We carried out an announced inspection of Admiral Care Limited on 22 June 2018.

This service is a domiciliary care agency. It offers personal care to people living in their own homes. It provides a service to older and younger adults, people living with dementia, learning disabilities or autistic spectrum disorder, mental health, people who misuse drugs and alcohol, people with eating disorders, people with physical disability and people with sensory impairment. At the time of our inspection there were 68 people using the service.

Not everyone using Admiral Care Limited receives regulated activity; the 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 take into account any wider social care provided.

The service had a registered manager in post. 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.

At the last inspection, in June2017 the service had been rated 'Requires Improvement'. At this inspection, we found evidence the service had improved to support the rating of good and there was no evidence that demonstrated serious risks or concerns.

People were kept safe from abuse and harm and staff knew how to report any suspicions concerning abuse. Risk assessments identified how potential risks should be managed to reduce the likelihood of people experiencing harm. Staff understood the risks to people and delivered safe care in accordance with people’s support plans.

Incidents and accidents were recorded appropriately and investigated where necessary. If learning resulted in changes to support plans or support guidelines, these were discussed and action was taken to reduce the risk of further incidents and accidents.

Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the service. People received their medicines when they needed them from staff who had been suitably trained and had their competency checked.

People's medicines were managed safely. Staff understood how to reduce the risk of the spread of infection.

Staff received effective training to meet people's needs. An induction and training programme was in place for all staff. A detailed assessment was carried out to assess people's needs and preferences prior to them receiving a service.

The management team effectively operated a system of spot checks, supervision, appraisal and monthly team meetings which supported staff to deliver care based on best practice.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The service was working within the principles of the Mental Capacity Act, 2005 and we found people's human rights were recognised and protected.

People were protected from the risk of malnutrition and supported to eat a healthy diet of their choice by staff who had completed training in food hygiene and safety.

Staff treated people with kindness and compassion in their day-to-day support. People's dignity and privacy were respected and upheld, and staff encouraged people to be as independent as possible.

People's care records were person-centred and staff provided people with support in line with people’s preferences. People were consulted about their diverse needs which were respected by all staff.

People had access to a complaints procedure and were confident any concerns would be taken seriously and acted upon.

The registered manager carried out their role in line with their registration with the CQC. They ensured all notifiable incidents were reported to the CQC. Staff respected the registered manager who encouraged them to

We carried out a comprehensive inspection of this service on 2, 3 and 4 November 2016. We found two breaches of regulations relating to records and the safe management of medicines. We gave the service an overall rating of requires improvement and told the provider to send us a report by 7 March 2017 of actions they proposed to take.

We undertook this focused inspection to check whether the provider had taken action and to confirm whether they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the “all reports” link for Admiral Care Limited on our web site at www.cqc.org.uk.

This focused inspection took place on 16 May 2017. We gave the provider 24 hours’ notice so that people we needed to speak with would be available.

The previous comprehensive inspection found the provider was not meeting the requirements of regulations concerning the safe management of medicines and maintaining up to date records. This inspection found that improvements had been made in both areas. The provider was now meeting the requirements of the regulations. However there were still areas where improvements could be made with respect to people’s medicines records and the provider had not sent us a report of actions when requested. The rating for the service therefore remains requires improvement.

Admiral Care Limited provides personal care to people in their own homes. At the time of this inspection the service provided personal care to 80 people with a range of needs including people living with dementia, older people, and people with a physical disability. Admiral Care Limited also provides services to people which are outside the Care Quality Commission’s regulatory remit.

The service had a registered manager in place. A registered manager is a person who has registered with us 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 taken steps to improve the consistency and clarity of records relating to people’s medicines. Where people had complex needs the registered manager only assigned experienced care workers who knew the person and understood their needs to call on them.

The provider had put in place processes and procedures to make sure records relating to people’s care and support were kept accurate and up to date.

The inspection took place from 2 to 4 November 2016. We gave the provider 48 hours’ notice of our intention to inspect to make sure people we needed to speak with would be available.

When we inspected this service in July 2015 we found breaches of legal requirements, we gave the service a rating of inadequate and placed it in special measures. We inspected the service again in April and July 2016. We found some improvements had been made but the service was still inadequate in one key area and remained in special measures. People were not properly protected against risks to their health and wellbeing. Training was not always effective in making care workers aware of their responsibilities where people lacked capacity to make decisions. People’s care did not always take into account their preferences. Improvements were needed to management systems, quality assurance processes and people’s care records.

Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that further improvements had been made and consolidated, and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Although the service was no longer in special measures, there remained one continuing breach and one new breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the end of the full version of this report.

Admiral Care Limited provides personal care to people in their own homes. At the time of this inspection the service provided personal care to 57 people with a range of needs including people living with dementia, older people, and people with a physical disability.

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 provider did not always make sure people’s medicines were managed properly and safely. However processes were in place to protect people against other risks to their safety and welfare, including the risks of avoidable harm and abuse. The provider carried out recruitment checks to identify that care workers were suitable to work in a care setting.

Records to do with people’s care were not always accurate and up to date. The registered manager had appropriate management systems and procedures to monitor and improve the quality of the service.

The provider supported staff to deliver effective care by means of a programme of training, supervision and appraisal. Staff were aware of the need to obtain people’s consent to their care. Where people lacked capacity, staff were aware of the legal requirements to protect people’s rights. Where people’s care plans included support with people’s food and drink, the provider supported them to maintain a healthy, balanced diet. Care workers supported people to access other healthcare services as necessary.

Care workers had developed caring relationships with people they supported. People were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s independence, privacy, and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. The provider carried out checks to make sure people received care in line with their plans. People were aware of the provider’s complaints procedure, and complaints were investigated and managed in accordance with the procedure.

This inspection took place on 25 and 26 April 2016 and 13 July 2016. It was unannounced.

Admiral Care Limited provides personal care to people in their own homes. At the time of this inspection the service provided care to 88 people with a range of needs including people living with dementia, older people, and people with a physical disability. The service had 38 care staff.

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.

We carried out a comprehensive inspection of this service on 28 July 2015. We found breaches of legal requirements and gave the service an overall rating of inadequate. This meant the provider was placed in special measures.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months from publication of the previous report.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection we found some limited improvements had been made. However there was not enough improvement to take the provider out of special measures because we judged the service was inadequate for one key question.

We are considering the appropriate response to the shortfalls we found during this and previous inspections. Where registered persons have not been meeting the fundamental standards, we have a range of enforcement powers we can use to protect the safety, health and welfare of people who use the service. When we propose to take enforcement action, the provider can challenge our decision through a variety of internal and external appeal processes. We will publish a further report on any action we take.

The provider had made improvements in the way it managed concerns about the safety and welfare of people made vulnerable by their circumstances. However their systems for identifying, assessing and managing risks to people’s safety and welfare were not fully effective, which meant people were not fully protected from such risks.

The programme of training and supervision was not always effective. Some staff did not show sufficient knowledge in important areas. Care workers were not familiar with legal requirements when supporting people who did not have capacity to consent to their care and support.

People were satisfied the care and support they received met their needs, but it did not always conform

This inspection took place on 28 July 2015. The inspection was unannounced.

Admiral Care Limited provides personal care to people in their own homes. At the time of the inspection the service provided care to 62 people with a range of needs including those living with dementia, older persons and people with a physical disability. The service had 34 care staff, a training manager, deputy manager, office manager and two senior care workers.

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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection on 21 November 2014 we found the service was in breach of two regulations because staff did not receive adequate training, supervision and appraisal and the provider did not seek the views of service users, or people acting on their behalf and staff. We asked the provider to send us an action plan to tell us how they would meet regulations and what actions they would take to make improvements. At this inspection the provider had not taken the appropriate steps to ensure staff were appropriately supported and views of service users were being sought.

At our last inspection on 21 November 2014 we also made two recommendations. We recommended training was provided for staff in the Mental Capacity Act (MCA) 2005 to enable staff and managers to increase their knowledge regarding the correct procedures to follow for people who were not able to consent to their care. We also recommended the provider referred to nationally recognised best practice guidance to improve the systems for training and assessment of staff competency to administer medicines safely. At this inspection improvements had not been made to meet the relevant requirements.

People gave us complimentary comments about the service they received. People felt happy and well looked after. However, our own observations of records we looked at and feedback provided by care staff and other professionals did not always match the positive descriptions people and relatives had given us.

Safeguarding concerns were not always identified and investigated. Care staff had not always received training on safeguarding but knew how they could keep people safe from harm and could recognise types and signs of potential abuse to look for. Care staff would report concerns to the manager but some care staff did not have confidence the registered manager would take appropriate action if there were concerns.

Staff demonstrated a good understanding of how to identify, manage and report any risks in line with their care role. Risk assessments relating to people’s environment, health, safety and welfare were completed but were not always updated or corresponded with the person’s assessment of need. Incidents and accidents were reported by care staff. However, they were not consistently reviewed or monitored by the registered manager or provider.

Care staff did not have the qualifications and competence to support people with medicines safely. Arrangements for giving medicines covertly were not in accordance with the MCA 2005.

People and their relatives told us they felt staff had the skills abilities and training to provide the support they or their relative needed. Training did not always take place. The training manager did not have the necessary qualifications to train staff effectively. The service’s training planner did not give an accurate reflection on the training provided to staff. Staff did not receive an appraisal and did not receive a supervision. Regular checks of their competencies were not carried out.

The registered manager and staff did not demonstrate a good understanding of the MCA 2005 and the code of practice and how it related to people they provided personal care to.

People were involved in day to day decisions about their care but people’s care plans did not reflect their choices and preferences on how they would like to their care to be received. People’s care needs were assessed but their assessments were not always dated. Care plans were not always in place for people and they were not always reviewed and did not reflect how people would like to receive their care.

People knew how to raise concerns or complaints and felt able to raise any issues or concerns and that these would be resolved. Appropriate action was not taken to respond to any failures identified by a complaint.

The registered manager was not always aware of their responsibilities for providing a care service. The provider had not displayed their rating. There were no systems for gaining the views of people, staff or other professionals about the service or for involving staff and people in the development of the service. Staff meetings did not take place. Care staff said they did not feel supported by the office. The out of hours support service was not always effective with providing support to staff.

There was no analysis of complaints, incidents and accidents. The commission had not been notified of 16 safeguarding concerns and one incident which had been reported to and investigated by the police.

People confirmed they felt safe with care staff that supported them and felt there were enough staff to meet their needs and keep them safe. People and their relatives said the service provided a good service and they would recommend the service to others. People were supported to eat and drink and have access to health care services. People and their relatives had a positive relationship with care staff and said they were kind and caring. People felt their views would be acted upon and listened to by the registered manager. Staff were respectful and mindful of respecting people’s privacy and dignity.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 21 November 2014 and was announced

At our last inspection on 4 December 2013 we found the service was in breach of regulation as adequate checks were not carried to ensure staff were suitable to work with vulnerable people. The provider sent us an action plan on 27 December 2013 to say this was addressed. At this inspection we found the service now carried out checks that ensured staff were suitable to work with people in a care setting.

Admiral Care Ltd provides personal care to people in their own homes. At the time of the inspection the service provided care to 60 people with a range of needs including those living with dementia, older persons and people with a physical disability. A service was also provided to 57 people who were able to request support on an emergency basis using a call system in their home. The provider told us this service had been provided to 13 of the 57 people who had this arrangement.

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 and associated Regulations about how the service is run.

People, and their relatives, said they felt safe with the staff. There were policies and procedures regarding the safeguarding of adults. Staff had a good awareness of the correct procedures to follow if they considered someone they provided care to was being neglected or poorly treated.

Staffing was organised so people received a reliable service. People, and health care professionals, told us staff often stayed longer than the agreed time so people got the right care and support.

People were supported by staff to take their medicines and this was recorded in their care plans. However, checks that staff were competent to administer medicines or that staff were following the correct procedures were not carried out for all staff.

Training, support and the induction of newly appointed staff was inconsistent. Staff told us they received an induction which prepared them for working with people. There was, however, a lack of assessments and observations that staff, including those recently appointed, were competent to provide care and were carrying out procedures correctly. Staff told us they were able to request support and advice when they needed it but also said they did not receive supervision and there were no records of supervision for any of the five staff whose records we looked at. The majority of staff had completed a National Vocational Qualification (NVQ) in care work or a Diploma in Health and Social Care. However staff also identified a lack of training since commencing work

People had agreed and consented to their care. Whilst there were policies and procedures for those who were unable to consent to their care as set out in the Mental Capacity Act 2005 (MCA), staff had not received training in the MCA . Staff had some awareness of what the MCA was but were unsure what to do when someone they provided care to was unable to consent to that care.

People received support with meals and drinks. Arrangements were made to support people with their healthcare needs, such as liaising with community health services and monitoring people’s general health.

People spoke fondly of the staff who provided care to them. Health care professionals told us staff established a good rapport with people so they were able to effectively communicate with them and find out what they needed. Staff treated people with kindness and respect and expressed a commitment to meeting people’s care and social needs.

People said their needs were reviewed and they were consulted about the care they needed. They told us their care was adjusted and amended to suit their changing needs and their preferences.

The provider contacted people to ask if they were satisfied with their care. However, this was limited and the majority of people we spoke to had not been asked to give their views on the service such as in a survey questionnaire so that this information could be considered for any improvements to the service. There were limited opportunities for people and staff to be involved in the development of the service.

There were systems to monitor staff provided care at times as set out in care plans. Staff were committed to their work and knew what to do if they had any concerns about people. However, checks by the service’s management were not sufficient so they could be assured staff provided a good service and had the correct attitudes and behaviours.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke to 11 people (or their relatives) who used the service. We also spoke to one staff member, the manager and the deputy manager. Two health and social care professionals were also asked for their views about the service provided by Admiral Care Limited.

People and their relatives told us they received a reliable and punctual service. This was also confirmed by the two health and social care professional we spoke to. Comment was made by both the health and social care professionals, and, by people, that the service “went beyond” its contractual obligations to ensure people were safe and well cared for.

We found that each person’s needs were assessed and care plans were recorded of how people’s needs should be met. These included the times care was to be provided and assessments regarding moving and handling. People told us they were consulted about their care and that there was a copy of their care plan at their home. There were records to show that the service carried out checks to monitor that care staff were providing care as set out in care plans.

The service carried out checks that newly recruited staff were suitable to work with vulnerable people, although we noted these were incomplete for one staff member.

People and their relatives told us they were supplied with a copy of the service’s complaints procedure.

The visit took place to follow up compliance actions made in the last inspection report after an inspection visit on 5 September 2012. These were made as assessment and care plans for people did not include all relevant information, and, the agency had not reviewed its procedures following injuries to staff whilst handling needles.

We spoke to the manager and to two members of staff as well as a member of staff who had responsibility for ensuring the service was compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We looked at care records for three people. We found that each person receiving a service had a care plan with comprehensive details about the care and support they needed. Full details of what staff should provide to the person were recorded. There were records regarding health and safety so that staff knew what to do to safely support people and to protect themselves.

We found that the service had reviewed its procedures where staff were involved in handling needles. This included updating individual’s care plans and additional training for staff in this. The manager also described how the service reviewed specific incidents but this was not recorded.

We spoke with three members of staff, three people who use the service, three relatives and someone who offers training to the staff. People were generally more than happy with the service received and said they felt able to speak with staff if there was a problem.

People using the service told us that they had regular staff visit them; they were on time or contacted them to say they were running late, “they ask what I need and give me care with respect”. Relatives told us that they were caring and used their initiative. The provider involved family members to build relationships and to ensure that the best care possible was provided. “I am particularly thankful that they don't just come in and stick to the care plan, they raise concerns with any health issues as they arise and contact the district nurses and GP as necessary”. “It is good to be able to praise a service instead of complaining”.

Staff said that people had the equipment they needed to make sure they were safe. "I enjoy working for this company, I have had regular training and having the out of hours service to contact is good".