Rapid Improvement Care Agency is a domiciliary care agency and registered for ‘personal care’. This service provides personal care to people living in their own houses and flats. It provides a service to older adults some of whom have physical disabilities, mental health needs, living with dementia and require end of life care. At the time of inspection 53 adults were receiving support with personal care from this service.

Some people supported by Rapid Improvement Care Agency did not receive a regulated activity from the service. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

This inspection was carried out on 7 and 8 November 2018 and was announced.

At the last inspection, carried out on 31 October 2017, the service was rated Good, with Requires Improvement in safe. We found a breach of Regulations relating to people’s safe care and treatment. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We have also change the rating for Safe from Requires Improvement to Good, because of the good practice we saw. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. 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 2008 and associated Regulations about how the service is run.

Risks to people's health and safety were sufficiently identified and appropriate risk management plans were in place to mitigate the potential risks to people. Staff were aware of the service’s procedures to provided immediate support to people if they noticed people being at risk to abuse or when incidents and accidents took place. Staff provided references and criminal records checks were carried out before they were employed by the service. People had support to manage their medicines safely. Relatives told us that staff had not always arrived for their shifts on time but to address this the service was in the process to start using a new electronic system to monitor staff’s punctuality and length of their visits.

Systems were in place to review staff’s performance and competence on the job. Staff supported people to identify any health-related issues and sought support to ensure their good health. People had assistance to meet their nutritional needs. Staff followed the Mental Capacity Act 2005 (MCA) principles to support people in the decision-making process. Although staff were trained in the areas the provider considered mandatory, some staff lacked knowledge and skills to support people effectively, but the provider had identified this and addressed as necessary.

Relatives described staff as kind and friendly. People consented before staff started supporting them with personal care. Staff respected people’s preferences and were aware of what was important to people, including their cultural and religious needs. Staff had training and were aware of the confidentiality principles they had to follow. However, people's relatives reported some concerns in relation to staff’s attitude and how they supported people’s privacy but the service took action to address this.

People’s care needs were assessed and staff were provided with sufficient levels of information relating to people’s health conditions, communication difficulties and end of life care needs. Regular review meetings were facilitated to find out if people had the right support. Systems were in place to gather

This inspection took place on 31 October 2017 and was announced. We gave the registered manager 48 hours’ notice of the inspection because the registered manager is often out of the office supporting staff. We needed to be sure that someone would be in.

Rapid Improvement is a domiciliary care agency that provides personal care for seven children and 42 adults living in their own homes who may have dementia, end of life care needs, learning and physical disabilities.

At the last inspection on 7 September 2015 the service was rated GOOD.

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.

Risk management plans had not addressed the support people required to minimise risks to their wellbeing. Information was missing on the assistance people required to meet their individual needs.

Systems were in place where there had been safeguarding concerns which ensured that any risks to people were monitored and actions taken to protect people as necessary. People told us that staff were on time and stayed for the full duration of their shifts as necessary. Staff had all the necessary pre-employment checks which helped to ensure their suitability for the role. Staff worked in conjunction with relatives and health professionals to ensure that people were assisted to take their medicines as prescribed. Some medicines administration sheets where not signed for by staff but this was already addressed by the management team.

Staff accessed appropriate training that gave them the knowledge and skills to support people effectively. The staff team had support to ensure good care for people. Staff were confident that any concerns raised would be investigated by the registered manager and acted upon. Staff understood and complied with the requirements of the Mental Capacity Act (MCA) 2005. Staff knew the importance of supporting people to make their own decisions where possible. Guidance and support from healthcare professionals was implemented into the care delivery to people. People had access to sufficient amounts of food and drink to meet their dietary requirements and complex nutritional needs.

Staff were patient and made people feel at ease when assisting them with personal care. People had their individual needs respected and attended to with care. Staff encouraged people to engage and undertake activities for themselves which increased their independence.

Care records lacked information about people’s individual interests and preferences. We have made a recommendation about this.

The registered manager was aware of people’s individual needs and involved other agencies in the assessment and delivery of care to people. Complaints were recorded, monitor and acted upon to ensure that issues raised were dealt with appropriately. People and their relatives were confident that their views were listened and adhered to in a professional manner.

There were good communication systems in place that enabled staff to share information efficiently. Staff had a say in care delivery which motivated their involvement in providing good support for people. The management team worked together and shared responsibilities to monitor the service’s performance.

We found a breach in relation to safe care and treatment. You can see what action we have taken at the back of the full version of the report.

This was an unannounced inspection that took place on 7 September 2015. At our previous visit on 23 February 2015, we judged that the service was meeting all the regulations that we looked at. Rapid Improvement Ltd is a domiciliary care agency providing personal care and support for 13 people with physical disability living in their own homes.

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.

People told us they felt safe with the service they received. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place to inform people who used the service, their relatives and staff about how to report suspected abuse. This meant appropriate action was taken to deal with suspected abuse and help provided to protect people who use services

People had risk assessments and risk management plans to reduce the likelihood of risk. Staff knew how to use the information to keep people safe.

The registered manager ensured there were safe recruitment procedures to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Staff received training in areas of their work identified as essential by the provider. We saw documented evidence of this.

People told us they did not receive assistance from the agency staff with the administering of medicines and this was confirmed by staff.

People said they were treated with kindness and compassion in the care they were provided with by staff and they said that their care was good.

Staff told us they received training on how to promote and maintain people’s dignity and privacy. This had helped people to feel they mattered and were understood.

Staff respected people’s privacy and dignity. People said staff asked them how they would like things to be done and were polite.

Staff told us that wherever possible people were encouraged to maintain their independence and undertake their own personal care. Where appropriate staff prompted people to undertake certain tasks rather than doing it for them.

People told us they were involved in the care planning process and they said the service responded to their needs and individual preferences. People also said that staff supported people according to their personalised care plans, including supporting them to access community-based activities.

The provider encouraged people to raise any concerns they had and responded to them in a timely manner. People were aware of the agencies’ complaints policy.

People gave positive feedback about the management of the service. The managers were clear in their views about the importance for service improvement based on feedback provided by their surveys. They told us their aim for the service was to progress towards providing a better standard of care. We found there was a positive management ethos that included an open and positive culture with approachable staff and a clear sense of direction for the service.