Cayon Care Service

The inspection took place on 14 February 2018 and was unannounced.

The registered provider had registered with the Care Quality Commission. The registered provider was not required to have a registered manager in place and they had chosen to manage the service as a 'registered person'. 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 the last inspection we rated the service requires improvement. At this inspection we found improvements had been made to support an overall rating of good with the key question of safe rated as requires improvement. This was because the provider had failed to display their current inspection ratings on their website and at their registered office. This is a legal requirement to show people had access to the ratings to inform their judgments about services.

Staff took knowledge from their training, [which was an area of improvement since our previous inspection], to reflect their understanding in how to report concerns about potential abuse, and when it was needed, knew how to take action to make sure people were protected from harm.

A person who used the service commented they received the care they needed from staff to feel and be as safe as possible within their home. The person valued the same regular staff who supported them to meet their needs at the agreed times and were flexible if changes were required.

Improvements had been made to the processes in place to reflect the person's up to date care needs with any potential risks to them and staff identified to guide staff practices in reducing avoidable harm. Environmental risks were also assessed within the person's home to help avoid any potential accidents to the person who used the service or staff. Staff understood their responsibilities in reducing the spread of infections whilst undertaking their caring roles.

The registered provider showed us they had made sure following our previous inspection their recruitment arrangements were strong so people were not at risk from being supported by unsuitable staff. Staff had received further training following our previous inspection which matched the needs of the person who used the service.

The organisation of staff rotas showed the person who used the service had regular staff who they had

formed relationships with and who knew their particular needs. Staff were supported by the registered provider and deputy manager to help them carry out their roles which included direct checks of their care practice.

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. The person who used the service told us they were involved in decisions about their day to day care.

The registered provider had made sure following our previous inspection their processes to support people where required with their medicines had been developed. People would only require support to take their medicines if this was part of their care service.

The person felt staff understood their care needs and wishes and these were followed by the regular staff who provided support. Where the person required support with their meals and drinks this was provided by staff who followed the person's preferences.

Daily care records reflected when staff support was provided and the improvements in care plans matched the person's needs. The registered provider and deputy manager had developed their processes to assist them in gaining an oversight of the care and support provided including any aspects which required improving.

The person said their regular staff knew them well and used their knowledge to respond to their needs in the right way and at the right time. People were supported to access healthcare services when required and staff were aware of people's health needs.

Staff knew what was important to the person who used the service and had learnt over a number of years how the person liked to be supported with their care which included respecting the person's privacy, dignity and independence.

We saw there were processes in place to manage any complaints or concerns received. We also saw the person who used the service had been encouraged to let staff or the registered provider know what they thought of the care they received and comments made had been positive.

The registered provider was supported by the deputy manager and together they had developed their quality checking processes. Checks had been undertaken on the quality of care provided, so they could be assured people were receiving good care and on this basis expand the service.

The five questions we ask about services and what we found