The inspection was carried out on 7 April 2017 and was announced.

The provider of Wisdom Healthcare Limited is registered to provide personal care and support to people in their own homes. At the time of our inspection there were 18 people receiving personal care and support from staff who visited them in their own homes. The frequency of and duration of visits people received within their homes varied depending on people's needs.

There was a registered manager in post who was not present during the inspection visit but the branch manager was. The branch manager was in the process of completing an application to become the registered manager. 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 were supported to remain safe in their own home because staff were aware of the risks associated with people's needs and home environments and how to reduce these. Staff were knowledgeable about the different types of abuse and knew how to report concerns. The provider followed well managed recruitment procedures to make sure potential new staff were suitable to work with people who used the service.

The branch manager assessed staffing levels dependent on people's level of needs. People were supported by staff who had the necessary skills and knowledge to understand and meet

people's needs. Staff felt supported and had access to training relevant to their roles. Staff put into practice the knowledge they had gained which included seeking people's consent before supporting them and respected their decisions. Staff provided information to people in a way they understood to support them to make their own decisions.

People were offered choice about what they wanted to eat and drink with staff checking where necessary people were eating and drinking sufficiently to meet their individual needs. People who needed staff assistance with their medicines were supported with these so their health needs were not at risk of deteriorating. Staff also worked closely with local health and social care services and supported people whenever this was required to access any specialist support they needed.

People were support by staff who were caring and showed respect towards them. Staff had formed positive caring relationships with people who used the service and their relatives. People were supported to remain as independent as possible due to staff knowing people’s individual likes and dislikes. Staff were mindful to support people in a way which maintained their dignity and upheld their right to privacy.

People received individualised care which reflected their needs and wishes. People benefitted from a flexible service which was responsive to changes in their needs and requirements. People were given opportunities to comment on the quality of the service and felt comfortable to raise any concerns with staff or the branch manager who they knew well.

There was a positive working culture where staff and the branch manager worked together to provide good quality care. People who used the service, relatives and staff found the branch manager easy to approach and helpful. Quality checks were developed and implemented on an on-going basis to continually drive improvements in the service people were provided.

We carried out this inspection to follow up on some information of concern that we had received. We spoke with nine people, four relatives, three staff members, the deputy manager and the registered manager who was also the provider.

We found that people had appropriate assessments in place. People and their relatives told us that the service provided appropriate care to meet individual needs. One person said, “Yes, they are great.”

Arrangements were in place to ensure that people were protected from the risk of abuse. Staff were aware of their duties to protect people. One person said, “I feel safe around staff.”

Selection and recruitment processes were robust to ensure that suitable staff were employed to work with people. One staff member said, “They did all the checks and then offered me the job.”

We found that systems in place did not always identify shortfalls in the service. We found that action taken was not always clear.

Records we looked at were accessible, accurate and fit for purpose. This would minimise the risk of people receiving inappropriate care.

We undertook an unannounced inspection of Wisdom Healthcare Limited on 23 and 24 April 2015.

Wisdom Healthcare Limited provides personal care to people in their own homes. At the time of our inspection there were 26 people using the service.

There was a registered manager in post 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 2008 and associated Regulations about how the service is run.

People and their representatives were positive about the care provided by the service.

Staff knew how to identify the signs of abuse and report it. Staff were able to accurately reflect the strategies they used to help reduce risk.

People received support at the agreed times from the agreed number of staff. Staff stayed for the full amount of time for each visit.

The provider used appropriate recruitment practices to ensure staff were suitable for their roles, although application forms were not always fully completed to show prospective staff’s work histories.

People received the medicines they required in order to support their health.

Care records were personalised. People received care assessments before using the service. People’s care needs were also reviewed on a regular ongoing basis to ensure care remained appropriate.

Staff were supported in their roles by the management team. This included staff receiving updated training and regular meetings with the management team, where their performance and development could be discussed.

New staff received induction training and periods of shadowing established staff so they could become familiar with the role and people’s needs. Staff were subject to a probationary period to ensure they were suited to their role, before being offered a permanent job.

Staff ensured people were consenting to the care they received. Staff were aware of how to respect people’s choices and their rights.

Where required, staff supported people to receive a diet which promoted their health and well-being. Staff liaised with, and took advice from, external healthcare professionals while caring for people with specific medical needs.

People described staff as being caring and compassionate. People knew the staff who came to support them. Staff received guidance on, and knew the best way, to interact with people. The provider listened to people and provided them with the information they required about the service.

People said they received a flexible service from the provider. Staff identified and reacted to people’s changing needs. People felt part of their care planning process.

People knew how to complain if they had any issues with the care they received. The provider dealt with complaints in a timely and thorough way.

The provider created a positive culture at the service. Most people praised the management team. Staff felt supported by managers and met regularly with them to discuss any issues they had.

We asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR.

The management team made themselves available to people. The service was regularly audited for quality by the provider. We found some minor issues with the auditing of medicines, but these were being addressed by the provider.