Flexecare Preston

A registered manager was 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

At the last inspection on 04 September 2017, we rated the service as requires improvement. This was because we found a breach of legal requirements. The registered manager did not ensure people's needs were properly assessed before a package of care was arranged. Not all support plans were detailed and held person-centred information. We further made recommendations about safe recruitment; sufficient risk management records; documenting of consent; review of their complaints policy; service user guidance information; and effective quality assurance auditing.

During this inspection, we saw the provider had made improvements to recordkeeping and their care planning systems. They recognised assessing people before taking on packages of care maximised the potential for the service to meet their needs. We found care planning was detailed and followed a person- centred approach. When we discussed this with staff, we found they had a good level of awareness. One staff member commented, "I always ask myself, 'how would I want to be treated?' I have that bond and it hurts me if something goes wrong or if a service user is hurting." People and their relatives were complementary about the responsiveness of care delivery. A relative told us, "I am so happy about the care [my relative] receives that I would have no hesitation recommending it to anyone else."

When we discussed safety with people and relatives, we were told this was consistently maintained by H & S Direct Solutions. One relative commented, "At every twist and turn they've been wonderful." Staff we spoke with demonstrated a good level of awareness about protecting people from poor practice or abuse.

The management team now followed safe recruitment procedures to ensure staff were suitable to work with vulnerable adults. We saw staffing levels matched each person's requirements to maintain continuity of care. A relative told us, "All the carers know [my relative's] routines and the communication is very good. It reassures us that she is safe and happy."

We found care records included risk assessments that detailed each person's independence level, risk factors, control measures and action to support them. All records were signed by people who used the service and staff to ensure their understanding of protocols to mitigate risk. The registered manager reviewed accidents and incidents and had systems to reduce risks to people.

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. We discussed the principles of the MCA and consent with staff and found they had a good awareness. A staff member said, "It's not taking over and about always taking their consent."

We saw information made available to people about raising concerns had been improved. Those we spoke with told us they found the provider being responsive to their minor complaints. One relative said, "We experienced them as being very flexible and respectful. They did precisely what we asked them for in response."

The registered manager had made required changes to their service user guide to provide correct details to people about the support they received. Additionally, new audits were implemented with measurable outcomes and actions taken to mitigate risk to people and staff. We saw examples of the registered manager addressing identified concerns to maintain everyone's welfare.

We observed, where applicable, staff administered people's medication in their own homes safely. They signed records on completion of procedures to evidence each person had taken their medicines. The management team provided training to ensure they had good levels of awareness.

When we discussed staff effectiveness with people they said they were well trained and skilled. Staff files we looked at evidenced they had guidance to carry out their duties confidently and competently. One staff member said, "It's good training that helps me to do my job effectively."

Care documentation included an evaluation of associated risks and measures to reduce the potential of malnutrition. People and their relatives confirmed they could choose what they wanted to eat and had ample meal portions.

We found H & S Direct Solutions had a strong focus on meeting people's diverse and cultural needs. Those who used the service and their relatives told us the management team checked whether staff respected their customs and traditions. Care records evidenced people and their relatives were fully included in their support planning.

We saw staff were respectful when they interacted with people and consistently maintained their privacy and dignity. A relative stated, "[The staff member's] a lovely girl. She knows how to talk with us. It's not patronising and she chats on our level. She understands what it likes to get old."

The service worked in partnership with other organisations to ensure they followed good practice and people in their care were safe. When we discussed the leadership of H & S Direct Solutions, we received complementary comments from staff, people who used the service and their relatives.

The five questions we ask about services and what we found