The comprehensive inspection took place on 8 and 9 October and was announced. This was so we could ensure someone would be available at the office when we visited.

This service is a domiciliary care agency. It provides live-in support and personal care to people living in their own homes in the community. Staff live in the person’s home, generally for a four week period and then have two weeks off while a second staff member lives-in with the person. Staff have a mandatory break each day and family or another carer cover this period, if required. The service mostly provides a service to older adults but can also provide a service to adults and younger adults.

The provider had previously operated the service providing shorter visits to people in their own homes and operated from a different office location. This was the first inspection of the service at the new location providing live-in care.

The provider was also the 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. The provider was supported in the day to day management of the service by the regional care manager. They were both supported by office staff.

People were supported, if they required, to book and attend medical appointments and some people were supported by staff to take medicines. Staff had received training in medicines management but were not always following best practice when completing records about prescribed and administered medicines. People had risk assessments in place but some people had risks relating to their needs that had not been assessed.

Most people still had the capacity to make their own decisions and staff understood the Mental Capacity Act 2005 (MCA). However, one person no longer had the capacity to make their own decisions. Their care plan described the way they wanted their care delivering based on their previous routines and preferences; but an MCA assessment had not been completed to show why decisions were being made on their behalf.

People were supported by staff who had information about the accessible information standard (AIS). However, where people had sensory impairments, AIS assessments had not been completed to identify whether the person required information in a non-standard format.

The provider and regional care manager regularly sought feedback about the service from people and their relatives and acted on any concerns. They also had regular contact with staff and checked staff daily notes and medicines administration records on a weekly basis to identify any changes to people’s needs or areas for improvement in practice. The provider told us people’s records were regularly checked to ensure they were complete and up to date; however, these checks had not been recorded and had not identified the gaps identified during the inspection. The regional care manager and provider were responsive to feedback and learned from mistakes. Following the inspection, they told us the gaps identified during the inspection had been rectified and shared new records that were being implemented to help ensure they were not repeated in the future.

People and staff had developed strong relationships which were based on trust and genuine friendship. The provider and regional care manager took action to ensure they knew people and staff well enough to recommend which staff members would suit each individual who required support. This matching of shared interests and similar characters helped enable bonds to form between people and staff. People became partners in developing their care. This helped ensure it reflected their wishes and preferences.

The service placed an emphasis on seeking information about what affected people’s wellbeing.