Handle with care Coventry and Warwickshire

At the last inspection in December 2015, the service was rated Good. At this inspection we identified improvement was required in the management of the service. The overall rating remains Good.

Since our last inspection we have reviewed and refined our assessment framework, which was published in October 2017. For this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

The office visit took place on 30 January 2018 and was announced. We told the provider we were coming so they could arrange to be there and arrange for staff to be available to talk with us about the service.

The service did not have 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 registered manager left the service in September 2017. The provider had appointed another manager who had applied to be registered with us.

This was the first senior management role for the new manager, who had previously been a care co- ordinator in the service. The manager acknowledged they needed to develop their skills in relation to quality monitoring, and driving improvements for the service, as well as their understanding of the responsibilities of a registered manager. The manager was confident they would receive the guidance and support from the provider to effectively develop these skills.

There were procedures in place to keep people safe and manage identified risks to peoples care. People felt safe using the service and staff understood how to protect people from abuse and harm. People who required support to take medicines received these from staff that had been trained to administer them. The provider conducted pre-employment checks prior to staff starting work, to ensure they were suitable to support people who used the service. Staff used protective clothing, such as disposable gloves and aprons when providing personal care, to reduce the risk of infection being passed from one person to another.

People had an assessment completed at the start of their service to make sure staff could meet people's care and support needs. There were enough trained and experienced staff to provide the care and support people required.

The managers and staff followed the principles of the Mental Capacity Act (MCA). Staff respected decisions

people made about their care and gained people's consent before they provided personal care.

People told us they received care from staff they knew, and who were kind and friendly. People said staff treated them with dignity and respect. Staff we spoke with knew the people they visited very well and spoke about people in a caring and considerate manner.

People said care staff usually arrived around the time expected and stayed long enough to provide the care outlined in their care plan. Care plans provided information for staff about people's care needs and the details of what they needed to do on each call.

People's care needs were regularly reviewed. The managers and office staff were in regular contact with people, or their relatives, to check the care provided was what people needed and expected. People knew how to complain and information about making a complaint was available for people. People knew who the managers were and felt they listened to them and dealt with any concerns they had.

Staff felt supported to do their work effectively and said the managers and provider were approachable and available. There was an 'out of hours' on call system, which ensured support and advice was always available for staff.

The provider's quality monitoring system included asking people for their views about the quality of the service. This was through telephone conversations, visits to people to review their care and satisfaction questionnaires. The management team checked people received the care they needed by observing staff during visits to people and through feedback from people and staff.

There was a programme of other checks and audits which the provider used to monitor and improve the service. We found procedures to ensure the service was effectively managed were not always implemented consistently or sufficiently robust to ensure people always received safe, effective care.

The five questions we ask about services and what we found