About the service:

Radis Community Care (Huntingdon) is a domiciliary care agency. The agency office is in Huntingdon. Care is provided to adults in their own houses and flats in the Huntingdon, St Neots, Ramsey, Yaxley, and the surrounding areas. There were 123 adults receiving personal care at the time of our inspection.

People’s experience of using this service:

Staff had not always identified risks to people who used the service or put in place guidance on how to reduce risks where these were identified. Staff had not always updated people’s risk assessments to reflect their changing needs. The registered manager had not always investigated incidents that occurred.

The registered manager had not always carried out robust checks of staff to make sure they were suitable for their roles.

Governance systems and provider oversight were not sufficiently robust to have identified the issues we found in relation to the management of staff recruitment, medicines, assessment and care planning.

People were satisfied with the way staff supported them to take their prescribed medicines and they said they received these at the right times. However, staff did not always record that they had administered medicines that had been bought over the counter, rather than prescribed.

There were enough staff to ensure people’s needs were met safely and at the right time.

People were protected from avoidable harm by a staff team trained and confident to recognise and report any concerns. Staff followed the provider’s procedures to prevent the spread of infection and reduce the risk of cross contamination.

Staff knew the people they cared for well and understood, and met, their needs. Staff were trained and well supported to meet people’s assessed needs. Staff supported people to have enough to eat and drink. Staff supported people to access external healthcare services to help maintain their health and well-being.

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 systems in the service supported this practice. People were fully involved in making decisions about their care and support.

People and their relatives were involved in the setting up and review of their or their family member’s individual support and care plans. However, some people’s care plans lacked guidance for staff in how to provide people’s care and had not been updated when people’s needs changed.

Staff were kind, caring and friendly. Staff respected and promoted people’s privacy, dignity and independence.

Staff worked in partnership with other professionals to ensure that people received care that met their needs.

People’s suggestions and complaints were listened to, investigated, and acted upon to reduce the risk of recurrence. The registered manager sought feedback from people about the quality of the service provided.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, fit and proper persons employed, and good governance. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Rating at last inspection: Good (report published 17 August 2016). At this inspection the rating went down to requires improvement.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service. We will return to re-inspect in line with our inspection timescales for services rated requires improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This announced comprehensive inspection was undertaken on 29 July 2016. We gave the service 24 hours’ notice of our inspection. Radis Community Care (Huntingdon) is a domiciliary care agency which provides personal care to people living in their home in Huntingdon, Ramsey, Yaxley, St Ives, St Neots and the surrounding areas. There were 85 people being supported with the regulated activity of personal care at the time of our inspection.

There was a registered manager in place during this 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager had an understanding that people being supported by the service who lacked the mental capacity to make day-to-day decisions should have an application to the Court of Protection made on their behalf. The majority of staff were able to demonstrate a sufficiently robust understanding of the MCA. This meant that any decisions made on people's behalf by some staff would be in their best interest and as least restrictive as possible.

People had care records in place which documented people’s support and care needs and assessed risks. Plans are put in place to minimise people’s identified risks and to assist people safely whilst supporting their independence. However, people did not have risk assessments or care plans for all of their identified risks.

People’s care records included how people wished to be supported, and what was important to them and their identified goals. These records and reviews of these, recorded that people and/or their appropriate relatives had been involved in this process.

Arrangements were in place to ensure that people’s medicines were administered safely. Records regarding the administration of people’s prescribed medicines were kept. These showed that improvements were needed by staff around the accurate recording of people’s medicine administration were being actioned by senior staff and the registered manager.

People’s nutritional and hydration needs were met. People, who required this support, were assisted to contact and access a range of external healthcare professionals to maintain their health and well-being.

People who used the service and their relatives said that staff respected their choices about how they/their family member would like to be supported. People were supported by staff in a kind and respectful way. Staff promoted people’s privacy and dignity.

There was a sufficient number of staff to provide people with safe support and care. Some people experienced care calls that were later than the agreed time and this was not their preference as this made them anxious.

Staff understood their responsibility to report any suspicions of harm or poor care practice. There were pre-employment essential checks in place to ensure that all new staff were deemed safe and suitable to work with the people they supported.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, competencies checks and appraisals to make sure that staff were competent and confident to provide the agreed care and support.

The registered manager sought feedback about the quality of the service provided from people who used the service and their relatives. Staff meetings took place and staff were encouraged to raise any concerns or suggestions that they may have had. Quality monitoring processes to identify areas of improvement required within the service were in place.

People that we spoke with were positive about the care and support they received from care staff and commented that, “The care staff are cheerful and very helpful.” People told us that they received care and support in a respectful and dignified manner. Some people we spoke with did raise concerns over the lateness of care staff for care visits

There was evidence of peoples’ involvement in the reviewing and planning of their care and support. Care and support was appropriately assessed and each care visit was documented with guidelines for staff for the care and support the person required.

However, improvements to the reviewing of some care planning documentation were needed.

Staff were trained in administration of medication and were aware of their responsibilities when recording medication that they had given or prompted people to take. The agency had effective recruitment procedures in place to ensure that only people who were suitable to work with vulnerable adults were employed.

Complaints were responded to but some people felt that improvements in communication with the staff in the office needed to be made

A single adult social care inspector carried out this inspection. We looked at 12 people's care records, spoke to five people and two relatives by telephone, visited five people in their homes and conducted a survey questionnaire to gather people's views about the care they were provided with. We considered our inspections findings to answer questions we always ask:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found-

Is the service caring?

Observations we made during our inspection demonstrated to us that people were provided with respectful and reliable support from care staff in a consistent manner. Four out of 12 people we spoke with told us that sometimes they were not informed that their carer was to be late. People were able to make choices about their care needs in an individualised way. Staff told us that the manager's door was always open and that if they ever had any concerns about people's care that they could raise these and be confident that changes would be made where this was practicable.

Is the service responsive?

Before people started to use the service their personal care and support needs were assessed to ensure that the provider was able to reliably meet these needs. This also included people's individual choices and preferences as to how they liked to be supported. We observed that people could make changes to their support and had been involved in reviews of their support. We saw that reviews were in place to update people's care and support needs. Where the provider conducted quality assurance surveys we saw that actions had been implemented to make changes according to people's most up to date needs.

Is the service safe?

Improvements to people's health risk assessments regarding people's individual activities had been reviewed and updated since our inspection in 2013. Staff training in mandatory subjects and also specialist care meant that measures were in place to minimise the risks to people's health. Staff member's understanding of their roles and responsibilities in identifying and reporting any potential abuse meant people were safely cared for. People we spoke with confirmed to us that they always, "felt safe" with staff. Staff were kept up to date with safeguarding training and the associated reporting procedures. Checks on staff and their care practices ensured that people were only assisted with their mobility by the appropriate number of staff.

Is the service effective?

We found that care workers were knowledgeable about people's individual care and support needs. Observations we made during our inspection confirmed that the care staff provided consistent support when assisting people with personal care and support. Care records we viewed demonstrated that people had made choices on the time they wanted their care, what care they needed and how they wanted this to be provided. Monitoring of people's health by trained staff ensured that people's care was effective.

Is the service well led?

The care agency was effectively led by a registered manager. Staff confirmed to us that that they felt well supported and were provided with regular training. This included how to help people with their mobility. Observations made during our inspection showed that staff responded to people's care and support needs in a respectful way. Health and safety checks had been completed in people's homes to ensure that were in place to monitor services provided. Quality assurance surveys were carried out to gather opinions from people using the service, relatives and staff to identify, as far as practicable, if improvements could be made to the service. Improvements and changes made since our inspection in 2013 showed us that the service was well led.

We found that the provider was compliant with the regulations in all the areas we assessed. If you wish to see the evidence supporting our summary please read the full

report.