations of abuse.

Staff had received training in how to keep people safe from harm and abuse. They knew how to spot the signs and symptoms of abuse and neglect, and how to report these to a manager or senior member of staff. The risks to individuals had been assessed and managed, and people’s involvement in these decisions had been encouraged. The provider followed safe recruitment practices to make sure staff were suitable to work with people.

People and their relatives were pleased with the support staff provided in relation to people’s medicines. Staff had been trained in how to handle and administer people’s medicines safely and their competency was checked.

Staff had the skills and knowledge needed to meet people’s individual needs. Staff received an induction to the service and an ongoing programme of training. Staff attended regular one-to-one sessions with a senior member of staff or manager.

The management team understood the requirements of the MCA, and the provider had taken steps to raise staff awareness of its implications. Staff sought people’s permission before carrying out care tasks and respected their decisions.

People received the level of support they needed with their food and drinks. Any risks associated with people’s eating and drinking were recorded in their care files and managed by staff. Staff played a positive role in helping people to maintain good health and assisted them in seeking professional medical advice and treatment when needed.

Staff adopted a caring approach towards their work with people, People felt listened to and involved in their own care. Staff treated people with dignity and respect, and understood the importance of respecting their people’s rights.

The management team encouraged people’s involvement when assessing or reviewing their care and support needs. Staff understood people’s individual needs and preferences, and promoted their people’s independence. People and their relatives knew how to raise any concerns or complaints about the service, and felt confident about coming forward with these.

The management team promoted an open culture within the service, based upon good communication. People found the management team approachable. Staff experienced consistent leadership and management and were well-supported. The provider had implemented a number of quality assurance systems and checks to assess, monitor and improve the quality and safety of the service provided.

This inspection was carried out on 11 and 12 November 2015 and was announced.

The provider registered this service with us to provide personal care and support for people within their own homes. At the time of our inspection 57 people in Herefordshire received care and support from this service.

There is not a registered manager in post, however the manager has applied to become 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 did not have consistent reliable care and support, and were not always informed when staff were not going to arrive.

Staff did not have regular supervision and did not feel supported by the manager or provider.

The provider and manager did not have any systems to monitor the safety and quality of the care and support provided. They had failed to address concerns that had been raised by people hat used the service.

People received care that was safe and got the support they needed with their medicines.

People were involved in their care and able to make choices regarding their care and support. They told us that staff were caring and kind and knew their needs, and treated them with dignity and respect.

If people were unwell they were supported to access health professionals. Where increased support was identified as being needed, the provider made additional staff available to respond to this.

Before staff were recruited checks were in place to make sure that new staff were suitable to support people in their own homes and keep them safe.

People had choice over the support they received and nothing was done without their consent. Staff understood the principles of consent and delivered care that was individual to the person.

You can see what action we have asked the provider to take at the end of this report.