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Inspection carried out on 16 January 2017

During a routine inspection

This inspection took place on 16 January 2017 and was announced.

Domiciliary Care Services (UK) Limited is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were 88 people using the service. People's packages of care varied dependent upon their needs. There were 33 staff employed who provided people’s care.

The previous comprehensive inspection of 4 January 2016 found improvements were needed and a breach in the regulations. The focused inspection of 3 November 2016 found the service to be compliant with the regulations.

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.

People’s safety and welfare was promoted by staff that understood and had received training on their role in protecting people from potential harm and abuse. Safety and welfare was further promoted through the assessment and on-going review of potential risks to people. Where risks had been identified measures had been put into place to reduce their likelihood, which were recorded within people’s records and understood and implemented by staff.

Staff upon their recruitment had their application and references validated and were checked as to their suitability to work with people, which enabled the provider to make an informed decision as to their employment. Staff underwent a period of induction and training, which included their being introduced to people whose care and support they would provide. Training provided to staff and staff understanding of their role and responsibilities meant people were supported appropriately with all aspects of their care, which included support with their medicines.

Staff understood the importance of seeking people’s consent prior to providing care and support. Staff were aware of people’s rights to make decisions and were able to tell us how they encouraged people to express their opinions on their care and support. Staff liaised with a range of health care professionals and kept in contact with people’s family members where they had concerns about people’s health.

The open and inclusive approach showed by staff from the service to people meant those using the service and family members had confidence in contacting staff at the service, knowing they would be listened to. This had a positive impact on people. For example, staff from the service were able to provide information and liaise with other agencies to ensure people’s needs were met. The service provided was flexible to meet people’s individual needs and people spoke positively about the attitude and approach of all staff.

The provider had acquired and continued to implement a quality audit system, which assisted them in determining whether they provided quality care and support to people within their own home.

Inspection carried out on 3 November 2016

During an inspection to make sure that the improvements required had been made

We carried out an announced comprehensive inspection of this service on 4 January 2016. A breach of legal requirement was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Knighton Road on our website at www.cqc.org.uk.

The provider submitted an action plan following the inspection of January 2016 advising us of the action they would take to address the breach of regulations identified by the 4 April 2016.

Knighton Road is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were 87 people using the service. The provider employed 61 staff to provide personal care and support.

This inspection took place on the 3 November 2016 and was announced.

A registered manager is 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.

There were effective systems in place to support communication between the registered manager and staff, to ensure staff had access to up to date information so that any changes in people’s needs was understood by all. Members of the management team carried out audits on documentation completed by staff to ensure that records were of a good quality.

The system to appraise and supervise staff had undergone improvement to enable the provider to determine whether the support and care provided by staff was of a good standard. The appraisal and supervision of staff was regularly assessed and improvements if identified were monitored through on going staff appraisal.

The local authority through their commissioning team had found the service to be complaint when assessed against their quality assurance framework.

The provider had acquired and implemented a quality tool kit, which assisted them in determining whether they provided quality care and support to people within their own home. The outcome of people’s views once collated was shared with them and included any actions undertaken to bring about improvement. To further support the commitment of the provider in keeping people informed, the provider circulates a newsletter to people, providing them with information, such as the training staff received so that people could be confident and reassured as to the knowledge of staff in meeting their needs.

Inspection carried out on 4 January 2016

During a routine inspection

This inspection took place on 4 January 2016 and was announced.

Domiciliary Care Services (UK) Limited is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were 98 people using the service.

Domiciliary Care Services (UK) Limited had 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.

People we spoke with and information we received through questionnaires showed that people felt safe when receiving care and support from staff. People told us this was because staff were friendly and helpful. Staff had a good understanding of their role in reporting potential abuse and were aware of the types of abuse people were at risk of.

Potential risks to people’s safety were assessed and plans to minimise risk were developed, however these were not always sufficiently detailed to provide clear information for staff as to how risk was to be reduced. Staff we spoke with were aware of potential risks with regards to the people they supported and told us how they reduced risk through the use of equipment to safely move people within their home.

People we spoke with and information we received through questionnaires stated that staff arrived on time to provide people’s care and support and that staff completed the tasks they were commissioned for.

People told us that where they needed support with their medicine this was provided by staff. We found there were sufficient staff to provide people’s care and keep them safe and that staff had received training to enable them to meet people’s needs safely.

People we spoke with and information we received through questionnaires showed that people were supported by a consistent group of staff and that in a majority of cases people using the service had been introduced to staff to ensure they were compatible. People told us that individual requirements were met, which included receiving care from staff who spoke their first language and had an awareness of their cultural and religious beliefs.

People using the service and staff told us that ‘spot checks’ were carried out to ensure the care being provided was reflective of people’s plans of care and that staff interacted with people well. However we found that the information recorded about these checks to be very limited and did not provide a record to evidence the assessment and outcome of staff’s competency.

People we spoke with told us that staff sought their views about their care and support and listened to them. Staff told us that they always sought people’s views to ensure that the care they provide is as they wished it to be.

Where people require support with nutritional needs this is provided, which includes the preparation of drinks and meals. People’s plans of care provide information for staff as to the support people need, which ensures people have access to food and drink throughout the day when required.

Staff we spoke with were aware of their role in dealing with unexpected situations, which included arriving at someone’s home to find them unwell. Staff were clear of their role in contacting emergency services where appropriate, seeking guidance from managerial staff and supporting people to access health care.

People we spoke with and information we received through questionnaires recorded that people found staff to be kind and caring. They told us they were supported by a consistent group of staff which meant positive relationships had been developed. People stated that their privacy and dignity was promoted and we found staff were able to provide practical examples of how they promoted people’s dignity.

People told us that staff’s ability to communicate with them in their first language was positive. However a minority of people did express concerns that on occasion’s staff spoke in their first language, which excluded them as they did not understand what was being said.

People’s plans of care provided an overview as to the care and support people required which had been developed from their initial assessment. The style and content of people’s plans of care was currently under review. A quality assurance audit carried out by representatives of the local authority who commission packages of care for people had identified improvements were needed to ensure people’s plans of care were person centred and were developed with the involvement of the person or their representative.

Information we received through questionnaires showed that a majority of people who used the service felt they were involved in the service they received. However people we spoke with felt involved in their care but did not always have knowledge of their plans of care and other information written about them and was kept within their home.

People we spoke with and information gathered from our questionnaires showed that people were confident to raise concerns with staff about their care and that they had confidence that any concerns would be listened to and acted upon.

We found there was not an effective system in place to asses, monitor and improve the quality and safety of the service and to identify where improvements were needed. This meant the provider had not identified areas for improvement and therefore did not have a plan of action to bring about improvement with a view to continually improving the service provided.

The registered manager acknowledged that improvements were needed in some areas, many of which had been brought to the attention of the provider by the quality assurance monitoring visit carried out by representatives of the local authority who commission packages of care for people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 September 2013

During a routine inspection

We asked people and their relatives for their views about the care and supported they received. People’s comments included: “Very happy with the service, they’re flexible if you need to change your visit times.” “Very good and responsive service. I can’t speak highly enough about the agency. The care staff have really taken on board my relatives dementia and the consistency of care staff mean they are safe and well cared for.” “I can’t think of a situation they haven’t managed well, they contact me with any concerns.” “I’ve had some lovely ladies (staff) to care for me, they’re generally speaking on time and if they’re going to be late for any reason they always let you know and why.” “The staff are very considerate and very kind.” “I’m very happy. I have the same girls (staff) looking after me, they’re so kind and I like the consistency of having the same people. They’re really, really good and I do appreciate them.” “I have no concerns, they’re always kind and courteous and if they’re running a little late they always apologise and explain why. We are supported by the same staff and we like that.”

We found people’s care plans and records provided information which enabled staff to provide the care and support each person required. Staff told us that where they noted changes to the health or welfare of people they reported these to a member of the management team who then liaised with people’s relatives or health and social care professionals where appropriate to ensure peoples care packages were reviewed in order that they received the care they needed.

Staff we spoke with told us they had regular access to training and that they were supported by the management team through supervision, one to one ‘spot checks’ and meetings. The supporting of staff was part of the providers’ quality assurance system, which included speaking with people who used the service and seeking their views.

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

The applicant has been found to be fit to be the registered manager for the regulated activity 'personal care'.

Inspection carried out on 7, 8 November 2012

During a routine inspection

We spoke with three people who use the service and the relatives of two people. People we spoke with told us that the carers arrived on time and stayed the agreed length of time allocated to them. People told us the staff who delivered their care were friendly and approachable and that they delivered the care as recorded within their care plan. People told us they had a copy of their care plan and that staff wrote in their daily records following each visit.

People’s comments included: - “They really are good. I’m very happy with them, if anything happens it gets sorted and the manager is very approachable.” “Both the carers and office staff are very friendly and organised.” “They’re generally speaking on time and they always provide the care and support that’s in my care plan.”

We spoke with four members of staff and found staff had a good understanding of the needs of people they cared for and told us that they found the manager of the service to be supportive. They told us they had access to regular training which enabled them to care for people well.

We found that whilst the service kept records well they had not notified the Care Quality Commission of changes to their management structure which they are legally required to do.

Inspection carried out on 28 September 2011

During an inspection in response to concerns

People told us the agency delivered a good service and they were satisfied with the care they received. One person said, “I am very happy with the care I get and I am definitely happy with the agency, in fact I don’t think there’s a better agency than this.’

Another person said they enjoyed it when the staff visited. They said, “I have a great time when my carers come. We always have a good chat and a laugh. They know their job and they look after me very well.”

The service was flexible to fit in with people’s lifestyles and individual needs. It provided a befriending service as well as care and domestic support. For example, one person was supported to visit their place of worship with a member of staff. Another liked to cook ‘a proper dinner from scratch’ at home and staff supported them in doing this.

People told us they were involved in making decision about their care and support. One person said, “I tell the agency what I want and they do it for me.” Another told us, “The staff always ask me what I’d like to eat when they come. I tell them what I fancy and they make it for me.”

People said they liked the staff team. One person told us, “The staff are marvellous. They are always polite and very kind.” Another person said, “The staff are excellent, very helpful and good to me. If they were late because they’d been held up at another house they’d phone to tell me.”

People told us they felt safe using the agency and trusted the carers. One person said, “The staff would never leave me if I was ill, they would get a doctor for me.” Another said “I don’t mind the carers coming into my house. They know their way around and I trust them.”