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Inspection carried out on 15 December 2017

During a routine inspection

Holistic Homecare is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The registered provider informed us that at the time of this inspection, Holistic Homecare was providing a service to adults and older adults from diverse multicultural backgrounds. Fourteen people were supported by the agency. Seventeen care workers were employed by the agency. The service office is based in the S3 area of Sheffield.

There was a manager at the service who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

Our last inspection at Holistic Homecare took place on 28 October 2016. We found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 12: Safe care and treatment, Regulation 17: Good governance and Regulation 19: Fit and proper persons employed.

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 asking if the service was safe and if the service was well led, to at least good.

At this inspection, we found sufficient improvements had been made to meet the requirements of Regulation 12: Safe care and treatment, as care plans contained accurate detail regarding the support required with medicines and appropriate safeguarding training had been provided to staff.

We found sufficient improvements had been made to meet the requirements of Regulation 17: Good governance, as systems were in place to effectively monitor the quality and safety of the service.

We also found sufficient improvements had been made to meet the requirements of Regulation 19: Fit and proper persons employed, as the recruitment files checked contained full and relevant information.

This inspection took place on 15 and 18 December 2017 and was announced. We gave the registered manager 48 hours notice of our inspection to make sure the registered manager, some staff and some people receiving support would be available to meet and speak with us.

People spoke very positively about the support provided to them. They told us they felt safe and their care workers were respectful and kind.

We found there were systems in place to protect people from the risk of harm. Staff we spoke with were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people, and management plans to reduce the risks were in place to ensure people's safety.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

Staff recruitment procedures were robust to ensure people’s safety was promoted.

There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff were provided with relevant training so they had the skills and knowledge they needed to undertake their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice. People had consented to receiving care and support from Holistic homecare.

Visit times were flexible to support people’s access to health professionals to help maintain their health.

People were supported to maintain a healthy diet which took into account their culture, needs and preferences, so their health was promoted and choices could be respected.

Staff knew the people they supported very well. People’s privacy and dignity was respected and promoted. Staff understood how to support peo

Inspection carried out on 30 September 2016

During a routine inspection

The inspection took place on the 30 September and 28 October 2016 and was announced. The provider was given notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the office. This is the first inspection of the service since it’s registration in December 2014.

Holistic Homecare Ltd is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing personal care to nine people. The provider supported several other people at the time of the inspection. However, they did not receive personal care. A large proportion of people who used the service and the care staff who supported them did not speak English as their first language. People using the service were on the whole, funded by direct payments. A direct payment a way that local councils enable people to purchase services that will meet their needs.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

Recruitment procedures were in place, but lacked rigour to ensure staff suitability, as pre-employment checks were not made thoroughly or consistently.

Although care staff received an induction training programme to support them in meeting people’s needs, the induction did not provide staff with sufficient training in safeguarding adults from abuse before they started working with people who used the service.

The provider had a medicines policy in place for care staff administering and prompting people’s medicines. Care staff knew what to do if they had any concerns. However, there was not enough information in people’s care plans to ensure staff knew people’s care and support needs with regard to people’s medicines.

Care staff were always introduced to people before starting work with them. They shadowed more experienced staff before they started to deliver personal care independently.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Care staff respected people’s decisions and gained people’s consent before they provided any care and support. However, the provider did not have any, more specific training on the MCA for staff to keep their knowledge up to date.

Care staff were aware of people’s dietary needs and food preferences, but this information was not always recorded in people’s care plans.

Care staff told us they notified the office if they had any concerns about people’s health and we saw records to show that it was followed up. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs and specialist nurses.

People’s relatives told us care staff were caring and knew how to provide the care and support they required. Care staff understood the importance of getting to know the people they supported and showed concerns for people’s health and welfare.

Staff respected people’s privacy and dignity, respected their wishes and promoted their independence. People’s first language and cultural requirements were considered when carrying out the assessments and allocating care staff.

People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. However, care plans were not always person centred and lacked detail.

People’s relatives knew how to make a complaint and were comfortable approaching staff if they needed to. There was an annual survey in place to allow people and their relatives the opportunity to feedback about the care and treatment they received and