This inspection took place on 29 January 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. The last inspection undertaken was a focused inspection on 6 July 2017. That inspection was to follow up if improvements had been made with the key questions of Safe and Well-led from a comprehensive inspection conducted on 24 February 2016. The July 2016 focused inspection found improvements had been made however we could not improve the rating at that time as a rating of good requires consistent practice over time.

Vantage Care Services Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing a service to 20 people.

There was a registered manager at the service at the time of our 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 and associated Regulations about how the service is run.

People and their relatives told us they felt the service was safe, staff were kind and the care received was good. We found staff had a good understanding of their responsibility with regard to safeguarding adults from abuse.

Risk assessments were in place which provided guidance on how to support people safely. Medicines were managed in a safe manner. There were sufficient numbers of suitable staff employed by the service in order to meet people’s needs. Staff had been recruited safely with appropriate checks on their backgrounds completed.

Person centred support plans were in place and people and their relatives were involved in planning the care and support they received.

Staff undertook training and received regular supervisions to help support them to provide effective care.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA). MCA is law protecting people who are unable to make decisions for themselves. People who had capacity to consent to their care had indicated their consent by signing consent forms. However, where people lacked capacity to consent to their care the provider had not followed the principles of the Mental Capacity Act (MCA) 2005. We have made a recommendation about following the principles of the MCA.

The provider respected people’s cultural and religious needs when planning and delivering their care. Discussions with staff members showed they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

The provider had a complaint procedure in place and people and their relatives knew how to make a complaint.

Staff told us the registered manager was approachable and open. The service had various quality assurance and monitoring mechanisms in place to improve the quality of care delivery.

We carried out an announced comprehensive inspection of this service on 13 & 14 February 2017. We issued one warning notice for detailed risk assessments not being in place and one requirement action for limited quality systems in place. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to detailed individual risk assessments not in place and quality assurance and monitoring systems not being robust.

We undertook this focused inspection on 6 July 2017 to check that they had followed their plan and to confirm that they now met the 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 Vantage Care Services Ltd on our website at www.cqc.org.uk. At this inspection we some found improvements had been made.

The service provides support with personal care to adults living in their own homes. The service was providing a service to 40 people at the time of our inspection.

There was a registered manager at the service at the time of our 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 and associated Regulations about how the service is run.

Most risk assessments were specific to the individual needs and included information for staff on how to manage risks safely. However two risk assessments were not detailed. The inconsistencies in risk assessments means there was a risk that people did not receive safe support. The registered manager told us additional training on risk assessments was to be provided by the end of July 2017. We will check this during out next planned comprehensive inspection.

The service had various quality assurance and monitoring systems in place. The registered manager told us and we saw records of regular quality checks. These quality checks included spot checks in people’s home, medicine audits, telephone monitoring and annual surveys to people who used the service and their relatives. Weekly staff meetings were being recorded.

We could not improve the rating from requires improvement to good because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

We inspected Vantage Care Services Ltd on 13 & 14 February 2017. This was an announced inspection. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. The service was last inspected 24 February 2016. We found concerns that risk assessments were not always comprehensive, care plans were not always person-centred, and medicine audits were not being recorded. We issued one requirement action and two recommendations. At this inspection we found the service had addressed the recommendation for care plans not always being person-centred. However, the service had failed to address medicine audits being recorded and the breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service provides support with personal care to adults living in their own homes. The service was providing a service to 100 people at the time of our inspection.

There was a registered manager at the service at the time of our 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 and associated Regulations about how the service is run.

Risk assessments were not robust and did not provide sufficient detail which meant there was a risk that people did not receive safe support. Medicine risk assessments and support plans did not always document what medicines and dosage people were to be administered, the reason for taking and any associated risks and side effects.

The service was not recording medicine audits. The service has a medicine policy that was not being followed.

Quality assurance systems were not sufficiently robust to ensure the delivery of high quality care. During the inspection we identified failings in a number of areas. These included risk assessments, medicine risk assessments, record keeping and recording medicine audits.

Staff had undertaken training about safeguarding adults and had a good understanding of their responsibilities with regard to this. Staff understood their responsibilities under the Mental Capacity Act 2005. We found there was enough staff working to support people in a safe way in line with their assessed level of need. People who were assisted with medicines and their relatives felt confident in the support they received from staff.

Care plans were in place detailing how people wished to be supported and people and their relatives were involved in making decisions about their care. Staff we spoke with had an understanding of people’s risks and could explain what they would do to minimise these. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

Recruitment records demonstrated that there were systems in place to ensure staff were suitable to work with vulnerable people.

The registered manager was open and supportive. Staff and relatives felt able to speak with the registered manager and provided feedback on the service.

We found two breaches of 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.

We inspected Vantage Care Services Ltd on 24 February 2015. This was an announced inspection. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. This was the first inspection of the service since it was registered with the Care Quality Commission. The service provides support with personal care to adults living in their own homes. The service was providing a service to 40 people at the time of our inspection.

There was a registered manager at the service at the time of our 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 and associated Regulations about how the service is run.

Risk assessments were not robust and did not provide sufficient detail which meant there was a risk that people did not receive safe support. Staff we spoke with had an understanding of people’s risks and could explain what they would do to minimise these.

Care plans were not always personalised and were task focused. The care plans were written mainly for staff use rather than being person centred. Staff knew the people they were supporting and provided a personalised service. We made a recommendation about person centred care being recorded in people’s care plans.

The service was not recording medicine audits. We made a recommendation that the service record the on-going checks for medicines.

Systems were in place to help ensure people were safe. Staff had undertaken training about safeguarding adults and had a good understanding of their responsibilities with regard to this. Staff understood their responsibilities under the Mental Capacity Act 2005. We found there were enough staff working to support people in a safe way in line with their assessed level of need. People who were assisted with medicines and their relatives felt confident in the support they received. Staff kept a record of medicines they had supported people to take.

The registered manager was open and supportive. Staff and relatives felt able to speak with the registered manager and provided feedback on the service. The service had various quality assurance and monitoring mechanisms in place.

We found one breach of 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.