Tranquillity care solutions is a small domiciliary care agency. Care and support is provided to people in their own homes. On the day of our inspection, 11 people were using the service.

When we last visited the service, it was rated requires improvement in safe and well-led. At this inspection we found the service had made the necessary improvements and therefore it was rated overall as good.

There was a manager in place who is in the process of becoming registered by the commission. They are supported in the daily running of the service by the two directors.

People were protected from the risk of harm and abuse. Staff had knowledge of safeguarding and were aware of their responsibilities to report any concerns. The manager knew of their responsibilities regarding the Mental Capacity Act 2005.

Risks were assessed and suitable control measures put in place, which still enabled people to maintain as much independence as possible. There were sufficient numbers of staff to make sure that people's needs were met and recruitment practices ensured that staff were of good character and suitable for their roles. People were supported to take their medicines safely, if required. Systems were in place to record when medicines were given and were regularly checked to make sure there were no errors.

Staff received an induction and on-going training to make sure they had the right skills and knowledge to provide people with care in their own homes. Staff were well supported and had opportunities to discuss any concerns and training needs they might have.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were positive relationships between people and members of staff. Staff treated people with kindness and took the time to get to know them and their interests whilst providing their care. The service had involved people in producing their care plans to ensure that care was provided in the way they wanted it to be. In addition, people and their family members were provided with information about the service and what they could expect from them.

The care plans we looked at were detailed. Staff could describe how individual people preferred their care and support delivered and the importance of treating people with respect in their own homes.

The service worked in partnership with community professionals and the local authorities to meet people's needs.

The provider had a system to regularly assess and monitor the quality of service that people received and identified and acted on areas for improvement.

We have made a recommendations about the providers annual assurance process.

The inspection took place on 25 November and 15 December 2016. It was announced to make sure there was someone available at the provider’s offices. We last inspected this service on 29 September 2014 and found that the provider was meeting the legal requirements in the areas we looked at.

Tranquillity Care Solutions UK Ltd is a domiciliary care agency providing personal care and support to people who live in their own homes. There were 10 people using the service at the time of our inspection.

Although the service had a registered manager in post, they had tendered their resignation to leave the service on 2 December 2016. A registered manager is a person who has registered with the Care Quality Commission (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 service was not always safe because people’s risk assessments were not compliant with current health and safety guidance and they did not always include instructions for staff on mitigating risk. Additionally, staff were trained in safeguarding people and they knew how to keep people safe from avoidable harm. However, some staff did not know about external agencies that they could report concerns to.

There were enough staff to safely meet people’s needs. People’s medicines were managed appropriately and there were robust policies and procedures in place for the safe recruitment of staff. Staff were knowledgeable about people’s care needs and were trained to meet these needs. They understood the importance of seeking people’s consent prior to providing care or support in line with the requirements of the Mental Capacity Act 2005. People were supported with the preparation of their food and drinks.

People were able to express their views and be actively involved in making decisions about their care. Staff were caring, friendly and supportive. They were also respectful of people’s dignity and privacy. People’s needs had been identified prior to them starting to use the service, and were reviewed regularly. People were supported in a personalised way and they all had individualised care plans in place. However, improvements were required in the management of records.

People knew who the provider was and were highly positive in their comments about them. The provider sought the opinion of people who used the service and their relatives to aid the development of the service. Staff were also involved in the development of the service by way of two monthly team meetings. Improvements were however required in the provider’s quality assurance system as this was not always effective in identifying and addressing shortfalls in the service.

We inspected this service on the 29 September 2014 to follow up areas of concern identified at a previous inspection on the 24 June 2014. The service had sent us their action plan telling us what action they were taking to become compliant in the areas where we had concerns.

We did not talk with any people who used the service on this occasion as during our inspection on 24 June 2014 people told us that they were happy with the service they received and we had not received any further concerns about the service.

During our inspection on 29 September 2014 we found that the service had made the improvements we had asked them to.

During our inspection and during analysis of our inspection findings we considered the questions we always ask, is the service safe, effective, caring, responsive and well led?

This is a summary of what we found;

Is the service safe?

We saw that people’s assessments and care plans had been redone and were detailed and reflected the needs of the people.

We saw that risk assessments had been completed and were detailed enough to ensure that risks associated with people’s care and support were minimised.

Is the service effective?

We saw that people had recently completed quality assurance questionnaires that had been sent to them by the service to ask their opinion of the service they received. One person made the comment, “Tranquillity Care Solutions are people who go the extra mile, I have confidence in them.” Another person had said that the service was flexible, even at short notice.

Is the service caring?

During our previous inspection in June 2014, people told us that staff listened to them and acted on any request or concern. One person said, "The staff are very kindly and friendly." Another person said, "They (care workers) do so much for me, I couldn’t do without them now."

Is the service responsive?

We saw that the service had taken action to update the care plans if people's needs had changed.

Is the service well-led?

The provider, who also offered care and support to people who used the service, had employed an experienced and qualified manager to take control of the day to day running of the service.

The manager, who had been recruited since our last inspection on 24 June 2014, had already put structures and systems in place to improve the quality of service that people received.

There were four people using the service. We spoke with one person, two people's relatives and the provider. We also spoke with two of the care staff and looked at all of the people's care records. Other records viewed included staff personnel records and some of the service’s policies and procedures.

During our inspection and during analysis of our inspection findings we considered the questions we always ask, is the service safe, effective, caring, responsive and well led?

This is a summary of what we found;

Is the service safe?

When talking to the staff and the provider we found that they were knowledgeable of the needs of the people who used the service. However, people’s assessments and care plans were not detailed and did not always reflect the needs of the people.

Staffing levels were adequate to support the current number of people supported by the service.

We saw that risk assessments had been completed, but were not detailed enough to ensure that risks associated with people’s care and support were minimised. This meant that we could not be confident that people would be protected from risks involved with their care.

Is the service effective?

People told us that they were happy with the service and that their needs were met. One person said, "I’m happy, I can’t grumble." Another person said, "The service is excellent."

People told us that the service was flexible, even at short notice, one person said, “…. they really go that extra mile.”

Is the service caring?

People told us that staff listened to them and acted on any request or concern. One person said, "The staff are very kindly and friendly." Another person said, "They (care workers) do so much for me, I couldn’t do without them now."

Is the service responsive?

People told us that they knew how to make a complaint if they were unhappy and were confident that it would be dealt with. One person said, "I have no complaints." Another person said, "I've got a book here (at their home) about how to complain, but don't need to."

Is the service well-led?

The provider, having gained many years experience of working with people as a carer, opened a new domiciliary care agency. However, they did not have management experience or qualifications. They employed an experienced and qualified manager to take control of the day to day running of the service and continued to work in the service as a carer. When, after a few months, the provider realised that the service was not being run effectively, they took action to rectify the matter.

The provider facilitated our inspection, the registered manager was no longer working at the service at the time of our inspection. Once an application is received to cancel their registration they will be removed from our records.

There is no evidence that the people who used the service had been poorly supported on a day to day basis, they told us that the staff who supported them were caring, helpful and met their needs.

However, the service had not been well-lead by the registered manager who worked unsupervised by the provider. There was no effective quality assurance systems in place, there was no training organised for staff. We did not have confidence that the proper safeguarding checks had been carried out on staff.

The provider’s quality assurance systems were not robust enough to identify what the manager was doing and the shortfalls. They had not acted promptly to protect the safety of the people they supported. However, at the time of our inspection, the provider had started to take corrective action.