The inspection took place on 18 January 2018 and was announced, as it is a small service, to ensure staff we needed to speak with were available. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It is also registered for nursing care but currently does not support any people who require this type of care. It provides a service to older adults, younger adults, people living with dementia or mental health needs. At the time of the inspection, the provider was supporting three young people.

The service had a registered manager and a manager who was in the process of applying to the Commission to become a second registered manager for the service. 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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well-led to at least good. At the last inspection on 22 December 2016, we asked the provider to take action to make improvements in relation to breaches of regulations we found in relation to medicines, safeguarding, notifications and good governance, these actions have now been completed.

At this inspection, we found people were safeguarded from the risk of abuse. The registered manager and the manager understood their role and responsibilities to raise any safeguarding concerns for people. Records were maintained of medicines staff either administered to people or supported people to take. Staff underwent medicines training and had their medicines competency assessed regularly.

At this inspection, we found processes were in place to monitor the quality of the service people received and to seek people’s feedback in order to identify any potential areas for improvement of the service for people. The manager had since the last inspection, updated the safeguarding policy to include the requirement to inform CQC of any safeguarding alerts made to the local authority.

Risks to people had been assessed and control measures were in place to manage any identified risks. People’s risk assessments were reviewed at least annually to ensure they remained relevant.

There were sufficient numbers of suitable staff to support people and meet their needs. The provider followed safe recruitment practices for people. Processes were in place to protect people from the risk of acquiring an infection during the delivery of their care. Processes were in place to ensure any required learning could take place following an incident to ensure people’s future safety.

People’s needs were assessed prior to the commencement of the service. The manager kept themselves up to date with developments and policies reflected current guidance to ensure people received effective care.

Staff underwent an induction to their role. We have made a recommendation about the provider assuring themselves that this meets current guidance. Staff underwent a range of training and some staff completed further training immediately following the inspection to ensure they had the knowledge to provide people with effective care. Staff received regular supervision and support in their role.

Staff supported people to eat and drink sufficient for their needs. Staff had worked with health professionals to ensure people received effective care. Staff were able to support people to meet their health care needs where they required this assistance.

People were 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.

People and relatives repo

This inspection took place on 16 and 22 December 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care; we needed to be sure that someone would be in.

The service had not previously been inspected.

White Bird Care and Nursing Agency provides personal care to people in their home. At the time of the inspection there were three people using the service.

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.

People did not receive care and support from a service that followed current legislation. The registered manager was unaware of the changes to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People did not always receive their medicines safely. The registered manager did not demonstrate good practice in safe medicines management. The service did not maintain records of medicines staff administered.

People were not protected against the risk of harm as the registered manager failed to submit safeguarding alerts to the local authority safeguarding team and the CQC. Staff were aware of the importance of reporting safeguarding incidents to the registered manager, however these were not always followed up with the local authority safeguarding team.

People received care and support from staff that did not always receive mandatory training to meet their needs. The service had failed to ensure staff underwent Mental Capacity Act 2005 [MCA] training. The registered manager was unaware that MCA training was mandatory, however on the second day of the inspection it had been confirmed that all staff had undertaken and completed MCA training and were applying the MCA principles in their work

The registered manager did not have robust audits in place to ensure care plans, staff training and personnel files were up to date and met people’s needs. The registered manager did not drive improvement of the service through auditing systems.

People were protected against the risk of avoidable harm as the service had risk assessments in place that reflected people’s changing needs. Risk assessments looked at people’s mobility and medicine needs. Risk assessments were reviewed regularly to reflect people’s changing needs and gave staff clear guidance on how to manage risks.

People received care and support from staff that reflected on their working practices. Staff received on-going supervisions and appraisals. Staff were given one-to-one time with the registered manager to discuss their roles, responsibilities and areas of improvement. Staff were also able to identify areas of training needs required to enhance their skills and knowledge.

People were supported by sufficient numbers of knowledgeable staff to meet their needs. The service had recruitment procedures in place to ensure suitable staff were employed. The service was able to demonstrate staff personnel files contained application forms, training certificates, references and Disclosure and Barring Services [DBS] checks. A DBS is a criminal check services carried out to enable services to make safer recruitment decisions. Staff underwent induction training, which gave them knowledge on the service’s expectations and appropriate practices.

People’s consent to care and treatment was sought prior to care being delivered. Staff were aware of the importance of ensuring people’s consent was given prior to delivering care and support. Where people did not give their consent, this was respected by staff. People were given information and explanations about the care they received which enabled them to make decisions.

People’s privacy and dignity was respected. People were enco