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Inspection carried out on 4 December 2018

During a routine inspection

We carried out an announced inspection at Ribble Homecare on 4 and 5 December 2018. 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 people, people living with dementia, younger adults and people with a physical disability. The service specialises in providing care to people at the end of their life. At the time of this inspection, there were a total of 20 people being supported by the service.

Not everyone using the service receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’, for example help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

The service had a registered manager in place. 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.

At our last inspection we rated the service good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We therefore found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good:

People received consistently high levels of care from staff who were kind, caring and willing to go the extra mile to support people. The registered manager was a positive role model for staff and demonstrated a commitment to ongoing service improvement.

The service specialised in providing care and support to people who were at the end of their life. Staff had received specialist training to help ensure they were able to provide people with high quality, compassionate end of life care which met their wishes and preferences. The service had a policy of ensuring no one died alone at home.

People's privacy and dignity was respected and promoted. Staff had received training in equality and diversity and there were policies in place to help ensure they provided care which promoted and respected people’s rights.

People told us they felt safe with the staff who supported them from Ribble Homecare. People's care records contained details of people’s needs and associated risks.

Staff had been safely recruited. Staff we spoke with were aware of how to safeguard adults at risk of abuse. There were safe processes and practices in place for the management and administration of medicines.

Staff received the necessary induction, training and support to help ensure they were able to deliver effective care. People told us staff were knowledgeable about their needs and the way they wished to be supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice.

Staff were responsive to any changes in people’s health conditions. Prompt advice and support was sought from health professionals when necessary; this helped to prevent unnecessary hospital admissions.

There were systems in place to monitor the quality and effectiveness of the service. The provider regularly sought feedback from people who used the service, their relatives and staff. Any comments received were welcomed as a means of improving the service.

Further information is in the detailed findings below.

Inspection carried out on 18 May 2016

During a routine inspection

This was an announced inspection which took place on 18 and 19 May 2016. We had previously carried out an inspection in March 2015 when we found seven breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We made requirement actions in relation to staff recruitment procedures, person-centred care, management of medicines, training for staff, need for consent, record keeping and quality assurance systems in the service. Following the inspection in March 2015 the provider sent us an action plan telling us what steps they were going to take to ensure all the regulations were met. They told us they would take action to ensure all the legal requirements were met by May 2015.This inspection was undertaken to check that the required actions had been completed.

Ribble Homecare is a domiciliary care agency which at the time of our inspection was providing personal care to 25 people who lived in their own homes. The registered manager told us that they continued to specialise in providing end of life care to people. Since the last inspection the service had moved to new premises in Blackburn.

The service had a registered manager in place as required under the conditions of their registration with the Care Quality Commission. 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.

We found significant improvements had been made since our last inspection to how the service was run. This meant that all the breaches in regulations previously identified had now been met.

People we spoke with during the inspection told us they always felt safe when they were cared for by staff from Ribble Homecare. Records we reviewed showed staff had received training in safeguarding adults. They were able to tell us of the correct action to take to help ensure people who used the service were protected from the risk of abuse. Staff told us they would also be confident to use the whistleblowing procedure in the service should they observe any poor practice. They told us the registered manager regularly reminded them to report any concerns they might have about people who used the service so that appropriate action could be taken.

We found that recruitment processes in the service were sufficiently robust to protect people from the risk of unsuitable staff. People who used the service told us staff always visited at the time agreed and stayed for the correct amount of time. They told us that staff did not appear rushed during their visits and always took the time to complete any tasks they asked of them. Records we reviewed showed that the registered manager placed an emphasis on ensuring that staff took their time when caring for people who used the service. This was confirmed by all the staff we spoke with.

People told us they received the support they needed to take their medicines. We saw that staff had received training in the safe handling of medicines. Staff told us they were regularly observed to check they were competent to administer medicines safely, although these checks were not formally recorded. We found that all medication administration records we reviewed were fully completed to show that people had received their medicines as prescribed.

Risk assessments for physical health needs and environmental risks helped protect the health and welfare of people who used the service. Arrangements were in place to help ensure the prevention and control of infection.

Where necessary people who used the service received support from staff to ensure their health and nutritional needs were met. Staff told us they worked closely with the district nurses who were also involved with many of the people they supported due to their comp