This inspection of Quality Support Solutions took place on 04,05 and 07 December 2018 and was announced. The service was last inspected in February 2016 and the rating at the last inspection was Good.

Quality Support Solutions 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 people, younger adults, people living with a physical disability, people living with a sensory impairment and people living with learning disabilities or autistic spectrum disorder. People using the service were all being supported with the regulated activity which the service was registered to provide.

There were 19 people using the service when we completed the inspection. There was a registered manager employed at the service. 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 last inspected in February 2016 and the rating at the last inspection was Good. At this inspection the rating has deteriorated to Requires Improvement.

We found that the service was not always safe. Risk assessments for some people were not detailed and did not explain how to reduce risks. Known risks were not always documented in people's care plans.

The current rota system meant that there was no way of effectively monitoring whether staff were arriving for calls at the correct time or staying for the entire call duration. People told us about calls that had been missed or late however these had not been picked up by the current rota system.

Staff members had necessary checks completed before starting employment including a disclosure and barring services (DBS) check.

People were not always supported safely to take medicines. Some people were prescribed as and when required (PRN) medicines however the protocols for these were often not clear as to when or how medicines should be administered. Staff members did not receive regular competency checks to ensure that they were able to support people with medicines safely. Monitoring of medication stock and administration records were not effective.

There were systems and processes in place to protect people from harm or abuse.

The service was effective although some improvements were needed. Some staff members had not received regular training in some areas of their job roles. Staff members did not receive regular supervisions or observations of practice to ensure that they were performing their job roles.

People were supported to maintain their health and well-being. The service worked with and referred people to other health and social care professionals to support people’s wellbeing. People were supported with their dietary needs where needed.

Consent to care and treatment was obtained from people and people were supported in line with the principles of the Mental Capacity Act (2005).

People were positive about the care and support that they received from staff members. There were systems in place to ensure that people’s privacy and dignity were respected and that people had the opportunity to remain as independent as possible and make choices about their care and support.

People were supported with kindness and respect and staff members. People and those important to them had been involved in making decisions about their support as much as possible.

People received care that was responsive to their needs. However, the service was not always responsive as changes to people’s care was not always documented thoroughly. People’s care plans were task-orientated and there was little information about people’s preferences, likes and dislikes in their care plans.

Assessments completed for people before they starte

During our inspection on 12 and 13 June 2013, we spoke with four people using the service, or their relatives. We also spoke with three members of staff, including the registered manager.

Everyone we spoke with told us they were “very satisfied” with the service they received. One person said it “really changed my life” and another described the service as “fantastic.”

People we spoke with told us that care staff carried out all the tasks they needed them to do, and everyone spoke of having regular carers who turned up when agreed. One person said “I could set my clock by them” and another person told us “it really does fit the bill.”

People confirmed that they or their relatives felt safe in the presence of the manager and care staff, who they described as “brilliant”, “kind” and “caring.”

Everyone told us that they were regularly asked for their feedback, to make sure the service was meeting their needs appropriately. They said they felt comfortable approaching the manager if required with any concerns.

This inspection took place on 26 November, 1and 2 December 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that the registered manager would be in. Quality Support Solutions Limited provides personal care to people in their own homes. At the time of our inspection there were 13 people using the service.

The inspection was undertaken by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The service had a 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.

Staff knew how to recognise signs of abuse and what they needed do to protect people from abuse.

Risks to individuals and the environment were identified and managed. Risk assessments were centred on the needs of the individual to enable people to live as safely and independently as possible.

Staffing arrangements ensured there were sufficient numbers of staff available to meet people’s needs. The recruitment systems ensured that staff had the right mix of skills, knowledge and experience and were suitable to work with people using the service.

Staff were trained in the safe administration of medicines and where the service was responsible people were supported to take their medicines safely.

Staff received regular training which provided them with the knowledge and skills to meet people’s needs. They also received regular supervision and support from their supervisors.

Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation.

Where the service was responsible people were supported to have a balanced diet that promoted healthy eating.

Staff met people’s day to day health needs and took appropriate action in response to changing health conditions.

People were treated with kindness and compassion and their privacy was respected. The staff understood and promoted the principles of person centred care.

People’s needs were assessed and their care plans had sufficient detail to reflect how they wanted to receive their care and support. People using the service and/or their relatives were involved in the care reviews.

Complaints were responded to appropriately and they were used as an opportunity for learning and improvement.

The registered manager understood their responsibilities. Their leadership style inspired the staff team to deliver a quality service. Staff at all levels understood the ethos and vision of the service.

Robust quality assurance systems were used to measure and review the delivery of care and drive continuous improvement.