Request Services Ltd is a domiciliary care agency and provides personal care and support for people living in their own homes in Hampshire and West Surrey. At the time of our inspection there were 59 people using the service, who had a range of physical and health care needs, supported by 145 staff. The service was providing 3546 hours of care per week. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including epilepsy, diabetes, multiple sclerosis and sensory impairments. The agency also provides what is described as complex care for people who require specific and unique support, for example people with acquired brain injuries.

This announced inspection took place on 25 and 26 September 2017 and 2 October 2017.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Staff understood their role and responsibilities to keep people safe from harm. Individual risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work with people to assess their suitability. Medicines were well managed and people received their medicines as prescribed.

Staff received regular supervision and the training required to meet people's needs. The service complied with the requirements of the Mental Capacity Act 2005 which ensured people were involved in making every day decisions and choices about how they wanted to live their lives.

Arrangements were made for people to see healthcare professionals when they needed to. People were supported to have a healthy balanced diet and had access to the food and drink of their choice, when they wanted it.

People received a service that was caring and compassionate. They were cared for by staff that understood their needs and knew them well. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. The care and support people received was tailored to meet individual needs.

People's independence was promoted by staff who encouraged them to do as much for themselves as possible. People were supported to have maximum choice and control of their lives and staff supported them to make as many decisions as possible.

The service was well led. There was a clear management structure in place and staff understood their roles and responsibilities. The vision, values and culture of the service were understood by all staff, which they demonstrated when supporting people.

Staff consistently said they had received good support from the management team who were always available to give advice and guidance. The safety and quality of support people received was effectively monitored to drive continuous improvement of the service.

Further information is in the detailed findings below.

During our inspection of Request Services Ltd. we found that people were asked for their consent before care or support was provided. Within the care plans maintained by the service people's consent had been recorded. One person who used the service told us, "The girls always tell me what they want to do and they make sure it's okay with me before they do it."

Following our inspection we spoke with people who used the service or a family member. We were told that the care received was of a high standard. One person said, "They are by far the best I have come across." Another told us, "They love my relative as if they were their own." However, we were told by two people that the office was disorganised and that on at least one occasion a member of care staff had failed to arrive as scheduled. One relative told us of two occasions when scheduled care visits had been missed. They said, "It wasn't too bad as I was here to cook lunch that day but it happened once before too." We found that care plans were, in some cases, incomplete or confusing.

Staff and people who used the service were protected from abuse.

Staff were supported through the provision of training and a programme of regular supervision and appraisal. One staff member told us "The managers and office staff give me good support".

The service monitored the quality of the service provided through questionnaires and face to face contact with people who used the service. They held regular staff meetings.

At the time of this inspection the agency was providing personal care to 50 people and complex care to another 30 people.

We spoke by telephone with three people who used the service, three relatives of people who used the service and three members of staff. We spoke with two senior staff and the registered manager at the agency office.

People told us the service was very good. Their comments included; "The service is brilliant, the staff are like friends but they act professionally" and "The staff are very good I have no problems". The relatives we spoke with were equally positive about the service the agency provided for their family members'. They said, "The staff are excellent" and "The service is very good, they always treat my family member with respect".

People who used the service and their relatives were pleased that they usually had the same teams of staff visiting them and they knew the staff. People told us the staff usually arrived on time and they were usually informed if staff would be delayed.

People were aware of the care plans that recorded their needs. They told us they had been involved in planning and reviewing their care and agreeing to these plans. One person said "I was involved from the beginning in writing and updating my plan. One relative told us "They consulted me about my relatives needs".

People said they felt safe, they knew how to make a complaint and that communication with staff in the office was effective.

This inspection of Request Services Limited took place on 17 and 18 March 2015 and was announced. The provider was given 48 hours notice of the inspection to ensure that the people we needed to speak with were available.

Request Services Ltd is a domiciliary care agency and provides personal care and support for

people living in their own home in North East Hampshire and West Surrey. At the time of our inspection there were 66 people using the service, who had a range of physical and health care needs, supported by 176 care staff. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including epilepsy, diabetes, multiple sclerosis and sensory impairments. The agency also provides what is described as complex care for people who require specific and unique support, for example people with acquired brain injuries.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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. The service also has a complex care manager responsible for complex care provision, who was supervised by the registered manager.

At our previous inspection on 17 and 18 September 2014 the provider was not meeting legal requirements in relation to people’s care and welfare, supporting workers and assessing and monitoring the quality of the service. Following the inspection the provider sent us an action plan and informed us they would make improvements to meet these requirements by 31 December 2014. During this inspection we found the provider had taken necessary action and the required improvements had been made.

People using the service were actively involved in making decisions about their care and were asked for their consent before being supported. Relationships between staff and people were relaxed and positive. Care staff engaged with people to identify their individual needs and what they wanted.

Comprehensive risk assessments had been completed with people and where appropriate their relatives. Where risks to people had been identified there were plans in place to manage them effectively. Staff understood the risks to people and followed guidance to manage them safely.

The service responded flexibly to people’s individual wishes and changing needs and sought support from health and wellbeing specialists promptly when necessary. People’s dignity and privacy were respected and supported by staff. Care staff were skilled in using individual’s specific communication methods and were aware of changes in people’s needs. People were encouraged to be as independent as they were able to be, as safely as possible.

People told us they trusted the staff who made them feel safe. Staff had completed safeguarding training and had access to local authority guidance. They were able to recognise if people were at risk and knew what action they should take. People also had access to guidance about safeguarding in a format that met their needs, to help them identify abuse and respond appropriately if it occurred. The registered manager had taken action when people had been identified to be at risk and learning had taken place. People were kept safe as safeguarding incidents were reported and acted upon.

The registered manager completed a daily staffing needs analysis to ensure there were sufficient staff with the necessary experience and skills to support people safely. Whenever possible senior staff worked together with people, and where required their relatives, to identify in advance when their needs and dependency were likely to increase.

Staff were encouraged to undertake additional relevant qualifications to enable them to provide people’s specific and complex care effectively, and were supported with their career development.

The provider had established a training facility where care staff received thorough instruction from the provider’s nurse about how to support people’s unique complex care needs.

Robust recruitment procedures ensured people were supported safely by care staff with the appropriate experience, skills and character. The suitability of care staff to form caring relationships with people was assessed as part of their recruitment process. The provider frequently arranged additional care staff to that required to shadow colleagues providing complex care. This ensured that when regular care staff were unavailable the replacement care staff had previous experience of people’s needs and how they preferred their support to be delivered.

Medicines were administered safely in a way people preferred, by trained staff who had their competency assessed by the nurse and provider’s training specialist.

Staff had completed training on the Mental Capacity Act (MCA) 2005 during their induction process and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

The service has innovative and creative ways of training and developing care staff that makes sure they put their learning into practice to deliver outstanding care that meets people’s individual complex needs. The service works in partnership with other organisations to make sure they are training staff to follow best practice.

People’s needs in relation to nutrition and hydration were documented in their care plans. We observed people supported appropriately to ensure they received sufficient to eat and drink. Meals provided by care staff reflected people’s dietary needs and preferences. When necessary people had been referred to appropriate health professionals for dietary advice.

We observed friendly and relaxed interaction between people and care staff. People told us that when they had a problem or were worried they felt happy to talk with any of their care staff. Whenever people had raised concerns or issues, prompt action had been taken by the registered manager to address them to their satisfaction. Where complaints were made they were investigated and actions taken in response. Complaints were analysed to identify trends and themes. Where these had been identified action had been taken to make improvements.

Staff had received training in the values of the provider as part of their induction. People, their relatives and care staff told us the service was well managed, with an open and positive culture. People and care staff told us the registered manager and complex care manager worked as a team and were very approachable, willing to listen and made any necessary changes to improve the quality of care experienced by people.

The registered manager and senior staff provided good leadership and support to the care staff. They were involved in day to day monitoring of the standards of care and support that were provided to people.