We carried out an inspection of 360 Degrees Health Care and Rehabilitation Services Limited on 6 and 7 December 2016. We gave the service 48 hours’ notice to ensure the registered manager would be available when we visited.

360 Degrees Health Care and Rehabilitation Services Limited is a domiciliary care agency. The service provides personal care and support to older people, younger adults, people living with dementia, people with mental ill health, physical disabilities, a sensory impairment or substance misuse issues. The agency’s office is located in Nelson in East Lancashire. At the time of our visits the service was providing support to 41people.

At the time of our inspection there was a registered manager at the service who had been the acting manager since July 2016 and had registered with the Care Quality Commission on 25 November 2016. 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 on 15 and 16 February and 25 April 2016, we found four breaches of our regulations relating to a lack of care plans and risk assessments in people’s homes, lack of effective staff induction and training, lack of effective audits of quality and safety and unsafe staff recruitment. During this inspection we found that improvements had been made and all of our regulations were being met.

During our inspection people told us they received safe care. Staff had a good understanding of how to safeguard people from abuse and what action to take if they suspected that neglectful or abusive practice was taking place.

We saw evidence that staff had been recruited safely. They received an appropriate induction, effective training and regular supervision. Staff told us they felt well supported by the registered manager and could request additional training if they needed it.

We found that recent improvements had been made to the management of people’s medicines and people told us they received their medicines when they should. People were supported with their healthcare needs and were referred to healthcare professionals when appropriate. We received positive feedback from community healthcare professionals involved with the service.

People told us they were happy with the service they received. They told us staff arrived on time and stayed for the full duration of the visit. People told us they were involved in planning their care. Where people lacked the capacity to make decisions about their care, their relatives were involved.

People told us the staff who supported them were caring and respected their privacy and dignity. They told us staff encouraged them to be independent.

Staff supported people to make everyday decisions about their care and support, such as what they wore and what they had to eat at mealtimes.

People were asked regularly to give feedback about the service they received. The people we spoke with and their relatives, expressed a high level of satisfaction with the standard of care and support being provided.

People told us they were happy with the way the service was being managed and they felt able to raise any concerns.

Records showed that staff practice was observed regularly and checks were made of the care records they completed. We found evidence that where improvements were identified as necessary, appropriate action was taken to ensure that appropriate standards of care and safety were maintained.

We carried out an inspection of 360 Degrees Health Care and Rehabilitation Service Limited on 15 and 16 March and 25 April 2016. This was the first inspection that had been carried out at this service.

360 Degrees Health Care and Rehabilitation Service Limited is a domiciliary care agency. The service provides care and support to people with a variety of needs including older people, younger adults, people with a learning disability or autistic spectrum disorder, people with mental health issues, a physical disability, sensory impairment and people living with dementia. The service is based in Nelson in East Lancashire. At the time of the inspection the service was providing support to 61 people.

At the time of our inspection 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. There was an acting manager in post who told us she had recently submitted an application to the Commission to become the registered manager for the service. We checked our records and found that an application had been received. However, this had been rejected on 17 March 2016 as it contained incomplete information and a further application had not been received.

During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the failure to recruit staff safely, failure to ensure staff had the competence, skills and experience to provide people with safe care and failure to ensure that staff had access to information in people’s homes about their needs and risks. There was also a failure to assess, monitor and improve the quality and safety of the service. We found that staff were recruited without the necessary checks being completed and without references being received from their previous employers. In addition, two staff members were providing care and support to people without having received an induction and appropriate training when they joined the service. Care plans and risk assessments were not available to staff in people’s homes and the service did not have effective processes in place to monitor the quality and safety of care being provided. You can see what action we told the provider to take at the back of the full version of the report.

During our visits on 15 and 16 March 2016, we found that safe recruitment practices were not followed when the service employed new staff. Applicants were not required to provide a full employment history, references were not always sought from an applicant’s most recent or current employer and appropriate checks were not carried out. We discussed this with the manager who assured us that safe practice would be followed in the future.

When we visited the service again on 25 April 2016, following further concerns we had received about unsafe recruitment practices, we found that improvements had not been made. Staff were providing care prior to appropriate checks having been completed.

People who used the service and their relatives told us that care plans and risk assessments were not always available in the home. This meant that staff did not always have access to information about people’s needs and risks and how to manage them.

We found that staff did not always receive an induction and appropriate training when they joined the service, before they provided support to people. This meant that the provider could not be sure they had the competence, skills and experience necessary to provide people with safe care and support.

The people we spoke with told us they felt safe when staff supported them. One person said, “I always feel safe when the staff are helping me. I need help from two