We carried out an announced comprehensive inspection of this service on 07 April 2015. During that inspection we found two breaches breach of Regulation under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in to relation to staffing and good governance. After that inspection, the provider wrote to us to tell us what action they had taken to meet legal requirements in relation to the breaches of regulation.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet 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 Westwood House on our website at www.cqc.org.uk.

Westwood House is a domiciliary care service based at Salford Quays, Manchester. It provides personal care for a range of people living at home. The service provides supported living; community based home care and 24 hour care packages for complex health care needs, challenging behaviour and/or autistic spectrum disorder.

There was a registered manager in place. 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.

This inspection was undertaken on 28 August 2015 and was announced. During our last inspection, we looked at the training, learning and development needs of individual staff members. We found limited information that formal supervision and appraisals had been undertaken. We looked at the staff supervision policy, which indicated formal supervision would take place at least once in every quarter. From reviewing records we found this was not happening. This was a breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because staff did receive appropriate on-going or periodic supervision and regular appraisals to support them in their role.

During this inspection we found the provider was now meeting the requirements of the regulation. We found that regular supervision had now been undertaken by the service. We looked at 12 supervision records for different members of staff. We were told that in line with policy, supervision would take place three times a year, unless more were required. We saw that supervision was managed effectively by use of a supervision monitoring form. The registered manager told us that an annual appraisal system had been introduced and was scheduled to commence next month for all staff members.

During our last inspection, we found the service did not have systems and processes to effectively monitor and improve the quality of services provided. The service was unable to demonstrate how they regularly sought the views of people who used the service and took regard of any complaints, comments and views made. This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. The registered person did not have appropriate arrangements in place to monitor the quality of service or regularly seek the views of people who used the service.

During this inspection we found the provider was now meeting the requirements of the regulation. We looked at a number of audits that had been undertaken by the service to monitor the quality of service delivery. These included weekly and monthly medication audits. The service had introduced a system of ‘spot checks,’ which covered staff competency to engage with people who used the service effectively, the quality of care files and that records were accurately maintained.

The registered manager told us that they were due to circulate questionnaires to people who used the service during September 2015 as an annual means of monitoring the quality of service provision. Questionnaires would also be circulated to relatives and health care professionals. At the time of our visit, the service provided support to 19 people living in their own homes. The service was able to demonstrate how they electronically maintained records of all contacts with people who used the service. This included any concerns or issues raised by people who used the service and recorded what action had been taken by the service to address the issue. We also looked at the service complaints and compliments policy, which provided clear instructions to staff as to what action take in the event of a formal complaints made against the service.

This was an announced inspection carried out on the 07 April 2015.

Piramid Care Service is a domiciliary care service based at Salford Quays, Manchester. It provides personal care for a range of people living at home. The service provides supported living; community based home care and 24 hour care packages for complex health care needs, challenging behaviour and/or autistic spectrum disorder.

There was a registered manager in place. 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.

At the last inspection carried out in April 2013, we did not identify any concerns with the care and support provided to people by the service.

We looked at the training, learning and development needs of individual staff members. Supervisions and appraisals enabled managers to assess the development needs of their staff and to address training and personal needs in a timely manner. We found limited information that formal supervision and appraisals had been undertaken.

We looked at the staff supervision policy which indicated formal supervision would take place at least once in every quarter. From reviewing records we found this was not happening. One member of staff told us; “I do have supervision with the manager and regular informal contact. It is not recorded as far as I’m aware.” Another member of staff said “I don’t really have any one to one supervision, but if I need anything I give them a bell.”

We spoke to the manager about these concerns. They confirmed that whilst supervision did take place it was informal, inconsistent and not recorded. They accepted that improvements were required in line with their supervision policy.

This is a breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because staff did receive appropriate ongoing or periodic supervision and regular appraisals to support them in their role.

We found the service did not have systems and processes such as regular audits of the service provided to assess, monitor and improve the quality and safety of the service.

In relation to the competency of staff administrating medication and meeting other support needs, we found that no competency or spot checks had been undertaken by management to ensure staff were delivering services safely and correctly. The manager told us that checks were undertaken, however no formal process existed for recording such quality assurance checks.

Though people told us they would not hesitate to contact the service if they had any concerns, it was not clear to us how the service responded to individual concerns and complaints. It was also not clear to us how the service used such information to make improvements and demonstrate that they have been made. The service was unable to demonstrate how they regularly sought the views of people who used the service and took regard of any complaints, comments and views made. For example, we found no satisfaction questionnaires had been circulated to people who used the service, relatives and health care professionals to seek feed-back on the quality of the services provided.

This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. The registered person did not have appropriate arrangements in place to monitor the quality of service or regularly seek the views of people who used the service.

You can see what action we told the provider to take at the back of the full version of this report.

People told us they or they loved ones were safe and they trusted staff coming into their homes. One relative told us; “We are very happy. They give us the care and support we need. All carers have had training to meet our daughter’s specialist needs.”

During our inspection, we checked to see how the service protected people against abuse. We found suitable safeguarding procedures in place, which were designed to protect vulnerable people and children.

We looked at how the service managed risk. We found individual risk assessments had been completed for each person and recorded in their care file.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure the service was safe.

There was a staff induction programme in place. This provided staff with an insight into working for the company when they first commenced employment. Staff confirmed that when they commenced employment with the service they underwent an induction course.

Staff told us they felt supported by the service and received regular training to support them in their roles. Comments included; “Training is excellent and I get enough.” “ Yes its good especially the behavioural course. There’s lots of training.” “I feel valued and supported by the manager who responds to any concerns we have. They manage the service very well.”

We spoke with staff to ascertain their understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DolS). A number of staff were able to confirm some training in the mental capacity act though training records indicated no training had been delivered by the service. The manager was able to tell us that as a result of her recent experiences with a DolS application and the MCA, they had arranged training with an independent provider for all staff.

People and relatives told us the service was professional, kind and caring. One person who used the service said “Yes, staff are very kind and treat me very well. I am happy with what they do for me. They are very good to me.” A relative of a person who used the service told us; “Really excellent interaction with the carers, they are our choice and are really caring. The team we have are absolutely wonderful.”

Each person we spoke with confirmed staff always treated them with dignity and respect when care and support was provided. Staff we spoke with highlighted the importance of treating people in a manner they or they families would want to be treated.

We found people who used the service had care plans in place with copies held at both the head office and in their homes. The structure of the care plan was clear and easy to access information. Staff told us that before they started with a new client they would read the care plan to ensure they knew the individual needs of the person.

We found the service was involved in regularly monitoring people’s health and worked well with other health care professionals.

Relatives and people who used the service confirmed that the service was responsive to people’s changing needs. One relative told us; “They are very responsive to any concerns I or my husband has and they always respond straight away. They take account of any concerns we have.”

Staff told us that they felt valued by the management and spoke favourably of the leadership provided. One member of staff told us; “No concerns for the way the service is managed, I feel supported and valued.”

We visited Westwood House on 8 April 2013. We looked at the care records for four people who used the service. They contained relevant information and were individual and personalised. People’s choices and preferences were noted.

We spoke with one person who used the service and three representatives. One person told us that the workers were all “friendly and approachable” and another said “the staff are excellent; there is not one person I have a bad word for.” One person had made a complaint recently and told us that this had been dealt with efficiently and that they were satisfied with the outcome.

We looked at records for three staff members and the staff training matrix, supervision notes and staff meeting minutes. We saw that staff were supported with an induction procedure, regular training, informal and formal supervisions and e-mail communication. We spoke with three staff members who all said they felt supported and that they could contact a member of senior staff at any time for help and guidance.

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There was a complaints procedure in place and complaints were followed up appropriately. We saw that there were various systems in place, for example spot checks, audits and service user visits to allow the continual monitoring and improvement of the service delivery.

We saw that all relevant policies and procedures were in place and that they were regularly reviewed and updated. We saw that all records were appropriately and safely stored.

People we spoke with told us that overall they were happy with the support provided. One person said, “I’m happy with the arrangements”. Another person said they had, “No problems, everything is fine”. Other comments about the support people received were, “consistent” and staff “understood what was needed”.

The relative for one person said that the manager kept in contact or they could contact her if they needed to discuss anything. They also told us that staffing arrangements were generally consistent and staff knew how to care for their relative.

People we spoke with confirmed that staff completed records to show that they had visited and what support or tasks had been completed.

None of the people we spoke with expressed any concerns about the agency. The people we spoke with felt able to raise any issues with the staff or manager should they need to.

Following our visit we also spoke with a social care professional who said the manager was “forthcoming with information and keeps in contact” and that they were “happy with the service provided”.

One person using the service told us that the care workers were: “all very nice, respectful and polite,” and that they felt they were treated with dignity and respect.

We were told by a person using the agency:"I feel safe in their care and involved. The management are approachable and I feel that if I needed to I could complain, but I don’t need to."