About the service: 370a Marsh Lane is a domiciliary care agency, providing personal care to people in their own homes. The service also provides accommodation and support to people over three properties but they are not in receipt of a regulated activity. This inspection only looked at the support provided to the eight people who received a regulated activity.

People’s experience of using this service:

At the last inspection in December 2017, we found the provider to be in breach of Regulation as safe recruitment practices were not always adhered to. At this inspection we found that some improvements had been made, but not all staff files showed that the safe recruitment practices had been followed. The provider was still in breach of Regulation regarding this.

A system of checks on the quality and safety of the service were undertaken by the management team. However, these could be further developed to include practical supervision sessions (spot checks) with staff to ensure they continue to provide a good service to people. The checks in place did not identify all the issues we raised during the inspection, such as those relating to staff recruitment, environmental risk management and recording of consent. We made a recommendation about this in the main body of the report.

Staff were knowledgeable regarding the MCA and told us they always asked for people’s consent before providing care. People told us they were happy with the care they received and took part in regular reviews of the care. However, there was no evidence that people had formally consented to the plans of care in place. We made a recommendation regarding this is the main body of the report.

Risks to the environment had not been assessed by the provider. Individual risks to people had been assessed and measures were in place to mitigate those risks. People told us they felt safe when staff were in their home as they knew the staff and had built good relationships with them.

There were sufficient numbers of staff to support people’s needs. Although staff were not allocated travel times between the calls on their rotas, calls were allocated in a small geographical area to enable staff to get to people without delays.

When people required support with their medicines, records of administration were maintained and most of these records were completed accurately by staff who had been trained in the safe administration of medicines.

Staff were provided with training to ensure they knew how to manage safeguarding concerns and records showed these were managed well. A system was in place to record any accidents and incidents that occurred in people’s homes. Incidents were reviewed for any themes or tends to help prevent recurrence.

Staff were competent, knowledgeable and skilled and carried out their roles effectively. They received regular supervisions and felt supported in their roles. The provider encouraged staff learning and development and several staff were undertaking additional qualifications. The provider worked in partnership with other agencies to continually learn and share best practice.

People using the service told us staff were kind and caring and treated them with respect. Staff spoke about people they supported with warmth and compassion and it was clear that staff knew the people they supported well. People’s dignity, privacy and independence was promoted by staff when providing support.

People were involved in regular service reviews, where they could share their views about the support they received and any changes they felt were necessary. The management team demonstrated a commitment to provide person-centred, high-quality care by engaging with everyone using the service, their relatives, staff and other stakeholders.

People’s individual needs in relation to their care and treatment had been assessed and plans of care developed based on their needs and preferences. Care plans were reviewed regularly and people were involved in th

The inspection took place on 14, 15 and 16 November 2017 and was announced. This is the second consecutive time the service has been rated Requires Improvement.

Our last inspection of Liver Care Ltd took place in October 2016. During this inspection we found the service was in breach of regulations relating to need for consent, safe care and treatment and the governance of service. The service was rated as Requires Improvement. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Are services Safe, Responsive and Well Led? to at least good. We checked this during this inspection and found the required changes had been made.

During our last inspection in October 2016 we found the service in breach of regulations relating to ‘Need for consent’. We found that consent was not always sought in line with the Mental Capacity Act 2005. We checked this during this inspection and saw that the registered manager had Implemented new documentation which contained consent forms that people receiving a service had signed.

Also at the last inspection in October 2016 we found the service in breach of regulations relating to safe care and treatment. This was because risks were not always assessed as part of people's plan of care. We checked this during this inspection and saw that the registered manager had implemented new documentation which contained risk assessments and found they had been completed during the initial assessment and reviewed during the service review.

At the last inspection in October 2016 we found the service in breach of regulations relating to governance. This was because we found quality assurance procedures were not in place to help prevent people from being exposed to potential risk. We checked this during this inspection and saw that the registered manager had introduced a new checking and auditing system which helped ensure people received support which met their needs and kept them safe. The new checking and auditing system helped assure managers that staff had administered medication safely and people's support was still meeting their needs.

Liver Care is a domiciliary care agency based in Bootle, Merseyside. It provides personal care to people living in their own houses in the community, mainly in the Liverpool area. It provides a service to older adults. At the time of our inspection 25 people were receiving domiciliary care services from Liver Care.

Not everyone using Liver Care receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

There is a registered manager at the service. 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 provider had recruitment procedures in place. However application forms did not show people’s employment history. This was immediately rectified during the inspection. References from previous employers had not been requested for one staff member to ensure they were suitable to work with vulnerable adults. Each staff member had an up to date DBS check.

People told us they felt safe when being supported by the Liver Care staff. Care staff we spoke with had a good understanding of how to keep people safe in their own home. Assessments were reviewed regularly to help ensure any changes in people's needs were reassessed so they received the appropriate care and support.

Staff were trained to ensure that they had the appropriate skills and knowledge to meet people's needs. They were well supported by the registered manager.

Medication was administered safely by suitably trained staff and was recorded correctly.

This announced inspection took place on 30 September and 1 October 2016.

Livercare is a domiciliary care agency based in Bootle, Liverpool. The service provides personal care to people in their own homes. At the time of our inspection six people were receiving domiciliary care services from Livercare. This was the services first inspection.

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.

We saw that there were some risk assessments in place to help keep people safe from harm; however, not all identified risks had been assessed.

During our inspection we saw that records relating to mental capacity were not completed Management and staff had some knowledge of the principles of the Mental Capacity Act (2005), but were unclear about how to apply it.

Staff were recruited appropriately, however some people did not have a copies of identification in their files, although they had produced identification at the time of interview. We raised this with the registered manager at the time and they took immediate action to address this.

There was a lack of governance systems and quality assurance procedures appropriately documented in the service. The registered manager informed us people were often called and asked for feedback with regards to their care packages, and people did confirm this took place, however there was no formal procedures or feedback documented. The registered manager has since sent us a quality assurance document appropriate for the size of the service that they plan to use and this has been implemented.

Everyone we spoke with told us they liked the staff and felt safe knowing they received their care from Livercare. Staff were able to explain what action they would take if they felt someone was being harmed in any way.

There was enough staff to keep people safe, and people told us that they saw the same faces and staffing was never a problem.

There was nobody receiving medications at the time of our inspection. Everyone had chosen to self-administer their own medications, however, the registered manager had sourced training for staff in case people’s needs changed and support was needed with medicines.

Staff training was delivered in house by an external training company and covered all mandatory subjects in accordance with the providers training policy. Staff induction was in line with the care certificate, and staff told us they completed shadowing before they worked on their own.

People told us that staff took time to ensure they had eaten and prepared them meals when necessary and if required to do so.

We saw that appropriate referral’s to other medical professionals had been made when necessary on behalf of people using the service.

Everyone we spoke with told us they liked the staff, and felt they treated them with kindness and compassion. Staff we spoke with were able to describe how they protected people’s privacy and dignity.

People told us they received good care and were involved in their care plan and any decisions about their care or support.

Care plans contained some information about people’s likes, dislikes and preferences. Care plans contained explanations of people’s daily routines.

There was a complaints procedure in place, records showed that there had been no formal complaints recorded. People we spoke with told us they knew how to complain.

People knew who the registered manager was and was complimentary about the management team in general.

During this inspection, we found three breaches of the Health and Social Care Act 2008. The provider has since sent us a detailed plan of action to address these concerns. You can see the action we