About the service: Rapid Improvement Care Agency is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. At the time of this inspection 30 people were using the service.

People’s experience of using this service:

¿ People were put at risk of receiving unsafe care and support because staff did not always arrive on time and the systems in place were not always effective in driving improvement.

¿ People received care and support that was personalised to their needs.

¿ Risks to people had been identified, assessed and they had management plans in place to reduce the risk occurring.

¿ People’s medicines were managed safely.

¿ People were protected from infectious diseases because staff followed appropriate infection control protocols.

¿ There were enough staff available to support people’s needs.

¿ 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.

¿ Staff had the knowledge and experience to support people's needs. They were supported through induction, training and supervision to ensure they carried out their roles effectively.

¿ People were supported to maintain good health and they had access to healthcare services where this was required.

¿ People’s privacy and dignity was respected and their independence was promoted.

¿ People were involved in making decisions about their care needs.

¿ People and their relatives knew how to make a complaint if they were not happy with the service.

¿ No one using the service required end of life care and support; however, there were systems in place to ensure that people had access to end of life care when required.

¿ Feedback from people, their relatives and staff was being used to develop the service.

¿ The provider worked with key organisations to plan and deliver joined-up care.

¿ Staff said they enjoyed working at the service and felt supported in their role.

Rating at last inspection: Requires Improvement. (Report published 3 March 2018) This is therefore the second time the service has been rated as Requires Improvement.

Why we inspected: This inspection was part of a scheduled plan based on our last rating of the service and aimed to follow up on some concerns we had found at our inspection in January 2018.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 16 January 2018 and was announced. Rapid Improvement Care Agency is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection 22 people were using the service. This was their first inspection since the registration of the service in 2017.

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.

The systems in place to check the quality of care and service provided did not always identify issues. We found that staff did not ensure that best practice guidelines were followed in line with the Mental Capacity 2005 (MCA) in connection to the decision made about one person’s care and support. The registered manager however took immediate steps to address our concerns. Staff had received training in the Mental Capacity Act 2005.

People’s care needs and risks to their health, well-being and safety were assessed and care plans developed on how identified needs would be met. Staff had training to do the job. Staff were supported through regular supervision, appraisal, spot checks and direct observation to be effective in their roles. Staff supported people with their nutritional needs.

The service had policies and procedures in place to protect people from the risk of abuse. Staff were trained in safeguarding adults from abuse and they knew what actions to take if they suspected abuse had occurred. People received care visits from staff to meet their needs. Staff recruited to work with people were thoroughly vetted to ensure they were suitable for their roles.

People were supported to manage their medicines safely. Staff were trained and followed good infection control procedures. The service had a system for reporting incidents and these were reviewed by the registered manager.

People had access to healthcare services they needed to maintain their health and staff supported them to attend their appointments. The service ensured people received the care they needed when the moved between services.

People and their relatives told us that staff were kind and caring towards them. Staff involved people in day to day decisions about their care. Staff respected people’s dignity and privacy. People were encouraged to maintain their independence as much as possible. Staff knew how to support people with their needs.

The service planned people’s care and support to meet their individual needs and requirements. The service supported people to maintain their religious beliefs and culture. Staff understood how to provide care to someone at the end of their life.

People and their relatives knew how to complain if they were unhappy about the service. People were asked for their views about the service. These were used to improve the service.

The service worked in partnership with other organisations to improve the service. They had an annual business improvement plan on how they would develop, sustain and improve the service.