About the service:

Special Care Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing care to 45 people.

People's experience of using this service:

People were safe in their home and there were enough staff to fulfil the visits to people.

People received the medicines they needed safely.

Staff understood their responsibilities about keeping people safe.

Risks were identified and managed well. Incidents and accidents were monitored to inform practice and make improvements to the service.

Staff understood their responsibilities to prevent the spread of infection whilst working between people's homes.

Staff had received the training and support they needed to carry out their roles well. People had confidence in the staff and were content with the care they received.

Care plan information focused on a person-centred method of supporting people. Information contained what support was required and consent to care forms had been signed by people who received a service from Special Care Services.

Risks associated with nutritional needs were identified and managed. People received the support they needed to have a healthy diet.

People were supported to access health care services when they needed to. Staff described positive working relationships with health care professionals.

Staff supported people to remain independent and promoted their dignity. People's privacy was respected and their personal information was kept securely.

There was a clear management structure that supported staff well.

Governance arrangements were embedded within practice. Regular audits identified any shortfalls in provision of care.

More information is in the full report.

Rating at last inspection: Good (published 27 August 2016).

Why we inspected:

This was a scheduled inspection based on the previous ratings.

Follow up:

We will continue to monitor the service through the information we receive.

The inspection took place on 26 July and 2 August 2016 and was announced. The provider was given 48 hours’ notice because the location provides domiciliary care and we needed to be sure that someone would be at the office. At our previous inspection during January 2015 the provider was not meeting all the regulations we checked. At this inspection improvements had been made in people receiving care at the agreed time, complaints were being addressed and arrangements to monitor the quality of the service had been implemented.

Special Care Services – Main Office is a domiciliary care agency providing personal care to young adults and older people in their own homes across Derby. This includes people with physical disabilities and people who lived with dementia. The agency is located in the Littleover area of Derby. The service was providing support for 48 people at the time of our inspection.

There was a registered manager in post; they were also the service provider. 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 care provided by staff. Staff we spoke with understood their responsibility in protecting people from the risk of harm. Recruitment procedures were mostly thorough. The provider mostly proved assurance suitable staff were employed to work with the people who used the service.

Staff understood the support people needed to make decisions. However the provider did not fully understand their responsibilities under the Mental Capacity Act 2005.

Risk assessments and support plans had been developed with the involvement of people. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way.

People received their medicines as prescribed and safe systems were in place to manage people’s medicines.

People told us that staff treated them in a caring way and respected their privacy and supported them to maintain their dignity. The delivery of care was tailored to meet people’s individual needs and preferences.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People knew how to make a complaint.

Suitable arrangements were in place to assess and monitor the quality of the service, so that actions could be put in place to drive improvement.

We spoke with two staff at the office during the inspection visit. We carried out telephone interviews with three people using the service, two relatives and three staff.

People we spoke with told us they were happy with the service they received.

People said that staff respected their privacy and dignity, and encouraged them to maintain their independence.

We saw that people's needs were assessed, and care plans were in place. This meant they received support in a way they prefer.

Comments from people about the staff and service included “my regular carer takes her time with me, she doesn’t rush me and is absolutely fabulous,” "They encourage me to be independent and they always ask me what I want" and “the carers provide me with all the support and care I need.”

People and relatives we spoke with confirmed they were aware of their plan of care and were involved in this process. This ensured that people received care and support in a way they that suited individual needs.

Staff we spoke with told us they felt supported by the management team.

We found that there were systems in place to monitor the quality of the service, and make improvements where required.

People told us they were treated with respect and were able to make decisions about their care. They also told us that staff provided them with good care. Their comments included “they treat you with dignity and respect and use your preferred form of address”; “I’ve always said what we want; we had a long talk with staff about what was needed” and said “the staff in the office make a phone call if I need to see the doctor”.

The service worked co-operatively with other care providers to ensure people’s needs were met. People felt safe when being cared for by care workers. They said that staff maintained good infection control and that they were supported to take their medications when needed. They told us “I am safe with them. I know what they are up to and they do it. I feel safe” and “the staff wash their hands and wear gloves. They change their gloves every time”.

Risk assessments were carried out in people’s own homes to ensure people were kept safe from environmental hazards. Staff were also properly trained on how to use the equipment people needed.

Care workers were properly recruited, trained and supervised. They were provided in sufficient numbers. People’s comments about the care workers included said “many of them are like friends and part of the family. They all try very hard”; “the girls are all lovely, they are very caring”; “as far as they can they are always on time, we are absolutely satisfied” ; “most of them that come regularly understand my needs”; “on the whole they have the right skills. They get a fortnight induction” and “even the trainees are encouraged and I’m quite happy”.

We found management systems in place to monitor care, but people were not always formally consulted about their care. Complaints were not always written down in a way that they could be analysed for trends. Personal records were not securely stored at all times. This meant that Special Care Services not fully involving people in the planning of the service and were not fully protecting people’s personal data.

This inspection took place on 13 & 14 January 2015 and was announced. This meant the provider and staff knew we would be visiting the agency’s office before we arrived. This ensured that someone would be at the office.

Special Care Services – Main Office is a domiciliary care agency that provides personal care to young adults and older people in their own homes across Derby. This includes people with physical disabilities and people living with dementia. The agency is located in the Littleover area of Derby. The service was providing support for 70 people at the time of our inspection.

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.

At the last inspection on 29 October 2013, we asked the provider to take action to make improvements. We found that the recruitment procedures were not robust to ensure that people were safeguarded from harm. Systems for monitoring the quality of the service did not ensure people’s welfare needs were met. Personal information about people using the service was not held in accordance with the requirements of the Data Protection Act 1988. The provider sent us an action plan during January 2014 after the inspection to confirm that improvements in these areas were being addressed. We found that improvements had been made in these areas.

We received information of concern during November 2014 that alleged that the agency was not keeping accurate records of people’s care needs, for example some people’s care records had not been updated for at least a few years, there was poor communication from office staff regarding the co-ordination of rota’s and that personal information regarding people using the service was not being kept securely. We looked into these as part of our inspection and found that some of the alleged issues were verified.

People who used the service told us they felt safe. Discussions with staff demonstrated that they were trained to look after people safely.

Some people raised concerns that there calls were not always taking place at the agreed time. This did not ensure that peoples individual assessed needs were being met at the times agreed.

Recruitment procedures had improved which ensured suitable staff were employed to work with people who used the service.

Staff told us that they received training and regular updates which related to their roles. However training records showed that some staff had not received all areas of essential training and some staff required updates.

People were supported to maintain good health. Staff told us that they alerted health care professionals if they had any concerns about people’s health.

People told us that staff treated them with dignity and respected their privacy

Complaints were not always well managed and communication within the office had not always been consistent or resolved issues satisfactorily.

Staff told us that they received support from the management team and felt that the agency was well-led.

Arrangements in place to assess and monitor the quality of the service did not ensure improvements when required were identified and actions put in place to drive improvement.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond with a number of 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.