R4R home care services is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people, some of whom are living with dementia, people with physical or learning disability, and people with a mental health need. The service also provides a 24 hour live in care service. Not everyone using R4R home care services received a regulated activity; Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

R4R home care services provided the regulated activity of personal care from an office based on the outskirts of Watford. At the time of this inspection there were two people using the service.

This inspection took place over several dates. On the 29 November 2017 we visited the site office. On the 5 December 2017 we visited people in their own homes and on13 December 2017 we telephoned relatives and staff members in order to obtain their feedback about the service. We gave the provider 48 hours’ notice of our intended inspection to make sure that appropriate staff were available to assist us with the inspection.

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.

When we previously inspected the service on 8 February 2016 we found that procedures in relation to the recruitment of staff was not always robust and the care and support people received was not always safe. We also found that staff did not always receive the necessary training to carry out their role effectively and the provider’s governance systems were not always effective in identifying and improving shortfalls. Following the inspection the provider submitted an action plan which detailed how they were going to implement and sustain the necessary improvement.

At this inspection we found that the provider had made the necessary improvements to ensure people received care and support in a safe, effective and personalised way and there were now systems in place to monitor and review the service provided.

Staff knew what keeping people safe meant as well as how to achieve this by managing any identified risk. Staff were trained in safeguarding people and were informed about who they could report any incident of harm to.

People were given information in a format that they could understand about staying safe.

People's needs were met by staff who were trained appropriately for their role and they were deployed to ensure people’s needs were met.

People were supported to take their prescribed medicines safely. Staff were trained and deemed competent to support people's medicines by staff who had the skills to do this.

Staff were supported in their role and they knew what standard of care was expected. Incidents were used as an opportunity for learning and to help drive improvements.

People were enabled to access healthcare services. People's nutritional needs were met by staff who knew each person's needs well. Staff knew when people needed support and also when to respect people's independence.

The equipment that staff supported people with was regularly checked to make sure that it was safe.

A positive and good working relationship existed between the provider, registered manager, staff and relevant stakeholders. People were supported in partnership with other organisations including healthcare professionals to help provide joined up care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and sys

The inspection took place on 8 February 2016. We gave the provider 48 hours- notice of our intended inspection to make sure that appropriate staff were available to assist us with the inspection. At the time of our inspection two people were being supported by the service.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People and their relatives told us that their family members were kept safe and well cared for when they were being supported by staff who worked at the service. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse.

Although there was a recruitment process in place, the process was inconsistent and not always followed. The manager found it difficult to demonstrate that they had followed their own process consistently. There were sufficient numbers of staff available to meet people’s individual needs, and the service provided was flexible.

Potential risks to people’s health and well-being had been assessed however there was no evidence that these had been reviewed regularly and this meant that the risks to people’s health and wellbeing were not effectively managed.

People and their relatives were very complimentary about the abilities and experience of the regular staff who provided care and support. Staff received some training however this was ad hoc and not delivered in a planned way. Staff had one to one meetings with their manager, however this was not always in a planned way, and the information recorded was basic and did not demonstrate how staff performance was developed or monitored.

Staff supported people to stay safe in their homes, and people were supported to maintain their health and well- being. Staff developed appropriate positive and caring relationships with the people they supported and their families, and feedback from people was consistently positive about the service they received.

Staff asked people for their consent before providing care and support. People and their relatives where appropriate were involved in the initial planning of the care and support people received. People's personal information was stored securely and confidentiality was maintained.

People told us they felt the staff provided care and support that was delivered in a way that promoted their dignity and respected their privacy. Staff were knowledgeable about people`s preferred routines and delivered care that was individualised to the person they were supporting.

People told us they felt that staff listened to them and responded to them in a positive way. People and their relatives knew how to raise concerns if they needed to and told us they were confident that the manager would take appropriate action to address any concerns in a timely way.

People and their relatives were positive about the service, and the staff and management of the service. However we found that records were not always sufficiently maintained and the systems in place to monitor the quality of services provided were not always effective.

We reviewed care records, staff records and policies and procedures that were in place for people who used the service. We found this service to be a very small provider with a person centred approach to care planning and delivery.

The records confirmed that people who used the service were involved in the assessment and were able to contribute to their care and support plans.

Staff had been recruited using a robust recruitment procedure, and we saw evidence of on-going support for staff which included training, supervision and appraisal.

Safeguarding arrangements were in place and staff had attended appropriate training. The provider had quality monitoring procedures in place.

We spoke to a person who uses the service who told us that they were 'very satisfied' with the service that is being provided. They said that they had no concerns at all and that carers always arrived on time and stayed for the full duration of the contracted time. The person told us that they feel fully involved in the care planning process and that they, and their family members are involved in meetings regarding reviews to their care.

We found that the provider was meeting all the standards we reviewed. People’s needs had been met appropriately. There was a recruitment policy and procedure in place and we noted that the required checks had been carried out for all employees.

We were not able to speak directly with people who had used R4R Home Care Services, as part of this review, as their personal circumstances had changed now they no longer required the service.