This announced inspection took place on 29 October 2018.

At our last inspection on 24 August 2017 we found a breach of the regulations in safe care and treatment. This was because the provider did not have an effective system to assess the risks to people using the service and did not have measures in place to minimise the risk to people.

Following the last inspection, we asked the provider to complete an action plan to show what they would do by November 2017 to improve the key questions safe and well-led to at least good. At this inspection we found the provider had improved their risk assessment process. However, there were still some risks that were not fully assessed and guidance was not always provided to staff.

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 people with a range of needs including older adults, some of whom were living with dementia, people with a learning disability or autistic spectrum disorder and people with mental health needs.

Not everyone using The Winning Box received a 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 consider any wider social care provided. At the time of our inspection ten people were receiving a service from The Winning Box, nine of whom received a service of personal care.

There was a registered manager in post who was also the owner of the business. 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.

Staff had received medicines administration training but we found one person was being supported with their medicines when their care plan had not addressed the support the person required with their medicines.

Furthermore, at the last inspection not all care plans were person centred. Once again, although work had been undertaken to address this, it was not completed at the time of our inspection. As such people’s diverse support needs were not specified and there was no background information to place people in the context of their life.

The registered manager audited people’s records and had identified shortfalls. However, these had not been addressed in a timely manner.

We identified two breaches of regulations. These were in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager audited daily communication records to ensure all safeguarding adult concerns were reported appropriately. Care workers demonstrated they knew how to recognise and report abuse.

The registered manager had attended training to support them to work in line with the Mental Capacity Act 2005. They understood the need to ensure people’s representatives had the legal authority to make decisions on their behalf.

The provider recruited staff following their recruitment procedures and recruited enough staff to meet people’s care needs. People and relatives told us that care workers usually attended calls in a punctual manner. They described care workers as, “good” and “very caring,” and often had the same familiar care staff to work with them or their family member.

Care workers had received infection control training and were provided with personal protective equipment to avoid cross contamination in people’s homes.

The registered manager told us how they were learning as they grew and were reviewing their systems and documentation to ensure they offered a quality service to people. They were working with a consultancy company to support the

This inspection took place on 24 August 2017 and was announced. We gave the provider 48 hours’ notice of the inspection as this is a domiciliary care agency and we wanted to ensure the manager was available in the office to meet us.

Invicta Care and Training Ltd is a domiciliary care agency who is registered with the Care Quality Commission to provide personal care to adults who require support. The service was registered on the 17 November 2016 and has not been inspected before. At the time of inspection, the service was offering personal care services to two people.

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.

People’s relatives spoke very positively about Invicta Care and Training Limited staff and the registered manager. Relatives described staff as very caring and kind.

However, we found the provider was not undertaking robust risk assessments when there was a risk to people’s safety so appropriate plans could be put in place to mitigate risks. Therefore, we found a breach of the regulations with regard to safe care and treatment.

We found that whilst care plans were clear about the tasks to be undertaken during each care call there was a lack of detail for staff about how the person wanted the care undertaken to fully reflect their wishes and preferences.

The provider had recruited sufficient staff to meet the needs of the people they supported and to ensure they could provide cover in an emergency or to cover a new package of care. The provider recruited staff in a safe manner.

Staff were provided with induction training to ensure they were equipped to carry out their duties appropriately. Staff shadowed the registered manager providing care prior to commencing their role and were introduced to the people they were going to provide care to.

The service worked within the principles of the Mental Capacity Act 2005. 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 agency supported this practice.

Relatives confirmed they had been involved in people’s care planning and the person’s individual history and aspirations were contained in the care plan for staff to learn about the person.

The provider had a complaints policy and procedure. This was contained in the service user guide for people’s reference. The registered manager described clearly how they would investigate complaints and address them speedily.

The registered manager had systems and processes in place for communication with people, relatives and their own staff, and for monitoring the quality of the service provided. However, the systems had not identified the areas for improvements we found so the provider could address these.

The provider acted on feedback they received to improve the service. The commissioning body had visited the service, and the provider and registered manager had made changes to their systems following the visit demonstrating that they were working in partnership.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.