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Inspection carried out on 5 February 2019

During a routine inspection

About the service: Star Domiciliary Care Limited. This service provides care to older people living in their own homes. Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection, eight people were receiving personal care as part of their care package.

People’s experience of using this service:

People were supported safely and had appropriate risk assessments in place to ensure any risk was minimised. Risk assessment were reviewed.

People felt safe while being supported by the staff team. People knew how to raise any concerns they had.

Staff had received training in safeguarding vulnerable people from abuse. Staff were confident they could report any concerns and they would be acted upon.

Staff were recruited safely. Appropriate pre-employment checks were in place to ensure staff were suitable to work with vulnerable people.

Medicines were safely managed. Staff were trained to administer medicines and regular checks were made to ensure people were receiving their medicines as prescribed. Staff received regular competency checks of their ability to administer medicines safely.

People were supported to receive a diet that reflected their choices. People received an assessment of their needs prior to using the service to ensure they could meet the person’s needs.

Staff received training and supervision to enable them to carry out their job role. However, supervision was not always regular. Staff told us they could raise any questions with the registered manager at any time.

Staff understood the importance of supporting people to make their own decisions and reported any concerns around people’s mental capacity to the registered manager.

People told us they felt well cared for. Relatives also felt the staff team were caring. Staff gained consent from people to enter their property to deliver care and support.

Care plans were reflective of people’s needs and were reviewed to ensure they remained accurate.

Complaints were responded to in a timely manner with outcomes shared. People and relatives knew how to make a complaint.

People could be supported at the end of their life. Staff were trained in end of life care and the service worked with other professionals to ensure dignity.

Audits to monitor the service were regularly completed but had not identified the need to manage people’s personal money.

Staff felt well supported by the registered manager. Relatives told us the registered manager was responsive.

The registered manager completed unannounced spot checks on staff to ensure they were carrying out their role effectively. The registered manager sought feedback on the service and responses were positive.

Rating at last inspection: Requires Improvement (report published 2 February 2018)

Why we inspected: This was a planned inspection based on the rating of the last inspection. The service has now improved to be rated as overall good.

Follow up: We will continue to monitor all intelligence received about the service and will re-inspect as part of our inspection process.

Inspection carried out on 20 December 2017

During a routine inspection

This inspection took place on 20 and 21 December 2017 and was announced.

At our last inspection in October 2016 we found three breaches of the Health and Social Care Act. These were in respect of the assessment and mitigation of risks, staff recruitment records, staff training and a lack of quality assurance systems.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. We found improvements had been made in all areas; however the quality assurance system was still not robust, with the registered manager telling us that checks were made but no record was made of these checks or any follow up action taken. You can see further details about what we found in the detailed findings section of this report.

This service 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 the agency supported 11 people.

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 registered manager told us they monitored the quality of the service by completing spot checks on staff and checking the medicine administration records (MARs) each month. They said they followed up any issues directly with the staff. However there were no records kept to evidence this. At the last inspection the registered manager told the CQC they would introduce guidance for when ‘as required’ medicines were to be administered and record their MARs checks. These actions had not been completed.

People told us they received their medicines as prescribed. We saw the MAR sheets had been fully completed. Comprehensive daily notes were completed for each visit.

All the people and the relative we spoke with were positive and complimentary about the support provided by Star Domiciliary. They said that they felt safe being supported and found the staff were on time, stayed the full allocated time and did not miss any calls.

Staff completed an initial training course covering topics considered as mandatory by the agency. This was refreshed each year. Staff also completed on line training. Where required, specific training, for example in catheter care, was provided. Observations of staff competencies when administering medicines had been completed by the registered manager.

Staff had started to receive supervisions with the registered manager, although these were not as frequent as planned. Team meetings were held every six months. Staff said they felt well supported by the registered manager, who was approachable and available if the staff had any queries or concerns.

Staff were introduced to the people they would be supporting by the registered manager and shown the support each person needed. This meant staff were able to get to know people before they started to support them on their own.

Care plans were person centred and included details of the agreed support required at each visit. Risks had been identified and guidelines put in place in order to mitigate the risks. Standard formats for care plans and risk assessments had been introduced.

We saw people’s relatives were involved in developing the care plans. Care plans and risk assessments were reviewed each month. An annual review was held with people and their families. A copy of the care plans was held at the agency office; however this was not the latest plan as all care plan reviews were completed in people’s homes.

All the people supported by the agency were funded by the local authority social services depar

Inspection carried out on 5 October 2016

During a routine inspection

We inspected Star Domiciliary Care on 5 October 2016. This was an announced inspection. We informed the registered provider at short notice (48 hours before) we would be visiting to inspect. We did this because we wanted the registered manager to be present at the service on the day of the inspection to provide us with the information we needed. This was the first inspection for the service which became registered in September 2014.

At the time of our inspection the service was providing personal care to 10 people. These were mainly older people some of who were living with dementia.

The provider had originally registered to also provide nursing care to people in their own homes but this side of the business had not yet commenced.

The service had a registered manager who is also the registered provider. 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 registered provider did not have a robust system in place to ensure all risks associated with delivering care were identified and control measures outlined for staff to follow. This placed people at risk of harm although we found no evidence of harm to people during our visit. Checks made on quality and safety were not recorded. Systems to support staff and for people who used the service to provide feedback to the registered provider were not formally in place. This meant the register provider could not evidence they were providing a quality and safe service for people.

Staff had received an induction and some basic training; however they had not received training in all areas the registered provider outlined were required for them to complete their role. For example, first aid and medicines training. Although staff told us the registered manager was supportive no formal staff supervision or appraisal had taken place. This meant staff did not have the training and support necessary to enable them to carry out their duties.

The service did not assess people’s capacity to make their own decisions or record best interest decisions made on behalf of people who lacked capacity in line with the Mental Capacity Act 2005. This meant there was a risk of people receiving support which was not in their best interests.

The registered provider did not ensure they completed all checks outlined in their recruitment policy to ensure safe recruitment of staff. Records relating to the recruitment of staff were not always available at the registered provider’s office.

Systems in place for the management of medicines so people received their medicines safely were not robust. For example; protocols for ‘as and when required’ medicines were not in place and staff had not been formally trained in this part of their role. The registered told us they would review and implement a system based on current best practice to improve this area.

The assessment tools used and care plan documents were not always clear for staff to follow. Care records we saw contained information about the person's likes, dislikes and personal choices in most areas. However, some records needed further detail to ensure care and support was delivered in the way people wanted it to be.

There were enough staff employed to provide support and ensure people’s needs were met. Staff were aware of the different types of abuse and what would constitute poor practice. Staff and the registered manager knew how to report concerns they may have to relevant authorities.

People and relatives told us staff treated people with dignity and respect. Staff were attentive, showed compassion and were patient with people.

People were provided with their choice of food and drinks which helped to ensure their nutritional needs were met. Staff at the ser