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Inspection carried out on 6 February 2018

During a routine inspection

This was an announced comprehensive inspection carried out on 6, 7, and 21 February 2018.

At the last inspection in November 2016, we found people were not protected against the risks associated with medicines because the provider did not always have appropriate arrangements in place to manage medicines. 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, safe and well led to at least good. At this inspection we found the provider had made the required improvements.

Ethical Homecare Solutions provides a domiciliary care service to adults and older people with varying needs and disabilities living within the Leeds area. The office, based in the Chapeltown area of Leeds is staffed Monday to Friday during office hours. An out of hours phone service is also available. At the time of this inspection the service was providing the regulated activity of personal care to 31 people who lived in their own homes. The service is provided to younger adults, older people, people living with dementia, people who may have a learning disability or autistic spectrum disorder, mental health issues and physical disabilities. Not everyone using Ethical Homecare Solutions 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.

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 feedback we received from people was very positive throughout. People who used the service spoke highly of all staff and services provided. One person told us, "The whole experience has been first class, I couldn't have wished for a better team of people to care for me."

People's medicines were managed safely. The safety of people who used the service was taken seriously and the registered manager and staff were aware of their responsibility to protect people's health and wellbeing. There were systems in place to ensure that risks to people's safety and wellbeing were identified and addressed and lessons were learnt to ensure problems or mistakes were not repeated.

The whole staff team were highly motivated and proud of the service. The registered manager told us, "We have recruited some really special people who share our values of being trustworthy and caring and who recognise that dignity, respect and integrity are at the heart of what we do."

People were encouraged to be as independent as possible by staff they trusted and felt safe with. They were supported to lead as good a quality of life as possible. The service supported people to access activities which were meaningful to them. People's wellbeing, privacy, dignity and independence were respected and encouraged.

People were never rushed and staff took the time to support them in the right way. People who used the service valued the relationships they had with staff and expressed satisfaction with the care they received. There was an effective complaints procedure in place and people told us they knew how to complain.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had received training on the Mental Capacity Act 2005. They ensured people were asked for their consent before they carried out any care or support.

People were cared for by staff who were aware of their safeguarding responsibilities. Staff had received training in how to safeguard people

Inspection carried out on 23 November 2016

During a routine inspection

This was an announced inspection carried out on 23 and 24 November 2016. At the last inspection in June 2015 we found systems and processes to ensure people were safeguarded against the risk of abuse were not operated effectively and it was not clear if the rights of people who lacked the mental capacity to make decisions were respected as mental capacity assessments had not been carried out where needed. We told the provider they needed to take action; we received an action plan. At this inspection in November 2016 we found the provider had made the required improvements.

Ethical Homecare Solutions provides domiciliary care services to adults and older people with varying needs and disabilities living within the Leeds area. The office, based in the Chapeltown area of Leeds is staffed Monday to Friday during office hours. An out of hours phone service is also available.

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 and associated Regulations about how the service is run.

People who used the service and their relatives felt they or their family member were safely looked after and had no current concerns.

We found the systems in place to manage and monitor people’s medication were not robust and there was a risk people may not receive their medication as prescribed which could affect their health and welfare.

People had plans in place to manage risks, which staff understood and followed. Staff could recognise abuse and knew what action to take to keep people safe. There were procedures in place to ensure any allegations of abuse were reported and acted upon.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 and we saw decision specific mental capacity assessments had been carried out where needed. Staff had a good understanding of promoting choice and gaining consent from people.

There were sufficient numbers of staff to meet people’s needs and keep them safe. We found people were provided with care and support by staff who had the appropriate knowledge and training to effectively meet their needs. Staff told us they felt well supported and received regular supervision. Robust recruitment processes were in place and were followed.

People were treated with dignity and respect by staff. Staff knew people well and were able to describe how individual people preferred their care and support delivered. The care plans we looked at were person-centred and reviewed on a regular basis to make sure they provided accurate and up to date information on meeting people’s needs as individuals.

People were supported to maintain their health and were supported with a balanced diet when this support was needed.

People we spoke with were aware of how to make a complaint and felt they were listened to. There were procedures in place to ensure the provider responded appropriately to any complaints they received.

The registered manager worked with the team of staff, monitoring and supporting the staff to ensure people received the care and support they needed. Staff spoke highly of the registered manager. There were systems in place to monitor and improve the quality of the service provided. However, the registered manager was unable to fully demonstrate how the service managed the administration of medicines safely.

We found the service was in breach of one regulation 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 and 24 June 2015

During a routine inspection

This was an announced inspection carried out on 19 and 24 June 2015. At the last inspection in July 2013 we found the provider met the regulations we looked at.

Ethical Homecare Solutions provides domiciliary care services to adults and older people with varying needs and disabilities living within the Leeds area. The office, based in the Chapeltown area of Leeds is staffed Monday to Friday during office hours. An out of hours phone service is also available.

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 and associated Regulations about how the service is run.

Records we looked at showed that staff conduct issues had been addressed and investigated as concerns and complaints. They had not been recognised as safeguarding matters and therefore not reported to the local authority or CQC. This did not safeguard people from the risk of abuse.

In the care plans we looked at they showed that people had not received an appropriate and decision specific mental capacity assessment which meant the rights of people who lacked the mental capacity to make decisions may not be respected.

Overall, recruitment procedures were effective. However, some staff had commenced work (under supervision) without the provider having completed an up to date status check on their Disclosure and Barring Service check. Arrangements had been made to rectify this to make sure people were protected.

Most people told us they or their relative felt safe using the service. The majority of people said their call times were adhered to but some people said staff who relied on public transport were often late and then rushed to meet their needs. The majority of people told us they were happy with the support they received from care workers and got on well with them. People who used the service spoke highly of the registered manager and said they were approachable.

Staff were trained to assist or prompt people with their medication. They said they felt confident to deal with any emergencies if they arose. There were systems in place to ensure people’s nutritional and hydration needs were met.

Staff had had induction training before they commenced work unaccompanied. They said they felt well supported by the registered manager and had opportunity to discuss their job role. Staff said they received good training to enable them to carry out their job effectively.

The registered manager investigated and responded to people’s complaints, according to the provider’s complaints procedure.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made if needed.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans included risk assessments. However, we suggested some improvements were needed to care plans and risk management plans to ensure they gave staff detailed guidance on meeting people’s needs.

People told us they had good relationships with staff members and staff knew how to respect their privacy and dignity.

We found the service was in breach of two of the regulations 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 2 July 2013

During a routine inspection

We spoke with four people who used the service or their relatives. They all spoke highly of the care provided for themselves or their family member. They said they were treated very well. Comments included:

“The care I get is very good, very much so.”

“We are really happy with the service, they are so reliable.”

People who used the service also said they got the help they needed with their medication. We saw that staff were trained to administer medication and spoke confidently of the systems in place to ensure medication was administered safely and correctly.

People were complimentary of the staff and said they found them to be professional, respectful and well trained. One person said, “I have every confidence in them, they are very well trained.” Another person said, “The manager expects high standards and that’s what we get.”

There were effective quality monitoring systems in place, which included people giving feedback about their care, support and treatment. We saw the manager acted upon suggestions made. We also saw that comments and complaints people made were responded to appropriately.

Inspection carried out on 28 August 2012

During a routine inspection

People who use the service were not able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service. This included talking with representatives of people who used the service, looking at records and looking at information on a care directory website.

Representatives of people who used the service told us they were happy with the service received. They said they got regular care workers who were always introduced to them before they began providing the care. They said they were prompt and punctual and always stayed the agreed length of time for their visit. One representative said, “Very obliging and flexible.” another said, “They follow my advice, provide high standards of care, I feel involved and listened to.”

We looked at comments from people who used the service that were on the care directory website. These were very complimentary of the service and the staff. One person had said, “Carers were caring, compassionate and professional.” Another had said, “They met my needs, I had no fears whatsoever.”

We saw records at the agency that showed people who used the service and their representatives were involved in developing their own plans of care.

Representatives of people who used the service had no concerns over the safety of their relatives. They said they felt they were “In good hands” and were reassured by the professionalism of staff and the manager.