This inspection took place on 28 September 2017 and was announced. The provider was given notice because the location provides domiciliary care services and we needed to be sure that someone would be available to answer our questions and assist with the inspection. We contacted people who used the service by telephone on 4 October 2017 and staff on 9 October 2017 to ask their views.

Ryedale Homecare is based in Malton and provides personal care to people in their own homes within Malton and surrounding areas. The service was registered with CQC in October 2012.

At the time of inspection 56 older people used the service, some of whom were living with dementia. The director, who was the registered manager, was present throughout the inspection.

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.

At the last comprehensive inspection in September 2016, we identified breaches of regulations. The registered provider had failed to keep accurate records of medicines that were administered. They had not completed appropriate recruitment checks before new staff were employed at the service and had not ensured completed and accurate records were maintained. The service was rated at that time as requires improvement overall. The registered provider wrote to us telling us what action they would be taking in relation to the breaches of regulation.

At this inspection, we found the provider had implemented their action plan and met all requirements within the regulations.

Robust recruitment procedures were now in place. We found that appropriate checks had been completed before new staff commenced employment. Staff recruitment records contained full employment histories and gaps in employment had been explored. References had been obtained and there was clear recorded evidence of interviews taking place.

Clear procedures were now in place to guide staff on the safe administration of medicines and staff had received medicines training. Records showed that people had received their medicines as prescribed. Where gaps in records had been identified, appropriate action had been taken. The manager had worked hard to improve quality assurance processes that were in place and now carried out a number of quality assurance checks to monitor and improve the standards of the service. Action had been taken when concerns were found.

Records showed risks were well managed through individual risk assessments that identified potential issues and provided staff with information to help them mitigate risks, while supporting people to maintain their independence. These had been regularly updated to reflect current needs.

There were systems and processes in place to protect people from the risk of harm. Staff we spoke with were all aware of the different types of abuse, what would constitute poor practice and what actions needed to be taken to report any concerns.

New staff completed an induction before they began working in the community. There were systems now in place that ensured staff received the training and experience they required to carry out their roles. Staff performance was monitored and recorded through a regular system of supervision and competency assessment.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005. Staff were aware of the procedure to follow if they suspected a person lacked capacity to make decisions. Signed consent had been sought where possible.

Some people were supported by staff with meal preparation. Records and people confirmed that they were given choice and appropriate support was provided in this area.

Care records contained evidence of close working relationships with ot

We inspected this service on 5 September 2016. The inspection was announced. The registered provider was given 48 hours’ notice of our visit because the location provides a domiciliary care service and we needed to be sure that someone would be in the location’s office when we visited.

Ryedale Homecare is a domiciliary care agency run by Ryedale Homecare Limited. It is registered to provide personal care to people living in their own homes. At the time of our inspection, the service was supporting 72 people who lived in and around Malton.

The service was last inspected in July 2014 when it was found to be compliant with the regulations in force at the time.

The registered provider is required to have a registered manager as a condition of their registration for this service. At the time of our inspection, there was a registered manager in post. They had been the service’s registered manager since October 2012. 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.

During the inspection, we identified that robust recruitment checks were not consistently completed before new staff started working. This meant people who used the service were exposed to increased risk of harm.

Medication Administration Records (MARs) were not completed appropriately. Poor recording on MARs increased the risk of medication errors occurring. Because of poor recording, we could not be certain that people who used the service were receiving their prescribed medicines. Robust checks were not completed of the support provided with medicines, meaning these issues had not been identified and addressed.

People who used the service, relatives and staff we spoke with were positive about the management of the service and felt it was well-led. However, the registered provider did not have robust systems in place to monitor the quality of the care and support provided. Concerns found during our inspection had not been identified and addressed by the registered provider.

The registered provider ensured new staff had an induction, had the opportunity to shadow more experienced members of staff and received on-going training and support. We identified that some staff training needed was not up-to-date. We have made a recommendation about this in our report.

People who used the service were supported to make decisions; however, staff did not document mental capacity assessments or best interest decisions regarding consent to care. We have made a recommendation about this in our report.

Staff we spoke with understood the types of abuse they might see and knew how to respond to safeguarding concerns to protect people from harm. People’s needs were assessed and risk assessments put in place. Risk assessments were reviewed and updated as people’s needs changed. There were sufficient staff employed to meet people’s needs safely and we received positive feedback about staff’s reliability and punctuality.

People who used the service were supported where necessary to ensure they ate and drank enough. Staff were attentive to people’s health needs and provided support to ensure people could access healthcare services where needed and in an emergency.

We received positive feedback about staff. People who used the service told us staff were kind, caring and provided support in a way that maintained their dignity.

People were supported by familiar staff who understood their needs. Person-centred care plans were put in place to guide staff on how best to meet people’s needs. People who used the service felt able to raise issues or concerns with the registered manager or staff in the office and were confident that their comments would be listened and responded to.

We found breaches of regu

One inspector carried out this inspection. During the inspection, the inspector focussed on answering five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we looked at records for ten people who used the service. We spoke with the manager, four people who used the service and a relative of a person who used the service. We also spoke with two carers and a senior carer. We reviewed records relating to the management of the service.

Below is a summary of what we found. The summary describes what people who used the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were systems in place to monitor staffing levels and organise rotas for calls. This meant that carers usually ran to time with visits. Both people we spoke with who used the service and staff confirmed that arrangements for staffing were well organised. This ensured that people were safe because their calls were carried out in a timely manner.

We spoke with people who used the service and a relative about whether they felt safe when being supported by staff. One person told us “The staff seem well trained so I always feel safe”. Another said “I feel safe as I have consistent carers and I know them well”.

We saw evidence of people consenting to their care plans and people told us they had been involved in developing them. Staff had a good understanding of the importance of getting people’s consent before carrying out care.

Is the service effective?

People had an individual care plan file which contained a care plan and any associated risk assessments that were required. We saw care plans contained information about people’s needs. The care plans we looked at contained sufficient information and were relevant to the person’s current needs. The risk assessments were sufficient to identify and minimise risks.

We spoke with people who used the service and they felt the support they received was meeting their needs well. Comments made to us included “They are very supportive and helpful”, “They support my relatives needs very well” and “They are a big help and I am very satisfied”. When we spoke with staff they felt they were able to provide fully effective care.

Is the service caring?

All the staff we spoke with were enthusiastic about providing caring and effective support. When we spoke with people who used the service they told us that staff were friendly and helpful. They also told us that staff were very good at respecting their privacy and dignity when providing support. Comments made to us included “They are very supportive, friendly and respectful. They definitely maintain my dignity”, “They are very caring, gentle and mindful of my privacy” and “The staff are very careful and I very much happy with the way they respect my dignity”.

Is the service responsive?

There were audit systems in place regarding health and safety, documentation and people’s satisfaction with the service they received. This was designed to allow management to monitor the quality of service. There were also systems in place for highlighting issues and learning from accidents, incidents, surveys and resident meetings, staff feedback and complaints.

We spoke with people who used the service about the ways they fed back and how this information was used. Comments made to us included “I would contact the office if I had any problems and they would listen and act”, “I know how to raise issues and I have previously given feedback which has been listened to effectively” and “I tell them what I think and they take notice of what you say”. The provider also formally gathered feedback from people who used the service in order to ensure improvements were customer led through questionnaires. Staff contributed through staff meetings. Staff training was also closely monitored.

Is the service well-led?

There was an consistent permanent staff team and no vacancies at the time of our inspection. Many of the permanent staff that worked in the service had done so for some time and knew people well. There were low levels of sickness and absence. The staff we spoke with told us that the manager was approachable and pro-active.

During our inspection of Ryedale Homecare we found that people who used the service were fully involved in the planning and reviewing of their care. Care plans were written in the words of the person themselves and regular reviews were conducted.

People who used the service and their relatives told us they were very satisfied with the support they received and comments included “They go above and beyond in supporting me”, “They really care about people” and “I am very satisfied with them”.

We found that staff were up to date with safeguarding training and they showed good knowledge of spotting the signs of abuse and the action they should take. People who used the service reported that they always felt safe when being supported.

The provider had robust systems in place for carrying out recruitment checks and staff said they felt supported by management. Regular supervisions and training opportunities were given to staff. There were processes in place to monitor the quality of service provision and the agency gathered feedback from people and acted on it appropriately.