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Inspection carried out on 5 November 2018

During a routine inspection

Ethos Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our inspection there were 21 people receiving a service from the agency. At our last inspection we rated the service good. At this inspection we found the evidence continued to support the 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.

At this inspection we found the service remained good.

The home had a 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 continued to be supported by staff who had been trained to recognise and report any concerns of abuse or poor practice. People had their risks understood and staff knew the actions needed to minimise risks of avoidable harm whilst respecting people’s freedoms and choices. Medicines had been administered safely by staff who were trained and had their competencies regularly checked. Infection control systems and practices were effective in reducing preventable infections.

Staff had been recruited safely including checks with the disclosure and barring service to ensure they were suitable to work with vulnerable adults. Staffing levels enabled a flexible approach to meeting people’s care needs. Staff induction, on-going training and support enabled them to carry out their roles effectively.

Assessments had been completed initially which captured peoples care needs and choices and included any necessary equipment such as telephone alarm systems. This information had been used to create person centred care plans that were person centred and reflected people’s individual life style choices and communication skills. People had their eating and drinking needs understood and when needed additional support had been requested of GP’s and speech and language therapists.

The care team worked effectively with other professionals such as district nurses and occupational therapists enabling positive outcomes for people. When people had changes in their health they had been supported to access healthcare. People had opportunities to be involved in end of life planning and files contained information about people’s decisions about resuscitation.

People are 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.

Care was provided in a kind and compassionate way which recognised and respected people’s right to privacy, dignity and independence. People felt involved in decisions about their care and felt able to raise a concern knowing it would be listened to and actioned.

The management of the home promoted an open and transparent culture which encouraged and enabled people, their families and the staff team to be involved and engaged with service delivery and development. Staff understood their roles and responsibilities and spoke positively about the management of the service.

Quality assurance processes were effective in ensuring regulations were met and sustained. When areas were highlighted as requiring improvement actions had been taken appropriately and had improved outcomes for people.

Information sharing with other professionals and agencies enabled the service to keep up to date with best practice and new innovations.

Further information is in the detailed findings below.

Inspection carried out on 26 May 2016

During a routine inspection

The inspection took place on the 26 and 27 May 2016 and was announced. The service provides personal care to older people living in their own homes. At the time of our inspection there were 15 people receiving a service from the agency.

The service had a 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.

Assessments had been completed to identify any potential risks people were living with. One person had risks associated with their weight and nutrition due to their physical and mental health. Reviews of the risk had been completed but were not robust enough. Although a care plan was in place it did not contain information about the actions staff needed to take to minimise any risk to the person of weight loss and poor nutrition. The care co-ordinator told us they would carry out an immediate review of the risk and add more detail to the care and support plan.

Risk assessments had been completed for people who needed support with moving and handling and management of their day to day money. The actions put in place minimised any associated risk to the person. Staff demonstrated a good understanding of any assessed risk and the actions they needed to take to minimise it.

People’s Medicine Administration Records (MAR) were maintained and medicines were stored and administered safely. However, care staff were not recording on the MAR chart when they had applied prescribed creams. We discussed this with the deputy care co-ordinator who told us they would have the creams added to the MAR sheets immediately.

People told us they felt safe. Staff had completed safeguarding training and knew how to recognise signs of abuse and the action they would need to take if they suspected abuse.

There were enough staff to support people. Staff had been recruited safely. Procedures were in place to manage any unsafe practice.

Staff received an induction and on-going training that enabled them to effectively carry out their roles. They received regular supervision and an annual appraisal which provided an opportunity for personal development.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service was working within the principles of the MCA. Care staff understood their role in ensuring people consented to their care and support.

Care workers had a good understanding of people’s food and drink likes, dislikes and allergies.

People had good access to healthcare which included GP’s, district nurses and occupational therapists.

People told us the service was caring. Staff had a good knowledge of the people they were supporting. We observed positive friendly relationships between people and care workers. Conversations were relaxed but professional. People were supported to maintain their independence. People and their families felt involved in decisions about care. People told us their dignity was respected. Staff had a good understanding of how to respect a person’s right to confidentiality.

People had their care needs assessed and individual care plans had been written that described the actions staff needed to take to meet them. Staff demonstrated a good knowledge of people and how they liked to be supported. People had been supported to maintain links with neighbours, friends and shops in their local commun