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Inspection carried out on 23 November 2016

During a routine inspection

The inspection took place on 24 November 2016. We contacted the service before we visited to announce the inspection. This was because the service provides a domiciliary care service to people in their own homes. We wanted to ensure that the manager was available to speak with us.

Complete Caring provides personal care to around 10 people who live in their own homes in Norfolk. The service provides support with other needs; however with domiciliary care the CQC only regulates personal care.

At our last inspection in October 2015, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the management of the service. Safe recruitment practices had not been followed. There was limited monitoring to ensure that staff had the skills and knowledge to do the job well. There was limited record keeping and care planning. There were limited audits to monitor the quality if the service.

At this inspection on 24 November 2016 we found improvements had been made so the service was no longer in breach of this regulation.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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.

However, the registered manager was no longer operating in this role. There was a daily manager who ran the service. For the purposes of this report they will be referred to as the manager. At the last inspection we were told that the registered manager would be de-registering as the manager and the manager would be applying to the CQC to become, the registered manager. However, this had not happened.

The service was not auditing the administration of people’s medicines to check people had received their medicines in the way the prescriber had intended. We found some issues with the recordings of people’s administration of medicines. This meant we could not be certain that these people had received their medicines as the prescriber intended. During our visit the manager told us of plans they would put in place to rectify this issue.

People were supported by staff who were knowledgeable in their roles and demonstrated the skills required. Staff had been safely recruited. There was a training system in place and staff had up to date training. Staff had a thorough induction to the service and their role. Staff were committed to provide a good service to people and felt supported to do this.

Staff demonstrated they understood how to prevent and protect people from the risk of abuse. Staff were mindful of this issue. The service had a procedure for reporting any safeguarding concerns. People and staff were protected from the potential risk of harm as the service had identified and assessed the risks people faced. People had assessments and reviews which were person centred.

People benefited from staff who felt valued by the service. Staff had confidence in the manager and the service they were providing. People told us they were treated in a respectful and caring way. People said they saw the same care staff at regular times, and did not have missed care visits.

Staff demonstrated that they understood the importance of promoting people’s dignity, privacy and independence. They gave many examples of a caring and empathetic approach to the people they supported. Staff formed positive relationships with the people they supported.

Staff had received training in the Mental Capacity Act 2005 (MCA) and demonstrated they understood the importance of gaining people’s consent before assisting them.

Staff assisted people, where necessary, to access healthcare services. Staff had a good understanding of people’s healthcare needs. Staff demonstrated they had the knowledge to manage emergency situ

Inspection carried out on 8 October 2015

During a routine inspection

The inspection took place on 8 October 2015 and was announced.

The agency provides personal care to approximately 30 people in their own homes. Support can range from a few hours a week, to live-in care if required.

There was a registered manager in post. 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.

The agency had not had consistent leadership from the registered manager, who was also the owner of the business, for some time. This had been left to a member of the management team. That staff member is referred to in this report as the manager. The manager did not have appropriatesupport and input to understand the requirements of regulations and the expected fundamental standards for the service. They had tried to make some improvements where they had identified this was needed but further improvements were needed in the way the agency was managed and led.

People’s safety was potentially compromised because some aspects of recruitment processes were not as robust and consistent as they should be, although improvements were being made. Potential risks to people using and working in the service were not always thoroughly assessed. However, staff were clear in their responsibilities to report any issues of concern that may suggest someone was at risk of harm. People were confident that they could raise any concerns or complaints they had directly with the manager and that action would be taken.

People were supported by kind, consistent, regular staff members who had got to know people well and the way they liked to be supported. Staff had developed a good rapport with people, delivering a high standard of care in line with people’s preferences and needs. This was despite these not always being clearly identified and recorded in way that properly reflected the support each individual required.

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

Inspection carried out on 19 December 2013

During a routine inspection

We spoke with two people who used the service. One person told us "They are all first class. They do my personal care and spend time talking to me as well." We saw evidence of information provided to people who used the service, describing the services offered, giving contact numbers for making complaints and finding additional support.

We examined care plans and found that these included clear instructions on how staff should meet people's needs and were written in a way that promoted the individual's choice and independence.

We spoke with members of the management team and carers. Both were able to demonstrate a good understanding of local procedures for responding to allegations or concerns of abuse.

We saw staff records that showed that employees did not start employment until all the required information had been received. This helped to protect people from staff who may be unsuitable to work with vulnerable adults. Staff had appropriate contracts of employment and job descriptions, so were clear about their role.

During a check to make sure that the improvements required had been made

At the last inspection of this service in January 2013, we found that staff were not always receiving appropriate supervision and appraisal. For example, we found that one member of staff, in post since 2007, had no record of any support or appraisal on file. Supervision and appraisal was needed so that there were opportunities for managers to discuss and evaluate the performance and development needs of staff. However, staff spoken with did tell us that they could raise issues or problems with the management team if they needed to.

After that inspection, the manager sent us an action plan telling us how they were going to arrange for improvements, so that staff were properly supported in their roles. We reviewed the action plan and followed this up with a request for information showing the work that had been completed. The manager sent us supervision contracts that had been drawn up with staff. These were signed by both the manager and the staff concerned. We also received confirmation that supervision was being held once every twelve weeks and there was annual appraisal of staff.

Inspection carried out on 22 January 2013

During a routine inspection

We spoke with four people using the service and two relatives. People said that they felt well treated by staff. Most had regular carers and one person said, "I can't praise them enough. They are excellent." Everyone spoken with felt that staff were always polite and respectful. The management team asked for people's views about their care.

People's needs were assessed and used to plan their care. There was guidance for staff about the support people needed on each visit. Daily records confirmed the care delivered met with the plan. Only one person expressed any concern that sometimes staff didn’t always check that they had everything they needed before leaving their home.

Staff had access to training in a range of issues to ensure that they understood people's needs and how to meet them safely. Staff spoken with felt well supported and able to contact the management team for advice. However, there was a lack of regular formal supervision and appraisal to look at staff competence and any training or development needs they had.

People told us that they felt safe with the staff that entered their homes and had no concerns about the way they were treated. Staff had access to training about protecting people from abuse, recognising signs of abuse and what to do about it. There was also guidance in the staff handbook given to staff when they joined the agency. A staff member spoken to was very clear that any concerns would be reported immediately to the management team.