This inspection took place on 6 March 2018 and was announced.

The Care Bureau is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in and around Banbury. It provides a service to children, younger adults and older people. At the time of the inspection, the service was supporting 59 people.

Not everyone using The Care Bureau received regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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. The registered manager worked closely with the care manager.

People told us they felt safe receiving care from The Care Bureau. Risks to people were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage people’s medicines safely.

The service had enough staff to meet people’s needs and keep them safe. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People had their needs assessed prior to receiving care from The Care Bureau to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular supervisions (one to one meetings with their line manager), spot checks, appraisals and team meetings to help them meet the needs of the people they cared for. People were supported to meet their nutritional needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager and staff had a good understanding of the MCA and applied its principles in their work.

People's care plans were current and gave clear guidance to staff on how people wished to be supported. Staff knew people's needs well and used this knowledge to provide personalised care. People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

People and staff told us they felt The Care Bureau was well run. The registered manager and the management team promoted a positive, transparent and open culture. Staff told us they worked well as a team and felt valued. The provider had quality assurance systems in place which were used to drive improvement. The service had established links with the local communities which allowed people to maintain their relationships.

The Care Bureau Limited is a domiciliary care service providing care to people in their own homes in and around Banbury. At the time of the inspection the service was supporting 71 people.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

We carried out an announced comprehensive inspection of this service on 7 February 2017. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches of Regulations 17 and 18.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Care Bureau Ltd - Domiciliary Care - Banbury on our website at www.cqc.org.uk

At the last inspection on 7 February 2017, we asked the provider to take action to make improvements and ensure staff received the support and supervision that they required to be effective in their roles. We also asked the provider to put systems in place and ensure people’s risk assessments were up to date and tailored to meet their needs. We requested effective systems be put in place to improve the service and the provider to adopt a clear accident and incident monitoring system. On this inspection we found these actions had been completed.

People told us they felt safe receiving care from The Care Bureau. Records showed people had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicines as prescribed. There were systems in place to ensure staff were competent to manage safe administration of medicines.

The service had enough suitably qualified and experienced staff to meet people's needs. The service experienced some late calls but always ensured all calls were complete. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

Staff told us and records confirmed they received adequate training and support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervisions (one to one meetings with their line manager) and spot checks to help them meet the needs of the people they cared for.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, staff knew assessments would have to be completed in line with the principles of MCA.

People’s nutritional needs were met. People were given choices and were supported to have their meals when they needed them. Staff treated people with respect and promoted people’s independence. People were supported to maintain their health and were referred for specialist advice as required. Where people needed emergency support, staff requested that support in a timely manner.

People, their relatives and staff told us they felt The Care Bureau was well run. The registered manager and management team promoted a positive and open culture. Staff told us they worked well as a team. The provider had effective quality assurance systems in place which

The Care Bureau Limited is a domiciliary care service providing care to people in their own homes in and around Banbury. At the time of the inspection the service was supporting 88 people.

There was a manager in post. However, they were not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 provider had just recruited a new manager and the director told us they planned to submit their application to register to CQC.

At the last inspection on 13, 14 and 15 January 2016, we asked the provider to take action to make improvements and ensure staff had the competence and skills to deliver delegated tasks, staff understood their responsibilities in relation to preventing and reporting abuse and staff understood their responsibilities under the MCA, and this action has been completed. However, we found further concerns.

People’s risks assessments were not always updated. Where risks had been identified, the risk management plans in place were not always tailored to each person’s individual needs and did not give clear guidance to staff on how to support people.

People’s consent was sought before support and care was offered. Staff had some knowledge of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. However, staff could not link its principles to the way they supported people.

Staff told us they had the knowledge and skills to support people. However, staff did not always receive the support and supervision that they required to be effective in their roles.

The provider did not have a clear procedure for recording incidents and accidents. There was no system in place for reviewing accidents or incidents to look for any trends or patterns and identify actions to reduce the risk of similar events occurring again.

People, their relatives and staff told us the service was well managed. However, some of the provider’s quality monitoring systems were not always effective as they had not identified the shortfalls we found in risk assessments and risk management plans.

People who were supported by the service felt safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicines as prescribed. There were systems in place to manage safe administration of medicines.

The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People’s nutritional needs were met. People were given choices and were supported to have their meals when they needed them. Staff treated people with kindness, compassion and respect and promoted people’s independence and right to privacy. People received care that met their needs.

People were supported to maintain their health and were referred for specialist advice as required. Staff knew when to seek professional support.

Staff knew the people they cared for and what was important to them. Staff appreciated people’s life histories and understood how these could influence the way people wanted to be cared for. Staff supported people to engage with a variety of social activities of their choice in the community.

The service looked for ways to continually improve the quality of the service. Feedback was sought from people and their relatives and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

Leadership within the service

The inspection was announced and took place on 13, 14 and 15 January 2016. The provider had short notice that an inspection would take place. This was because the service provides a domiciliary care service to people in their own homes and we needed to ensure that the registered manager would be available to assist us. At the last inspection in January 2014, we found the provider was meeting all of the requirements of the regulations we reviewed.

The Care Bureau, Banbury provides care and support to people living in their own homes. At the time of the inspection 97 people were receiving a personal care service.

There was a registered manager in post at the time of 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.

People, their relatives and staff felt the service was well managed. The registered manager and management team sought feedback from people and their relatives and was continually striving to improve the quality of the service. However, systems to monitor the quality of the service were not always effective because they had not identified the issues we found during our inspection.

People felt safe when being supported by staff. However, staff were not clear about the action they would take to keep people safe from abuse. People and staff were confident they could raise any concerns and these would be dealt with.

People had a range of risk assessments in place. However, the service had not ensured people were always protected from the risks associated with their care. This was because staff had not received training from a health professional or other authorised person about how to carry out complex care tasks for specific people.

People were asked for their consent before care was carried out. However, the registered manager and staff did not understand their responsibilities under the Mental Capacity Act 2005 (MCA) because they were not clear about the action they must take if the person did not have capacity to consent to their care.

People told us they felt safe and staff were kind and caring. People were cared for in a respectful way. People were involved in their care planning. They were provided with person-centred care which encouraged choice and independence. Staff knew people well and understood their individual preferences. People were supported to maintain their health and were referred for specialist advice as required.

People told us there were enough staff to meet their needs. People told us staff were often late and they did not always know which staff would be visiting them

Peoples views about if staff were knowledgeable and well trained was mixed. Staff completed a range of training and were supported to gain extra qualifications to help them meet the needs of the people they supported. Staff felt motivated and supported to improve the quality of care provided to people. Staff benefitted from regular meetings with their line manager. The management team carried out regular spot checks to ensure staff were completing the required tasks to an acceptable standard and to check people were happy with their care.

We found three 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.

At the time of our visit over 80 people were using the service. They were supported by 42 members of care staff. We spoke with 15 people. Everyone we spoke with was complementary about the service. They told us they felt well cared for, respected and involved in their care. One person said "I am very happy. They are punctual, polite and caring". Another said "I don't always need help and they respect my decisions". People were assessed prior to the commencement of care and we saw that care plans were maintained and appropriate. We also spoke with seven care workers, the manager and operations manager. One care worker said "I give people choices. They are people not tasks and choices help to re-enforce that".

The provider had taken steps to protect people from abuse. We spoke with seven care workers. Everyone we spoke with demonstrated a good knowledge of abuse and what to do if they suspected abuse was happening. We saw that all care workers had been trained in safeguarding vulnerable adults.

Care workers were supported. They received regular supervision, appraisals and training. One said "I can call the office anytime. They are always there for us".

The provider monitored the quality of service. Complaints, accidents and incidents were recorded, investigated and managed appropriately. Regular audits were conducted. The provider sought the opinions of people who used the service. Surveys were conducted and the results fedback to people via a six monthly newsletter.

We spoke with people who used the service who told us they were happy with the care they received and that they felt safe. One person said "they are very good, the girls who call are excellent". Another said "I have no concerns about my care, I feel safe and well looked after".

We looked at the care plans for people and found them to be clear on the care and support required with up to date risk assessments. That meant people were well cared for and were safe from hazards and risks.

People were safeguarded from the risk of abuse because the provider had procedures in place that were robust and appropriate. We found that staff had been appropriately recruited and trained. One member of staff said "the training is excellent, it gives me confidence to do my job". Another said "this is the best agency I have worked for".