We carried out an announced inspection of Allcare Agency Limited on 23 October 2018. Allcare Agency Limited is registered to provide personal care to people in their own homes. 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 consider any wider social care provided. At the time of our inspection, the service provided personal care to 19 people in their homes.

At our last inspection on 15 September 2017 the service was rated ‘Requires Improvement’ overall. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not ensure staff received regular training, supervision and an appraisal to enable them to carry out their role in an effective manner. The service did not have adequate governance systems in place to ensure people were receiving a service that safe, effective or responsive to their needs.

At this inspection we found that these previous breaches had not been addressed and we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

People’s risk assessments had failed to identify or address their support needs, which meant staff were not aware of how to keep people safe. Staff were not always recruited in a safe manner and line with the provider’s recruitment policy, which meant we could not be assured that they were suitable to carry out their role. People were not supported to receive medicines in line with best practice and the provider had failed to provide medicines training for all staff who required it. The service did not have systems in place to ove

This announced inspection took place on 15 September 2017.The service was meeting all legal requirements at the last inspection in June 2015 and was rated “good”. We have rated them “requires improvement” at this inspection as we identified areas for development.

All Care Agency Limited provides personal care services to people living in their own homes mainly in the London borough of Havering. On the day of our visit there were 17 people using the service who were mainly privately funded.

On the day of the inspection there was a registered manager in place. 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.

During this inspection the provider was not meeting legal requirements in relation to record keeping, staff training and appraisals. Training was not up to date in key areas such as first aid infection control and, mental capacity. Similarly appraisals and supervisions were not always completed in a timely manner leaving a greater risk of people receiving inconsistent care from staff who had not updated their knowledge and practice. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe and were happy with the service provided. They said they were treated with dignity and respect by staff who understood their needs. People felt able to express any complaints about their care and told us they were resolved.

Staff were aware of the procedures in place to keep people safe. They were aware of the different types of abuse and how to report any allegations of abuse. Although there had been no recent incidents there were aware of the incident and accident reporting procedures.

There were enough staff to support people. Schedules were prepared a week in advance so staff and people were aware of expected visit times. People received consistent care form a core set of staff in order to encourage continuity of care.

There were effective recruitment practices in place which included appropriate checks to ensure suitable staff were recruited.

People, their relatives and staff thought there was an open and transparent culture where the registered manger was also very visible and hands on.

There were effective systems in place to monitor and receive feedback. However we noted the current systems in place to monitor staff training, reviews of policies and risks assessments were not consistent and had failed to ensure training, appraisals, spot checks and care plans were updated in a timely manner.

This inspection took place on 26 June 2015 and was announced. The provider was given 48 hours’ notice because we needed to be sure that someone would be in the office and able to assist us with the information we required for the inspection. At our previous inspection of this service on 21 February 2014 we found they were not meeting the legal requirement relating to care and welfare of people who used the service. During this inspection, we found they were now meeting the required standard.

All Care provides personal care for over 20 people in the London borough of Havering. They also provide care for people with complex healthcare needs.

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.

People told us that they were treated with dignity and respect and that their wishes were respected. They were aware of how to make a complaint and thought that their complaint would be listened to and resolved.

People told us they felt safe and secure and that they trusted staff who provided their care. We found that there were robust recruitment checks that included the necessary disclosure and barring checks to ensure that staff were suitable to work in the health and social care environment. The service ensured that there was enough staff available to cover for emergency absences and other leave in order to ensure that there were no missed visits.

Medicines were managed safely. Risks to people and the environment were regularly assessed in order to protect people from avoidable harm.

People were supported by staff who were aware of the procedures in place to protect people from abuse. Staff were enabled to support people effectively by means of training, appraisal, regular spot checks and supervision. Staff demonstrated an understanding of how they would obtain consent to care and an awareness of how the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards applied in practice.

People told us that they were supported to eat and drink sufficient amounts according to their tastes and preferences. Staff were aware of the procedures in place to refer people to other healthcare professionals when required.

The service had a positive culture that was open and inclusive. People and staff thought the registered manager was approachable. There were systems to obtain and act on feedback raised by people and staff, and quality checks in place in order to monitor and improve the quality of care delivered.

The relatives of people who used the service told us that they would recommend the provider. They told us that the staff did a thorough job and they felt able to ask the staff for help. One relative said, "I know what is in the plan and if there are any changes, we are informed." We did not see evidence that the individual needs of people who used the service were assessed and recorded.

The provider was a small agency and had difficulty recruiting care workers but was able to deliver the activities to people. The manager worked on shifts and the relatives told us that the staff never let them down. The provider was recruiting additional care workers. We found that the recruitment process included the required checks on the suitability of staff before they commenced their duties.

People's views were sought and we found that people were happy with the quality of the services and the care workers. One relative told us, "I speak to the office regularly and can raise concerns, if needed."

People who use this service and their relatives told us that they felt safe and were happy with the care and support that the agency provided. One relative said “the quality of care is excellent. It’s a reliable service with regular carers.” Another told us “yes we are happy with the agency. We have regular carers and my wife is safe with them. They are polite and gentle.”

People’s care and welfare needs were being met and the agency cooperated with other providers to ensure that people had access to other health and social care services that they needed. A healthcare professional said “they are proactive. They contact me and give me feedback about my client and they say if they have any concerns." A person who uses the service commented “they will phone up on my behalf if there is anything I need or am worried about. Recently they phoned the district nurse for me.” Some staff assisted people with their medication and had received training and guidance to do this. People were satisfied with the support that they received with their medication.

People who use the service and their relatives said that staff “knew what they were doing.” Staff received training and support from the provider and felt that this enabled them to provide a good service to people.

People who use this service and their relatives told us that they were very satisfied with the care and support that the agency provided. Overall, comments were very positive.

People said: “We have had the odd hiccup over the years but overall I have found them very good. We mainly get the same regular carers.”

“Most of the girls bend over backwards in the care and are lovely. They know what they are doing.”

“The care is excellent. The girls are very careful with my mother as she is very disabled and needs to be moved very carefully and gently. We have never had any problems. There is no aspect of the care that I could fault.”

“On the whole the service is very good and so are the carers. There was one who wasn’t suitable but as soon as I raised this the person was moved. I can’t praise them highly enough. This is the best care that I have received.”

“The carers are always cheerful, kind and professional. Very pleased.”

A healthcare professional said, “They are able to be flexible with the care provision as the patient’s condition changes. We receive timely and appropriate feedback regarding all the packages of care we fund and have jointly worked via multidisciplinary meetings in service user’s homes to affect a good outcome.”

A social care worker said, “I have found the level of commitment to the service users they support to be exceptional. Their approach to the delivery of care and support for the service users that I have introduced to them is always personal and tailored to the individual.”