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Inspection carried out on 18 December 2018

During a routine inspection

About the service: Harrogate Care at Home provides people with personal care needs in their own home. Some people were supported whilst their main family carer took a break from their caring role. 43 people used the service at the time of the inspection. The majority of people receiving personal care were older people, people with a physically disability or people living with dementia.

People’s experience of using this service:

People and their relatives were confident they were in ‘safe hands’. Safe staffing levels were maintained. Care visits were arranged to ensure staff had sufficient time to support them safely. Risks to people were identified in their care plans. Risk assessments were not always in place to help identify risks and guide staff in how to manage these.

We have made a recommendation about medicines best practice guidance.

People received an assessment prior to receiving support to help staff understand their needs and preferences. People signed their care plans to indicate their consent to this. Records did not always reflect that the provider had followed the Mental Capacity Act 2005 for people that may lack capacity.

Staff received training and support to assist them with understanding and carrying out their roles.

The provider promoted the values of dignity and respect. People felt these values were reflected in the care they received. Staff understood people’s preferences and how to support them effectively while promoting their independence.

People received care personalised to their needs. Staff understood their preferences and adapted people’s care depending on whether they were having a ‘good’ or ‘bad’ day.

The provider was proactive in seeking feedback from people and their relatives. Complaints were addressed promptly.

The registered manager had completed a range of checks to help maintain safety and quality across the service. They planned to review these to ensure they covered the points we identified.

People and staff were involved in the running of the service. Surveys were used to monitor the experience of people using the service. Staff attended team meetings, where they had the opportunity to make suggestions.

Staff worked with local charities to support people. They understood the role of other professionals, acting on their recommendations and seeking advice when this was needed.

More information is in the Detailed Findings section below.

Rating at last inspection: Good (report published 29 June 2016)

Why we inspected: This was a planned inspection based on the previous rating of the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 4 May 2016

During a routine inspection

This inspection took place on 4 May 2016. 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 location offices when we visited.

At our last inspection on 3 October 2013, the provider was meeting the regulations that were assessed.

The registered provider is registered to provide personal care to people who live in their own homes. The registered provider primarily supports people in the Harrogate area. At the time of our inspection, there were 81 older people receiving a service from Harrogate Care at Home.

There was a registered manager at 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.

Care and support was provided to people in their own home in accordance with their individual needs. People who received care and support from the agency gave us positive feedback. They said they received a reliable service and a good standard of support from caring, kind and compassionate staff. People told us they felt safe and had confidence in the way staff supported them.

When people were identified as being at risk, their care plans showed the actions required to manage these risks. We saw risk assessments for areas which included moving and handling, falls, nutrition, skin and pressure care.

There were sufficient staff available to ensure the safe delivery of the service. Recruitment checks were in place. These checks were undertaken to make sure staff were suitable to work with people who used the service. The training programme provided staff with the knowledge and skills to support people. We saw systems were in place to provide staff support. This included staff meetings, supervisions and an annual appraisal. Staff told us there was good team work and support from the registered manager.

There were safe systems in place for supporting people with their medication. The agency had a medication policy and staff received training which included a practical test to demonstrate competency.

People’s health and care needs were assessed before a service was provided. People were involved in planning the care and support they wished to receive. People told us how their service was effective in meeting their needs.

People told us they were introduced to staff prior to them providing support and described staff as kind and considerate. People told us that they were treated with dignity and respect.

The registered manager had a clear knowledge and understanding of their roles and responsibilities in relation to the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. Where a person lacked capacity to make their own decisions they were able to explain how the service worked with other health and social care professionals and family members to ensure a decision was made in the person’s best interests.

Staff liaised with healthcare professionals at the appropriate time to help monitor and maintain people’s health and wellbeing.

There was a complaints policy in place which people were aware of. People we spoke with said they would raise any concerns or complaints with the registered manager or staff and were confident they would be taken seriously and addressed.

We saw the content of the records reviewed covered all aspects of an individual's care needs and were sufficiently detailed to provide clear information for staff on how to carry out individual care and support for people. We saw that documentation had been updated and reviewed when people's care and support needs had changed. This meant staff had up to date information to deliver continuity of care and suppo

Inspection carried out on 3 October 2013

During a routine inspection

We spoke with nine people and their relatives on the telephone and received 30 feedback questionnaires.

Before people received any care or treatment they were asked for their consent and the service acted in accordance with their wishes. We asked people if their plan of care had been discussed with them and they confirmed they or their representatives had been involved in planning their care.

The majority of people told us their satisfaction with the care they received was either good or excellent and that they received the care and support they needed all or most of the time. Comments from people included �They do everything very well and are very good to me�, �They carry out their duties efficiently and understand my needs� and �Overall they do everything satisfactorily."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. All the people we asked told us they felt safe when carers went into their home.

Staff received appropriate professional development. We saw arrangements were in place for new staff to complete an induction programme and for their competency to be assessed. We saw and staff confirmed they received regular supervisions sessions and appraisals.

The provider had an effective system to regularly assess and monitor the quality of service people received.

Inspection carried out on 29 May 2012

During a routine inspection

We spoke with nine people who receive support from the agency. People told us that they were happy and satisfied with the care and support being provided. Comments made to us during this review included, "They really do well - we are happy with all of them" and "The care staff are amazing. If you want something they get it for me and all the office staff are very polite." People also said "All the carers are very good but I have a regular carer who is very good indeed" and "The agency is brilliant they don't put a foot wrong, they need to be commended as they all do a good job." People told us that they hold copies of their care plans and confirmed that they were always involved in any care planning with the agency.

Staff told us that they were well supported and were provided with the information and training they needed to do their jobs. Staff we spoke with told us the training at the agency was 'very good'

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.