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Inspection carried out on 10 January 2018

During a routine inspection

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults, younger adults with disabilities and children. Not everyone using Adriel Care Ltd 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 this inspection there were three people receiving ‘personal care’.

This announced inspection took place on 10, 12 and 15 January 2018. We gave the service two days’ notice of the inspection site visit. We gave the service notice to ensure the manager would be available and that people could be supported to make decisions about taking part in the inspection. We received further information form the service until 12 February 2018.

There was a registered manager for the service. 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 in January 2017 we identified a breach of regulation. This breach was in respect of the robustness of recruitment systems and processes. At this inspection we checked to see if the provider had made the improvements necessary to meet the requirements of the regulation. We found that staff were recruited in a way that included appropriate checks on their employment history and their suitability to work with people who may be vulnerable.

At our last inspection we also made a number of recommendations. We recommended the provider updated their complaints process. We recommended that the provider reviewed its systems for assessing and monitoring the service. We found these recommendations had been followed. There were systems in place to ensure that the quality and safety of care people received was monitored and improved. People and staff contributed to these processes both formally and informally. People felt able to raise concerns and there was information about which agencies could handle these concerns available.

We also made a recommendation that the provider evaluated how records keeping could become more accurate, contemporaneous and more readily available. We found this recommendation had been followed. However we also identified that reporting could be more person centred and we made a recommendation about this.

Staff understood how people consented to the care they provided and encouraged people to make decisions about their lives. Care plans did not however reflect that care was being delivered within the framework of the Mental Capacity Act 2005. We highlighted this and the registered manager addressed it immediately. We have made a recommendation about this.

People were happy with their care. They felt supported to maintain their independence and were confident in the skills of the staff team. They told us staff were kind.

Staff understood people’s care needs and spoke with confidence about the support people needed to meet these needs. They told us they felt supported in their roles and had taken training that provided them with the necessary knowledge and skills. There was a plan in place to ensure staff received refresher training as deemed necessary by the provider.

People felt safe. They were protected from harm because staff understood the risks people faced and how to reduce these risks. Measures to reduce risk reflected the person’s preferences. Staff also knew how to identify and respond to abuse.

People told us they received the care and support they needed. They also told us they were supported to maintain their health by staff including support to access he

Inspection carried out on 20 January 2017

During a routine inspection

We visited the office on 20 January 2017, made telephone calls to relatives and staff on 23 January and returned to the office again on 31 December to gather further information and to give feedback. We gave three days’ notice of the inspection so we could be sure the people we needed to speak with when we visited the office on the first day were available.

The provider operates a domiciliary care agency that provides personal care to people in their own homes, as well as running an employment agency that provides nurses and care staff to fill temporary vacancies. We inspected the domiciliary care service only, as the employment agency part of the business is not regulated by CQC. At the time of our inspection it had five older people on its books, although two were in hospital.

The service had a registered manager, who was also the owner of the company. 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.

People gave positive feedback on the care they received. However, some areas required improvement to ensure people received safe, high quality care.

Staff recruitment procedures were not fully robust. Criminal records checks and checks of entitlement to work in the UK were made before staff started working for the service. Employment and character references were also obtained. However, most staff files showed gaps in employment, with no written explanation of these or a record showing they had been explored at interview. Without checking gaps in employment, there was a risk unsuitable staff would be recruited. You can see what action we told the provider to take at the back of the full version of the report.

The service’s quality assurance processes had not identified the shortcomings we found in relation to checking and recording gaps in employment. We have made a recommendation that the service reviews its quality assurance systems to ensure they are fully effective.

Following the inspection the registered manager advised us that all staff files had been corrected to include a full employment history with explanation of any gaps.

Medicines were managed safely by staff who had the necessary training and had been assessed as competent to handle medicines. Some people had staff apply their prescribed creams and ointments. Staff had clear instructions for how and when to apply these. We have made a recommendation that the service reviews how staff record the administration of prescribed creams.

There was a basic contingency plan that stated the service had access to the provider’s agency staff in the event the regular staff were ill and unable to cover calls. It did not address whether or how particular people’s visits were to be prioritised, for example visits that were time-critical because of medication. In practice, within this small service the registered manager and office staff had a good understanding of people’s circumstances, including any time-critical visits. We have made a recommendation that the service reviews its contingency plan.

Complaints and concerns were encouraged, investigated thoroughly and responded to in good time. A relative told us, “If I have a query or a complaint they’re on to it straight away”. However, the service’s complaints policy incorrectly referred people to CQC if people were not happy with the way their complaint was handled. This is incorrect, as CQC has no power to follow up individual complaints, although it values hearing about people’s experiences of services. We have made a recommendation regarding updating the complaints policy.

The service had identified that keeping accurate, complete and readily available records had not been its strength. Following a commissioners monitoring visit duri

Inspection carried out on 31 October 2013

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

At our previous inspection in June 2013 we made a compliance action about staff recruitment. The agency had not ensured that a full employment history was obtained from care workers. The provider wrote to us following the inspection to tell us the action they would take.

At this inspection, we made an announced visit to the agency and checked staff recruitment files. We found that appropriate steps had been taken to ensure there was detailed information on care workers previous employment.

Inspection carried out on 3, 4 June 2013

During a routine inspection

Adriel registered with the CQC in November 2012 and has started to build a client base. We visited one person in their home and reviewed their care plan. We also spoke with the person's relative. Both of these people were happy with the service provided and said they had "no complaints". They considered that they had been involved in the assessment and care planning process. Their views on how support should be given and at what times had been taken into consideration when visits were organised.

We found that the person's plan clearly set out how support should be provided and included details of what they were able to do themselves. People confirmed support was given as detailed in their plan.

Staff were recruited according to a set procedure. However, we found that there were some gaps in information of staff's previous employment. Relevant checks such as Criminal Records Bureau and Disclosure and Barring Service checks had been made. References had been obtained from previous employers when staff had worked in care settings.

All staff were given induction training, which they confirmed met their needs and enabled them to support people appropriately. The provider was in the process of developing ongoing training to ensure staff were competent to carry out their role.

The provider had a statement of purpose that set out the aims and objectives of the service, the regulated activity and type of service provided.