This inspection took place on 13 September 2016. We gave the registered manager short notice as we needed to be sure she would be present.

Realcare+ Limited provides domiciliary care support to seven people in the community living in their own homes. The service is also registered to provide support to people living supported living settings but was not doing so at the time of this inspection. The service also provides a range of other services outside the remit of inspection.

The service had a registered manager as required to manage its day to day operation. 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 and relatives felt staff were kind, caring and supported people’s dignity and privacy effectively. They told us staff involved them in making decisions about their day-to-day care and encouraged them to do what they could for themselves. People’s care needs were regularly reviewed with them or their representatives. Staff asked people’s consent before providing support.

Staff knew how to respond to signs of possible abuse and how to report it. They felt the registered manager would respond appropriately to any concerns raised.

Staff received an appropriate induction and their competency was assessed. A rolling programme of training was provided, although not all staff had completed all of the required training. The care practice of staff was monitored through spot checks of their care practice and seeking feedback about them from the people supported.

An appropriate recruitment process helped ensure that staff had the necessary skills and approach to care for vulnerable people. However, some records were incomplete and this was addressed following the inspection.

Staff received ongoing support through supervision meetings, annual appraisals and a range of team meetings and other forums. The management kept staff up to date with developments in the service and the wider care industry.

Complaints were addressed appropriately by the service. People’s views about the service had been sought by means of a survey and other feedback systems. The feedback was positive and where any issues had been raised they had been addressed. The service also sought the views of staff through a survey.

Effective management monitoring and review systems were in place and the service looked to learn from feedback and continue to develop.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with two people who use the service, two of their representatives, the manager, the registered provider and six staff. We also reviewed records relating to the management of the agency which included care plans, risk assessments and other records.

Below is a summary of what we found. The summary described what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

People received care and support in accordance with their agreed care plan. Care plans were regularly reviewed with the person supported or their representative. Care plans were supported by appropriate risk assessments and additional equipment was available where needed.

Where people had healthcare needs, the agency had consulted external healthcare specialists appropriately and obtained appropriate staff training to maintain their wellbeing and safety. The staff we spoke with were aware of the needs of the individuals they were supporting and of the expectations on them around safeguarding and reporting any concerns.

The people we spoke with told us the service was very good. They felt safe and told us they were listened to.

Is the service effective?

People’s needs had been effectively met and any changes were referred to management to update care plans. The people supported told us they enjoyed good relationships with the staff. People told us the agency met their or their relative’s needs effectively.

People felt the agency was well managed and consulted with them. Feedback from surveys indicated good levels of satisfaction with the support provided.

Is the service caring?

Staff described how they worked in a caring and respectful way while supporting people. The care plans referred to how to meet people’s needs and to treating them with respect and dignity.

The people we spoke with thought the service was caring. One person told us the staff were: “very helpful”. Another person who had used the agency for several years said: “I wouldn’t still be using them if I didn’t think they were caring.”

Is the service responsive?

We saw that people’s care plans and other documents recorded people’s needs and where these had changed. Care files showed that the agency responded promptly to any changes and amended care plans. Care was provided based on people’s known and indicated wishes and preferences.

The people who use the service and relatives we spoke with all felt that they were involved in their care and that the service responded to their wishes. People told us if they did not get on with individual staff, the agency responded promptly to replace them.

When issues had been raised in feedback surveys or within complaints, the agency had identified an action plan and addressed them. Where issues were raised in the course of this inspection, the manager took immediate steps to address them and provided evidence of the changes made.

Is the service well-led?

We found that the agency provided consistent care to people and was well-managed. There were clear lines of managerial responsibility. A range of audit and monitoring systems were used by the management team to maintain an effective overview of the agency’s operation. Action had been taken to address issues where these were identified. The views of people’s relatives were sought and acted upon.

People described the service as caring: “to a very high standard”, being: “very understanding” and communicating well with them.

We spoke with people who use the services and their relatives. They were complimentary about the care received. One person told us “they are one of the best services I have ever had.”

People told us staff treated them with respect and supported them to make their own choices. One person who uses the service told us “staff respect my privacy. Staff respected my decision not to have a shower due to the cold weather.”

Care was planned with the involvement of the people who use the service and their relatives, and reflected their individual needs. People told us they trusted the staff and felt safe in their care.

All the required information checks were in place prior to the employment of staff with the exception of full employment histories. The provider was unable to provide a satisfactory explanation for these gaps in employment histories. This meant the provider did not have an effective recruitment process to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable to provide their care and treatment.

There were systems for monitoring the quality and safety of services provided to people which included recording and investigating complaints, and collecting feedback from people who use the service and staff. Where improvements to services were required, these were made.

During our inspection we found the provider had put measures into place to strengthen the recruitment, interview and selection process. This was to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable to provide their care and treatment. These included a revision of the provider's recruitment, interview and selection procedures to reflect the requirement for obtaining a full employment history and seeking explanations for any gaps in employment histories. Existing staff recruitment files were reviewed to ensure they recorded satisfactory explanations for any gaps in employment histories.