We carried out the inspection on 5 January 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.

The service was last inspected on 17 February 2016. During the last inspection the provider was found not to be meeting a regulation. This was in relation to how the service was run and the quality of how the service was monitored. We asked the provider to implement changes to ensure that they met the regulations. At this inspection we found that the necessary action had been completed and improvements had been made.

The service is a domiciliary care agency that provides personal care to people in their own homes. At the time of our inspection19 people used the service. The service is also registered to provide accommodation and personal care at 8 Wyndham Close and treatment for disease, disorder or injury (TDDI). Since its registration in January 2015 the service has not provided TDDI or accommodation and personal care to people at 8 Wyndham Close. Therefore we did not inspect these aspects of the service.

The service had a registered manager. However they had not been active in the service for some time. The provider had informed us of this via a statutory notification and had ensured suitable management cover was in place. At the time of our inspection the nominated individual was in the process of applying to become the registered manager. 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 were protected from harm. People told us they felt safe and that staff met their needs. There was a recruitment policy in place which the provider followed. We found that all the required pre-employment checks were being carried out before staff commenced work at the service.

Risks associated with people’s care were assessed and managed to protect people from harm. Staff had received training to meet the needs of the people who used the service. People received their medicines as required. Medicines were administered safely by staff who were appropriately trained and competent to do so.

Staff had received training and supervision to meet the needs of the people who used the service. Staff told us that they felt supported. Their competence to do their role was regularly assessed.

People made decisions about the care and the support they received. People’s consent was sought and respected. The provider understood their responsibility to ensure people were supported in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People’s nutrition and hydration needs were assessed and met. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People’s independence was promoted and people were encouraged to make choices. Staff treated people with kindness and compassion. Dignity and respect for people was promoted.

The care needs of people had been assessed. Staff had a clear understanding of their role and how to support people who used the service. People contributed to the planning and reviewing of their care.

People could be assured that staff would arrive at agreed times to provide their care and support. The provider monitored call times to ensure that people received their care when they should.

People were supported to pursue their interests and access the community.

Complaints were addressed in line with the provider’s policy. People were encouraged to give feedback about the service they received.

People and staff felt that the provider was approachable and action would be taken to address any concerns they may have.

Sys

We carried out the inspection on 17 February 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available. This was the first inspection of the service since it registered in January 2015.

The service is a domiciliary care agency that provides personal care to people in their own homes. At the time of our inspection 13 people used the service. The service is also registered to provide accommodation and personal care at 8 Wyndham Close and treatment for disease, disorder or injury (TDDI). Since registration in January 2015 the service has not provided TDDI or accommodation and personal care to people at 8 Wyndham Close. We did not inspect these aspects of the service.

The service had a registered manager. 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 registered manager had not ensured that systems or processes were in place to assess, monitor and reduce risks relating to the health, safety and welfare of people using the service. Accurate and complete records had not been maintained. This is a breach of Regulation 17 of the Health and Social Care Act (RA) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Staff understood their responsibility to keep people safe from harm and risk of abuse.

The service did not follow safe recruitment processes. We saw that there were occasions when the relevant pre-employment checks had not been carried out. The registered manager had not followed robust disciplinary processes.

Some people who used the service had their medicines administered by staff. People told us that they were happy that their medicines were being administered correctly and this was being recorded. However the medicines that people received were not clear in their care plans and medication systems were not monitored.

Risks associated with providing care for people in their own homes had not been formally assessed. Where people’s conditions put them at risk of harm or their conditions deteriorated these had not been adequately assessed and measures had not been put in place to reduce the likelihood of harm.

People could not be assured that they would receive the care that they needed at the agreed times or for the agreed amount of time.

Staff had not received training prior to providing support to people to ensure that they could meet the needs of the people who used the service. Staff told us that they felt supported but they did not always receive formal supervision in line with the provider’s policies. Supervision records did not consistently indicate if training or support needs were discussed.

Where people were likely to lack capacity to consent to aspects of their care and treatment, assessments had not been completed. Best interest decisions had not been made. Staff lacked knowledge and understanding of the requirements and their responsibility under the Act. Consent to care had been requested for people who had capacity to consent.

Staff were not always caring and communication between staff and people was not always clear. People felt included in decisions about their care. People’s privacy and dignity was respected.

Some of the support that people needed was documented in the care plan in people’s homes. Staff had access to these when they were providing care. Care needs were not always assessed fully, recorded or reviewed.

Complaints about the service had not been accurately recorded or acted upon. The registered manager sought feedback from people using the service but did not keep records to reflect this.