We inspected the service on 6 December 2018. The inspection was announced.

Awesome Healthcare Solutions Limited is a domiciliary care agency which provides care and support for people in their own homes. Care is provided for a range of people including older people and people with dementia. Not everyone using Awesome Healthcare receives a regulated activity; 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. At the time of the inspection there were 55 people using 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 provider had an appropriate recruitment policy but did not always adhere to it to ensure suitable staff were selected to support vulnerable people as we found inconsistencies with references during staff recruitment. Staff we spoke to were aware of safeguarding processes. Staff were able to tell us the different types of potential abuse people may experience and were aware of how to report concerns to outside agencies. Medication records contained omissions and lacked information. Risks to people's health, safety and well-being had not always been identified and the information to guide staff about how to support people in a way that minimised these risks was insufficiently detailed.

We received mixed responses regarding the measures in place to minimise the spread of any infection. Staff told us they had a plentiful supply of equipment such as, gloves and aprons. However, some people told us, “Some of these carers are messy and leave their disposable gloves around the house when they’ve finished with them,” and “My carers wear gloves, but I’ve never seen an apron being worn.”

Accidents or incidents that had occurred had been appropriately recorded but not sufficiently investigated or resolved. For example, the missed or late calls had been identified by the provider’s electronic monitoring system. These had then been recorded and reported to the local authority. However, the longstanding nature of the issue in people’s experience did not demonstrate that lessons had been learned.

The provider did not always work within the principles of the Mental Capacity Act (MCA). Capacity assessments and best interest decisions were not always in place where required. Care records lacked detail on the specific decisions people who were assessed as lacking capacity would require support to make. Staff told us they sought people's verbal consent before they provided care and support.

The training schedule and records we looked at showed staff were up to date with their training.

People often received support which was much earlier or later than their preferred time, or sometimes did not receive support at all. They told us the uncertainty made them feel anxious. Where required, people were prepared food in line with their preferences and dietary needs.

People told us that they were supported by caring staff. One person told us, " The staff are kind and they treat me with respect, for example they always listen and act on what I say. The staff respect my privacy and dignity for example they protect my modesty when they are delivering personal care. They cover me with a towel and close the door."

People did not always receive support at the time they wanted it. We received a significant amount of feedback from people about poor timekeeping of staff. Although people were asked what time they wanted support to be provided as part of their assessment, the person's preferred times were not always met. People told us the inconsi

This unannounced comprehensive inspection took place on 12 December 2017. The last inspection took place on 21 April 2017. The service was meeting the requirements of the regulations at that time. The service was rated Good. We undertook this inspection in light of concerns we received. At this inspection we identified issues stemming from a lack of oversight and governance. As a result, the service is rated as ‘Requires Improvement.”

Awesome Healthcare Solutions Limited provides assistance to people who require support with daily tasks and personal care in their own homes. The service was supporting approximately 45 people when the inspection took place.

There was a registered manager in place. A registered manager is a person who has registered with the 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.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The provider had appropriate policies and procedures in place to ensure that people received their medicines safely but did not use them effectively. People's records were not always clear as to what support they received with their medicines and were not being robustly checked to ensure they received them safely.

Staff had the skills that they needed to provide people's care safely. Arrangements were in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support. Staff had been provided with sufficient training in key areas such as safeguarding, mental capacity and manual handing but did not always receive regular supervision.

The provider followed safe recruitment procedures and ensured that necessary risk assessments had been completed as part of the staff selection process. People could always be assured that their care visits would be attended by the appropriate number of staff needed to meet their care needs appropriately.

People were protected from harm arising from poor practice or abuse; there were clear safeguarding procedures in place for care staff to follow if they were concerned about people's safety. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns.

People were supported by staff to make choices with their daily care needs. Staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA2005) and there were systems in place to assess people's capacity for decision making under the Mental Capacity Act 2005.

The provider did not meet the CQC registration requirements regarding the submission of notifications about specified events, for which they have a legal obligation to do so.

The provider did not have sufficient oversight of the service. Ineffective quality assurance systems were in place to monitor the care and support people received. The improvements that were required to the service had not always been identified, and there had been on-going shortfalls as a result, including missed care visits.

People and their relatives knew how to make a complaint and were comfortable approaching staff if they needed to, although some people found it difficult to contact the office.

This inspection took place on 21 April 2017 and was announced. We gave the registered manager 48 hours' notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office. This was the first inspection for this provider.

Awesome Healthcare provides a domiciliary care service. It is registered to provide personal care to people living in their own homes. The service provided personal care to 52 people on the day of our inspection.

A registered manager was in post and was present during our inspection. 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 felt safe with the service provided to them and staff were aware of how to protect them from the risk of potential abuse. People were protected from the risk of harm because staff were aware of their responsibility of identifying possible risks and to avoid them happening. There were enough staff to ensure people's needs were met and to support them to take their prescribed medicines.

People were supported by staff who had been checked to make sure they were suitable to work in their homes. Employment and criminal records checks were carried out on all staff before they started work at the service. Staffing levels were kept under review and people saw the same staff regularly which helped to make sure they had consistency of care.

People were treated with respect and their privacy and dignity was promoted. People said their care workers were kind and caring. Staff were responsive to the needs of the people they supported and enabled them to maintain their independence as much as possible.

People were cared for by staff who were skilled and who received regular support and supervision. People's human rights were protected because staff applied the principles of the Mental Capacity Act in their care practices.

Staff had the skills and knowledge to understand and support people's individual needs. These skills were kept up to date through regular training.

People's care needs were assessed and measures were in place to manage risks. People were involved in the development of their care plans which provided staff with guidance on how to support people safely whilst promoting their independence. The provider had recognised care planning as an area they wished to develop greater detail.

There was a complaints procedure and people knew how to use it. People and their relatives were confident that any concerns raised would be responded listened to and addressed.

People benefitted from receiving a service that was managed well. Quality assurance systems were in place to monitor the quality of the care and support being delivered and the running of the service.