The inspection of Richmond Village Letcombe Regis DCA (domiciliary care agency) commenced on 28 June 2018 and was unannounced.

We undertook this focused inspection of Richmond Village Letcombe Regis DCA on 28 June 2018. This inspection was prompted by the provider’s statutory notification to CQC of a significant event. The information shared with CQC about the incident indicated potential concerns about safe care and treatment. This inspection examined those risks and reported on the findings in the safe and well-led domains. The incident is subject to a separate external investigation and as a result we did not examine the circumstances of the incident as part of this inspection.

This report only covers our findings in relation to the above topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Richmond Village Letcombe Regis DCA’ on our website at ‘www.cqc.org.uk’. The last inspection was carried out 11 July 2017. At that inspection the service was rated as “Good” and was meeting all of the relevant regulations.

Our findings at this inspection have not changed the current rating of “Good for the key question in Safe, the current rating of ‘good’ for the key question Well-led or the overall rating of ‘good’ for this service because we did not look at all the areas for the key question Safe and Well-led. We will review all areas of the key questions of Safe and Well-led in full at our next comprehensive inspection.

Richmond Village Letcombe Regis DCA provides personal care services to people in their own homes. At the time of our inspection 25 people were receiving personal care from the service.

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

Risks to people’s well-being had been assessed and recorded. Staff had clear guidance how to assist people so the risks associated with their care, such as moving and handling or the risks of falls were managed safely.

Systems were in place to monitor risks and quality of service. The registered manager ensured improvements were made when risks had been identified. The provider took prompt action following the safety incident to ensure people received safe care and treatment.

We undertook an announced inspection of Richmond Village (DCA) on 11th July 2017. We told the provider one day before our visit that we would be coming. Richmond Village provides personal care services to people in their own homes. At the time of our inspection 33 people were receiving personal care from the service.

At the previous inspection in September 2016 we found the provider had not taken the necessary steps to mitigate the risks associated with people’s care in that not everyone had appropriate risk assessments in place. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We also found that the services quality monitoring systems were not always effective. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we found that the service had made significant improvements to address the areas of concern and bring the service up to the required standards. People’s care records contained up to date and accurate information and guidance for staff to mitigate the risks associated with people’s care. The manager conducted regular audits to monitor the quality of service. Learning from these audits was used to make improvements.

The service had a registered manager. 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 were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People received their medicines as prescribed. Records confirmed where people needed support with their medicines they were supported by staff that had been appropriately trained.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with staff who had a caring approach to their work.

People were supported by staff who had been trained in the MCA and applied it's principles in their work .

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service.

The service sought people's views and opinions. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

This inspection took place on 14 September and was announced.

Richmond Village Domiciliary Care Agency (DCA) provides personal care services to people in their own homes. At the time of our inspection 35 people were receiving a personal care service.

There was 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 were safe. People were supported by staff who could explain how they would recognise and report abuse. However people were not always protected as people’s care records did not always include up to date risk assessments.

The provider and the registered manager conducted regular audits to monitor the quality of the service. However these systems were not always effective. Staff told us they felt supported and had access to effective supervision. However records relating to staff supervision were not always completed.

Staff knew the people they cared for and people told us they received person centred care. However care records did not always evidence this. Care records were not always accurate or complete.

The service sought people's views and opinions and acted upon them. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People received their medicines as prescribed. Records confirmed where people needed support with their medicines, they were supported by staff that had been appropriately trained. People told us and staffing rotas confirmed there were sufficient staff to meet people's needs.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with staff who had a caring approach to their work. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The registered manager and staff understood the Mental Capacity Act (MCA) 2005 and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery. People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

A single inspector carried out this inspection. The focus of the inspection was to answer 5 key questions: Is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at. This is a summary of what we found.

Is the service safe?

People and their relatives told us that they felt safe with the provider’s support. One person told us, "I feel safe.” People and relatives told us that they felt their rights and dignity were respected.

Staff had received safeguarding training and understood how to safeguard people they supported. This involved recognition of signs of possible abuse and how to report concerns.

Staff knew about risk management and we saw examples of this in the care plans. People had access to choice and remained in control of decisions about their care and lives.

Is the service effective?

People told us they were involved in their care. One person told us they had “signed the care plan yesterday”. People’s health and care needs were assessed with them, and they were involved in writing their care plans. People said that their care plans were reviewed and reflected their current needs.

Is the service caring?

We spoke with people or their relatives being supported by the service. People said that they valued having visits from regular care staff. One person told us “I think most are extremely caring and thoughtful.” A member of staff told us that it was important to ask people’s preferences about their care.

People using the service and their relatives completed an annual satisfaction survey. This helped to identify good practice and areas for development.

Is the service responsive?

One person told us that staff visited at the arranged times and “they’re quick at knowing what to do” if there were changes to the care plan.

The provider monitored the quality of the service and responded to feedback from people and relatives. People knew how to make a complaint if they were unhappy.

The service worked with other agencies and services to make sure people received effective care.

Is the service well-led?

There was no registered manager in place at the time of our inspection. The village manager told us that the service manager had applied to become a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The service has an effective quality assurance system, and records showed that identified problems and opportunities to improve the service were addressed. As a result the quality of the service was improving.

Staff told us they understood their roles and responsibilities and that senior staff supported them well.

We spoke to four people who use the service, one relative and four staff members (carers). We reviewed records including care plans and staff files.

People told us that they were treated with respect and were involved in their care. One person said “They certainly look after you.”

A variety of facilities and activities were arranged by the provider. People said that these were of great benefit. One person told us “There’s plenty for everybody.”

People reported that they felt safe. One person said “I feel safe. I like it here. I like the people here.”

The provider assessed the quality of its service regularly. A relative we met said “I can’t speak too highly of the care.” A staff member told us “It’s a lovely company to work for.”

We reviewed four care plans and also spoke to four people who use services. All care plans were signed by staff and people who use services. Each folder had consent form which was signed by the person and gives the provider permission to hold the care plans in safe place with in the domiciliary care premises. People were happy with the care that they were receiving and stated that staff were helpful and friendly. One person told us that due to the deterioration of his eyesight he was having to rely more on staff which he was grateful for. He had no complaints and would be able to discuss any issues with staff. Another person told us that they were happy with staff and their accommodation. They were independent to carry out their own activities of daily living.

Staff told us that they enjoyed their work and that they felt supported by managers. One staff member told us that she had achieved her NVQ 2 in social care and health. She did not think she would achieve but with support from other staff was able to. Staff were positive in ensuring that people where involved in all their aspects of care. Staff were also positive about the provider.