The inspection took place on 1 and 2 August 2017 and the first day was unannounced. The previous inspection took place in May 2016 and we found breaches of the legal requirements in relation to person centred care, need for consent, staff training and governance systems. At our recent inspection, we noted the provider had made significant improvements which rectified the issues and concerns we found in May 2016.

The Care Company Plus Limited (The Care Company Plus) is a domiciliary care agency which provides personal care and support to people living in their own home. Their office is located in North Manchester and the agency provides care and support to people living in Bury, Manchester and Trafford. At the time of our inspection the service was supporting 96 people.

The service had a registered manager who had been in post since July 2016. 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 and their relatives told us they received care and support that was safe.

There were robust recruitment processes in place. This helped to ensure suitable staff were employed.

Risk assessments were in place and contained sufficient details and guidance to help ensure people were supported safely.

There were suitable systems to help ensure people were protected from harm. Staff were well-informed about the types of abuse and the action they would take if they suspected that abuse was taking place. This meant people using the service were protected from harm due to organisation systems and staff knowledge.

People and relatives told us they had consistent staff supporting them. This meant people were supported by people who knew and understood their needs. People told us staff arrived punctually for their visits and they were informed if staff were running late. This meant that people received care and support at times that suited them.

People told us staff had good hygiene practices and wore personal protective equipment when carrying out their duties. This should help to ensure that people were protected from the risk of infection.

Where required, people were supported to take their medicines safely. We noted the registered manager had taken further action to ensure medication administered was recorded appropriately. We were assured that there were effective systems in place to help ensure people were supported safely with their medicines.

People and their relatives told us staff were well trained and did their jobs effectively. Staff received an induction and mandatory training prior to working with people. There was evidence that staff were supported with on-going and refresher training as required. Staff received regular supervisions and appraisals to help ensure they received the necessary support to carry out their roles. Staff we spoke with confirmed this. This meant staff had the right knowledge and skills and received continuous support to function effectively in their caring role.

Staff sought people’s consent before undertaking tasks. Care records we looked at contained evidence that people had consented to the care they received. We saw improvements had been made to ensure the service worked within the principles of the Mental Capacity Act (MCA). This meant people’s rights were protected.

Where needed, people were supported with meal and drink preparation. Everyone we spoke with told us they were satisfied with the support provided and said the staff always consulted them prior to carrying out the task. This helped to ensure people maintained good nutrition and hydration.

People told us the service supported their access to health care professionals and medical attention, if required. In the case of an emergency, medical attenti

We inspected The Care Company Plus Limited (The Care Company Plus) on 31 May and 1 June 2016 and the first day of our inspection was unannounced. The Care Company Plus is a domiciliary care service which provides personal care to people living in their own home. They also provide specialist care and support to people who require catheter or colostomy care. Their office is located in North Manchester and the company provides care and support to people living in Manchester and Trafford. At the time of our inspection the service was supporting about 88 people.

The previous inspection took place in May 2014. At this inspection, we found that the service had met all regulatory requirements.

The service had been without a registered manager for just over one year. A manager had been recruited in January 2016 and we saw that they had submitted their application to register 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.

We found breaches of regulations. You can see what action we have told the provider to take at the end of the full report.

People told us they felt safe using the service. This was in part due to the consistency of the care staff that visited them, and staff’s knowledge and competence. We found the company’s recruitment processes were robust, ensuring that all appropriate checks were done before staff started working with people.

We saw identified risks and actions to be taken to reduce these risks were recorded in people’s care plans. Risk assessments were done, for example, for manual handling, eating and drinking, and medication administration. We saw some good examples of clear and specific guidance to help staff manage risks to people. However there were some assessments that were not always so clear. We highlighted these gaps to the manager.

Staff were trained in safeguarding vulnerable people and knew what action to take if they suspected abuse was happening. We saw that safeguarding was a regular agenda item at peer group or team meetings and there was an up-to-date safeguarding policy to guide staff.

People told us they were supported appropriately with taking their medicines and we saw that medicines administered were recorded by care staff.

People we spoke with said that their care staff did not keep them waiting and that they had had no missed visits. The service told us they used an electronic call monitoring system which helped to ensure that missed calls were kept to a minimum.

We did not see evidence that the service fully understood and put into practice the principles of the Mental Health Act 2005. In some people’s care plans we saw that relatives had signed them on their behalf. However, we did not see any records to show that relatives had permission to sign on people’s behalf. People were potentially receiving care or support where consent had not been obtained in the appropriate way.

The service had formal systems in place to train and support staff. We saw that staff received quarterly supervisions and annual appraisals, where appropriate. The service was delivering the Skills for Care, Care Certificate as part of its induction programme. Management and staff told us the training programme was good and that group work and discussions had been introduced to complement DVD-led instruction. We noted however that some care staff were overdue for training updates in key areas of their knowledge.

People were happy with the quality of care and support they received from The Care Company Plus. They thought of care staff as either friends or family. People appreciated that they had regular carers because this encouraged relationship building and trust. People told us they were supported t

An inspector visited this service on 1 May to carry out an inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During the inspection we spoke with four people who used the service, two relative's, five care staff, and three members of the office management team. The registered manager was not present during the inspection, therefore we also spoke with two directors of the service. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

We saw that people were treated with respect and dignity by the staff. We spoke with four people who used the service who all told us that staff respected their privacy and dignity and supported them in a way that suited their individual needs and personal preferences. We also spoke with two relative's who told us they were happy with the care and support the staff provided to their family members. We saw that the service had systems in place to identify and respond to allegations of abuse and we checked that staff were knowledgeable of these and the actions to take if they had concerns for a person’s safety. Systems were in place to make sure that the service sought people’s feedback and that risks were identified and managed.

Is the service effective?

We saw that people who received care and support from Manchester Asian Care had a care record that included assessments of their individual needs and risks. The care plan had been developed to meet those assessed needs. The assessments and care plans were reviewed on a six monthly basis and updated accordingly. We saw that one care record required updating. This was discussed during the inspection and we saw that this was currently being completed. Prior to people receiving care and support, we saw that information regarding the person’s health needs was obtained from other health professionals, such as social workers and a member of staff visited the person to carry out an assessment of their needs. This meant that people could feel confident that the service could meet their individual and personal care needs. We were told that relatives were encouraged to be involved in the person's care and treatment, if their family member consented to this.

Is the service caring?

All the people we spoke with were complimentary of the staff and management of Manchester Asian Care. We were told that the service engaged with them to ensure that their needs and wishes were met. Some comments included; “My needs have changed so the care's had to change and they were simply brilliant”, “They’re very good, they can’t do enough for (my family member)” and “Faultless.”

Staff spoken with were all positive regarding the care that was delivered. Some comments included: “I feel comfortable with all the office staff, they’re open and approachable, they’re brilliant,” and “We want to improve people’s lives.” We spoke with two relatives who confirmed they were happy with the care and support provided. One person said “(My family member) has a fantastic relationship with the staff. They are really caring and professional.”

Is the service responsive?

The service had systems in place to ensure that people were regularly consulted about their views and ideas on how the service should be run. This was done by means of regular discussion with people and satisfaction surveys. We saw that if improvements were identified, these were actioned as appropriate and staff were informed of any changes required. All the people we spoke with told us that they were happy with the service provided and were involved in making decisions about their care and support. Comments we received included; “They don’t make assumptions, they work with you”; “We did my care plan together”; “They met with me and went through everything. I could see I was important to them” and “It’s very good.” This showed us that people were consulted in the development of a care plan which met their needs.

Is the service well led?

For the areas we looked at during this inspection visit we saw that staff had received appropriate training to ensure they had the knowledge, skills and experience to meet the assessed needs of people receiving care and support. This meant that people who received support from Manchester Asian Care could be confident that their needs were being met by fully trained staff. When we spoke with staff they spoke highly of the support they received from the manager and the senior staff. They told us they received regular supervision and training. They also told us they had regular staff meetings and if they had any problem they would go straight to the manager who was always available and approachable.

We spoke with two people who used the agency and two relatives of people who received care from the agency. The people we spoke with receiving services from the agency were positive about the care they received. This was summed up by one person who received care from the agency who said "They look after me very, very well". Another person said "I have confidence in them. All the people we spoke with told us that they had an opportunity to comment on the service and did not have any formal complaints.

We found that people were involved in their care and were asked before care was provided. We found that the care people received was of a good standard. The provider had proper arrangements in place to ensure people received their medication where appropriate and there were sufficient staff on duty to meet people's needs.

Since our last inspection, we found that the provider had improved its' systems for managing people's individual risks properly. The provider responded appropriately to complaints and comments.

We spoke with three people who used the service. They were very happy with the care they received. This was summed up by one who told us about the care agency staff: "They understand my situation," "they're respectful and kind", and "they make sure they do everything before they leave even if they are over the time". We spoke to the relative of one person who used the agency. They told us: "[my relative] is quite happy, they try and keep to the same staff and [my relative] has a nice relationship with the regular lads that come".