Transition Care is a home care provider which offers domiciliary care services and personal support. The service provides care and support for adults within their own homes and supported living accommodation. The service offers support for people living with learning disabilities, acquired brain injuries and enduring mental health conditions. Care includes assistance with personal care, medication, nutrition and hydration, activities and accessing the community. At the time of our inspection there were 33 people using the service.

At our last inspection in June 2016 we rated the service overall as ‘Good.’ At this inspection we found the evidence continued to support the overall rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was in post. A registered manager is a person who has registered with 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 people were kept safe using appropriate risk assessments and management tools and provision of care by staff who were familiar with the person and their needs. People using the service told us they valued receiving support from staff who knew them well.

Any accidents and incidents were reported and recorded appropriately.

Staff’s suitability to work with vulnerable adults at the service had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken. People who were supported by the service were involved in the recruitment of new staff.

Staff had received training which equipped them with the knowledge and skills to ensure people received adequate care. Some staff had received more specific training to meet the needs of people living with specific mental health conditions, for example, distraction techniques.

Medication was managed safely and was administered by staff who were competent to do so.

Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA). The MCA is legislation which protects the rights of people to make their own decisions.

Care records contained information to identify people’s requirements and preferences in relation to their care and there was evidence to show that they had been consulted about decisions. People we spoke with told us their choices and preferences around their care and support were respected. People also told us that staff actively supported them to reach their own personal goals.

People were supported by staff to attend health care appointments. This helped to maintain people’s health and well-being. Staff also supported people to visit their families.

Quality assurance processes were in place to seek the views of people using the service and help give them a say in how the service was run. This helped to maintain standards and identify areas needed for improvement.

We asked both people using the service and staff about how they thought the service was managed and their feedback was positive.

The service was a preferred domiciliary care provider of Liverpool City Council which meant that they were a leading provider for care of people contracted by the council.

We carried out an announced inspection on 20 June 2016.

Transition Care Company is registered to provide personal care to people living in their own homes and communities. Specialist support is provided to people with enduring mental health conditions and learning disabilities. People who use the service are provided with a range of hours of support per day in line with their assessed needs. Transition Care Company provides staff over 24 hours for people living in supported tenancies and on an outreach basis. At the time of the inspection 16 people were living in supported tenancies and a further eight people were receiving outreach support.

A registered manager was 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 people that we spoke with had no concerns about the safety of services. People were protected from potential harm and self-neglect because staff knew people well and were able to recognise when people’s mental health was deteriorating.

The care files that we saw showed clear evidence that risk had been assessed and reviewed regularly. Risk assessments were extensive and detailed. Risk was reviewed by staff with the involvement of the person or their relative and healthcare professionals where appropriate.

Staff were recruited safely following a robust process which included individual interviews and shadow shifts. People who used the service were encouraged to take part in interviews.

Staff were trained in the administration of medicines but because the services were community-based, they were not always responsible for storage and administration. Some people who used the service were able to self-administer their medication, others required prompting. Medication Administration Record (MAR) sheets were completed by staff where appropriate. The records that we saw had been completed and showed no errors or omissions.

People using the service and their relatives said that staff had the right skills and knowledge to meet people’s needs. People’s day to day health needs were met by the services in collaboration with families and healthcare professionals.

We had limited opportunities to observe staff providing support during the inspection. Where we did observe support we saw that staff demonstrated care, kindness and warmth in their interactions with people. People told us that they very were happy with the care and support provided. People were clear that they had choices regarding how and when support was given.

The provider encouraged people and their families to provide feedback through a range of formal and informal mechanisms. They issued annual surveys and sought feedback at each review. Information from surveys was shared with people and their families and had resulted in changes being made.

People were given a number of options if they chose to complain about the service. They could speak directly to staff or managers. They could also use the complaints process. We saw that there were a small number of formal complaints received by the provider. Each complaint had been recorded, processed in a timely manner and a written response produced for the complainant.

Open communication was encouraged at all levels and everyone spoke positively about the influence of the registered manager and service manager.

The staff that we spoke with were motivated to provide high quality care and understood what was expected of them. They spoke with enthusiasm about the people that they supported and their job roles.

The registered manager and service manager had completed a series of quality and safety audits on a regular basis. Audits were completed monthly and focused on; medicines, finances, the physical environment, s

This was an announced inspection of Transition Care. The inspection was announced as the manager of the agency works in the community with the staff and is not always office based. The inspection set out to answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on discussions with two people who used the services of the agency, the staff, manager and looking at care records and records related to the management of the service.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they had confidence in the staff who supported them.

People and/or their families were involved in decisions about their care and support. People and/or their families were provided with the opportunity to read and sign their support plans.

The manager set the staff rotas; they took people’s care needs into account when making decisions about the numbers of staff required. This helped to ensure that people’s needs were always met. People we spoke with confirmed this.

In accordance with the Mental Capacity Act [2005], we saw evidence that the agency protected the rights and welfare of people. The Mental Capacity Act [2005] is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances.

Is the service effective?

Care plans/support plans and risk assessments were up to date and provided guidance to staff on the support people required. Care documents reflected current care needs and included information about peoples' preferences and preferred routines. Discussions with staff showed that they understood people's support needs and how to meet these in a way the person preferred. This was confirmed when talking with people during the inspection.

Training was provided for the staff to help them support people safely and in accordance with their individual needs.

Staff were aware of the actions they should take if an emergency arose. People we spoke with informed us they knew who to contact in an emergency or ‘out of hours’.

Is the service caring?

The people we spoke with told us staff were caring and polite. They also told us that staff spent time talking with them and making sure they were happy with the support provision.

A relative we spoke with supported this view and said the agency staff communicated well with them around their family member’s support. Staff told us about the importance of promoting people's independence and having a supportive approach when assisting people to develop life skills.

Is the service responsive?

People we spoke with told us the staff responded promptly to their requests for support and that the staff were always available to help them.

The care documents we saw showed the staff had acted promptly in respect of supporting people with changes in their medical conditions and seeking external advice from health professionals at the appropriate time. Care documents were revised as people’s needs changed.

The agency had a policy and procedure for dealing with concerns and complaints. Complaints received had been investigated and complainants responded to.

Is the service well-led?

The agency had systems in place to regularly monitor the quality and safety of the service provided; this included a number of audits [checks] which the manager completed. Records we looked at demonstrated that action plans were developed to

address identified shortfalls in a timely way.

People who used the services of the agency were provided with satisfaction surveys to provide feedback about the service provision. Meetings were also held with a number of people however the provider however may find it useful to note that there was no record of 'spot' checks being undertaken; these checks are a means of making sure the care and support the agency staff gave people in their own homes was safe and in accordance with the person's plan of care. The manager confirmed these visits would be undertaken as part of the develoopment of the agency.

Staff told us they were able to speak with the manager and their views and experience were taken into account.

The agency worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

At our last inspection in August 2013 we found people's care and medicine records were not accurate and appropriately maintained. Action was needed for this essential standard.

Following the inspection we received an action plan from the provider (owner) and this addressed the issues raised. On this inspection we looked to see if these standards had been maintained.

We saw improvements had been made to medicine and care records to ensure people's safety and well-being. A number of new care documents had been introduced to ensure an accurate record was kept of people's care needs. This also included the support required to help maintain people's health and well-being. Records we looked at included a care needs assessment, a self-assessment tool, support plans, risk management plans and medicine charts. People had been consulted regarding completion of these records so they were fully involved and informed.

At this inspecton we did not speak with people who used the services of the agency.

Staff employed by the agency were aware people's care needs and the support they needed to ensure their health and well-being. A person who used the services of the agency told us they were satisfied with the support they received. They told us the support workers (staff who deliver support to people from the agency) were polite, helpful and conducted the calls in accordance with their plan of care and also their individual wishes.

Policies and procedures were in place to safeguard people against the risk of abuse. Staff employed by the agency understood the signs of abuse and how to raise a concern with the relevant external agency.

Staff employed by the agency received training and support to ensure they had the skill, expertise and knowledge to carry out their job role. We saw evidence of formal meetings with the support workers to review their training needs and professional development. Staff employed by the agency told us they received good support from the manager.

People were placed at risk as a number of care records did not record the care and support people needed to ensure their health and well-being. This included supporting people with their medicines.