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Inspection carried out on 9 May 2017

During a routine inspection

We carried out this inspection on 9 May 2017. The inspection was announced. We gave the provider 48 hours’ of this inspection because we needed to be sure that someone would be available to support us with the inspection process.

At the last inspection in February 2016, the service was rated ‘Good’. At this inspection we found that the service remained ‘Good’.

We carried out this inspection due to high number of safeguarding concerns that we had received about the service and how it was being managed.

Felicity Care provides home care services to people living in their own homes. At the time of the inspection the service provided personal care and support to 56 people.

People and relatives told us that they felt safe and happy with the care and support that they received from care staff from Felicity Care.

Care staff understood the term ‘safeguarding’ and were able to list the different types of abuse that people could experience. Care staff clearly demonstrated the actions they would take if they suspected that people they supported were being abused.

The provider had a variety of systems in place to ensure people were kept safe and free from harm. This included individualised risk assessments, robust recruitment procedures and safe processes to ensure the safe administration of medicines.

Sufficient staff were available to meet people’s needs. People and relatives confirmed they received care from regular and consistent staff with whom they had established positive and caring relationships.

Staff received induction and regular training to enable them to carry out their role effectively. In addition to this, staff confirmed that they also received regular supervision and an annual appraisal which supported them in their role.

Care plans contained consent forms that had been signed by people and relatives consenting to the care and support that they received from Felicity Care. Where possible, people were encouraged and supported to make choices and express their preferences in the least restrictive way possible. Policies and systems in place supported this practise.

People were supported with their nutritional, hydration and health care needs where this had been identified as an assessed need.

Care plans were detailed and person centred and clearly outlined the person’s needs and requirements as per their choice and preference. However, we did note that the provider did not always follow a consistent approach with all care plans that we saw. Care plans did not always include records of people’s likes and dislikes as well as some background information..

People and relatives knew the registered manager and felt able to raise any concerns or complaints and were confident that these would be dealt with and resolved appropriately. However, some people and social care professionals had raised concerns about the registered managers approach when issues or concerns were raised.

The registered manager had a number of systems in place which enabled the service to assess, monitor and improve the quality of care provision. This included spot checks of staff whilst at work and customer satisfaction surveys. However, some feedback from social care professionals that had been received and feedback from one person suggested that the registered manager was not always positive in their approach.

Further information about our findings is detailed in the sections below.

Inspection carried out on 19 February 2016

During a routine inspection

We carried out an inspection of Felicity Care on 19 February 2016. This was an announced inspection where we gave the provider 48 hours’ notice because we needed to ensure someone would be available to speak with us.

Felicity Care is a domiciliary care service specialising in providing rehabilitation support to people in their own home. At the time of our inspection there were six people who received personal care from the agency.

We last inspected the service on 1 July 2014 and found that the safeguarding policy did not include details to report all allegations or incidents of abuse to the local safeguarding team or the Care Quality Commission. We also found that complaints made by relatives were not recorded by the service. At this inspection we found that the provider had now met these standards.

The service had a registered manager in place. 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.

People were protected from abuse and avoidable harm. People told us they were happy with the support received from the service. The staff member we spoke to knew how to report alleged abuse and was able to describe the different types of abuse. Staff knew how to ‘whistleblow’. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service to external organisations such as the CQC.

Risk assessments were recorded and plans were in place to minimise risks for most people.

People were supported by suitably qualified and experienced staff. Recruitment and selection procedures were in place and being followed. Checks had been undertaken to ensure staff were suitable for the role. Staff members were suitably trained to carry out their duties and knew their responsibilities to keep people safe and meet people’s needs. One staff member had not received training on the Mental Capacity Act 2005 (MCA).

The staff we spoke with was not able to tell us the principles of the Mental Capacity Act 2005 (MCA) and how this was applied. The staff told us permission was always sought when providing support.

Staff received regular one to one supervisions. Staff told us they were supported by the registered manager.

People were supported to plan their support and they received a service that was based on their personal needs and wishes. People were involved in the planning of their care.

People told us they did their own weekly shopping and were able to buy their own ingredients.

There was a formal complaints procedure with response times. People were aware of how to make complaints and staff knew how to respond to complaints in accordance with the service’s complaint policy.

Questionnaires were completed by people and their relatives about the service, which we saw were positive.

Spot checks were carried out to provide feedback to staff on areas that needed improving and this was communicated to staff.

Inspection carried out on 1 July 2014

During a routine inspection

Two inspectors carried out this inspection. The focus of the inspection was to gather evidence to answer five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

During this inspection we spoke with one person who used the service and six relatives of people who used the service. We also spoke with the registered manager, one member of office staff and three care staff.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

One person who used the service told us that they felt safe when being cared for by care staff in their own home. They also told us that staff treated them with respect and dignity. Relatives of people who used the service told us that they were confident that people living in the home were safe and had no concerns in respect of this.

The agency had a safeguarding policy. However, we found that it was not sufficiently comprehensive as it did not mention that the agency needed to report all allegations or incidents of abuse to the local safeguarding team or the Care Quality Commission.

We looked at the training records for care staff and noted that the records indicated that staff had received training in various areas which included safeguarding, health and safety and basic life support.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. We saw that the necessary employment checks had been carried out prior to staff starting work.

Is the service effective?

We spoke with one person who used the service and six relatives of people who used the service and they were generally satisfied with the care provided by the agency and felt that people’s needs had been met. One person who used the service told us, “My carer is excellent. She is understanding, polite and respectful”. One relative said, “The carer is absolutely excellent”.

Three relatives we spoke with commented on the lateness of care staff. Further, one person who used the service and two relatives told us that they experienced difficulties communicating with some carers due to a language barrier because some carers were not fluent in English.

We looked at a sample of four care records and saw that they contained assessments with details of the personal needs of people, routines and the type of care to be provided. Risk assessments were in place.

Care plans had been prepared following consultation with people who used the service and their representatives. Contracts for the provision of care services had also been signed by either people or their representatives.

We found that care plans failed to include information about people’s preferred routines, people’s interests and their likes and dislikes and we raised this with the registered manager.

Is the service caring?

People we spoke with were positive about care staff. They told us that they had been treated with respect and dignity by care staff. One person who used the service and relatives we spoke with told us that they felt comfortable around care staff.

Staff we spoke with said that they were aware that all people should be treated with respect and dignity and were able to give us examples to demonstrate how they ensured this.

Is the service responsive?

We spoke with one person who used the service and six relatives. The majority of people told us that if they had any concerns or complaints, they would feel comfortable raising them with the agency.

Relatives we spoke with confirmed that the registered manager had contacted them and had visited them to check whether they were satisfied with the quality of care received and to see whether any changes were required to their care package. One relative told us, “Someone did visit to do a review” and another said, “We have had reviews”.

The registered manager stated that telephone monitoring calls had been carried out to ensure that people who used the service or their relatives were happy with the care provided. In addition she stated that spot checks had been carried out to assess the competence of care staff and to ensure that they were carrying out tasks detailed in the care plans.

Is the service well-led?

We found that adequate arrangements were in place for monitoring and reviewing the quality of the service provided to people. A satisfaction survey had been carried out recently. Although the analysis of the results had not yet been completed, we noted that the completed forms we saw indicated that people who used the service or their relatives were satisfied with the services provided.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff meetings were held regularly and staff we spoke with confirmed this. All staff we spoke with told us that they felt able to consult the registered manager if they had concerns or queries and said that they felt supported. Staff were positive about working at the agency.

Inspection carried out on 14 January 2014

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

At the last inspection of the service on 17 October 2013 we had concerns because although the planning and delivery of care met some of the person's individual needs this did not ensure the welfare and safety of people. The provider told us they were providing personal care to one person. There was not an effective system to regularly assess and monitor the quality of service that people received. We found a lack of policies and procedures in relation to obtaining people's consent, their care and welfare and safeguarding.

At this inspection we found the provider was still providing care to one person. The person was protected against the risks of receiving care or treatment that was inappropriate or unsafe. The provider was assessing and monitoring the quality of service. However the provider’s policies and procedures did not include guidance for staff. The provider did not have a system in place to regularly review the information contained in these records and bring them to the attention of staff.

Inspection carried out on 17 October 2013

During a routine inspection

We found that the person using the service gave their consent verbally and in writing. Staff told us that they respected the person's right to refuse care or treatment.

The person’s needs were assessed and care and treatment was delivered in line with their individual care plan. The planning and delivery of care met some of the person’s individual needs but did not ensure the welfare and safety of people.

Suitable arrangements were mostly in place to ensure that people were safeguarded against the risk of abuse. Staff were aware of how to recognise abuse but some staff were not aware of how to report abuse.

There was not an effective system to regularly assess and monitor the quality of service that people receive. We found a lack of policies and procedures in relation to obtaining people's consent, their care and welfare and safeguarding. The provider had a system in place to receive complaints and comments to improve the service.