This inspection took place on 3 and 8 May 2018 and was announced. We gave the provider 48 hours' notice that we would be visiting their main office so that someone would be available to support us with the inspection process.

We last inspected the service on 12 and 16 December 2016 and found the service to be in breach of Regulation 12 of the Health and Social Care Act 2008. The service was not always undertaking robust risk assessments in areas including moving and handling and skin integrity. In addition, where an environmental risk assessment had identified an issue, remedial action had not been taken to address the risk. We also found gaps in the auditing processes in place that monitored the quality of care delivery. In addition, the auditing of care records had not identified the gaps in risk assessments we found at the inspection.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-led to at least good.

At this inspection, although some improvements had been made to certain risk assessments identified as issues at the last inspection, we found that where the service had identified individual risks associated with people’s health and medical needs these had not been assessed and guidance had not been provided to staff on how to manage and mitigate the identified risks to keep people safe. During this inspection we also found that completed audits still did not identify the issues around the lack of risk assessment that we found.

BMM Care Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to predominately older adults with physical disabilities or those living with dementia. Not everyone using BMM Care Ltd 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. Where they do we also take into account any wider social care provided. At the time of this inspection the service was providing personal care services to 52 people.

There was a registered manager in post who was also a director of the company. 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.

Although the service had risk assessments in place which covered specific areas such as moving and handling, environmental and fire risk, where risks associated with people’s individual health and social care needs had been identified, an assessment had not been completed to give guidance and direction to staff on how to reduce or mitigate the known risk to keep people safe.

We saw records confirming that the registered manager had some systems in place to monitor the overall quality of care being delivered. However, these processes were not always recorded and management oversight and governance was not sufficiently robust whereby the provider had failed to identify the issues we found during this inspection.

The service had processes and systems in place to ensure the safe administration of medicines. However, as the electronic systems were relatively new, the service had faced some difficulties with care staff recording whether medicines had been administered where required.

The provider followed robust recruitment processes to ensure that only care staff assessed as safe to work with vulnerable adults were recruited.

The service carried out an assessment of need before starting any care package to confirm that the service could meet the person’s needs. People's choices, wishes, likes and dislikes were recorded as part of this assessment to ensure that care an

This inspection took place on the 12 and 16 December 2016 and was announced.

BMM Care Ltd (also known as Kare Plus Barnet) is a domiciliary care agency providing personal care to adults in their own homes. At the time of our inspection the agency was offering a service to thirty two people. There was 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.

There is no inspection history for this service at this location as the provider changed location on 21 June 2016.

We found there was one breach of the regulations as the service was not always undertaking robust risk assessments. In addition where an environmental risk assessment had identified an issue remedial action was not taken to address the risk.

The service checked with staff they had received their rota in advance of their shift but did not have a ‘log in’ system and therefore the management team relied on people or their relatives to tell them if staff had not arrived for their call. There were some ‘spot checks’ undertaken to check staff attendance and performance and to allow people to give feedback but these had not been regular prior to our inspection. However following the inspection a field supervisor had been employed and had completed ‘spot checks’ for all staff.

People told us they felt safe and that they liked being supported by familiar care staff. They confirmed they were informed by the office staff if there was a change of staff member. There were robust recruitment processes in place to ensure staff were safe to work with vulnerable adults. We found staff could recognise possible signs of abuse and understood their responsibility to report safeguarding adult concerns appropriately.

Staff received training to administer medicines and this was audited by the care manager to ensure they were competent and that they followed the correct procedure. Staff told us they felt well supported by the registered manager and the office team. Staff had received appropriate training to equip them to undertake their role. This included training in the Mental Capacity Act 2005.

We saw examples of where staff had supported people to access the appropriate health care services and care plans gave details of people’s health care support needs.

Care plans detailed people’s support to eat healthily and to remain hydrated. People’s care plans were person centred and clearly outlined what people’s support needs were and how they would like to be supported.

People told us staff were caring and kind in their manner. We saw respectful interaction between a staff member and people when we visited their homes. Most people and relatives told us they were involved in their care planning and most plans identified people’s diversity support needs.

There were good lines of communication between the management team and staff with all staff describing them as ‘approachable’. In addition we received mostly positive feedback about effective communication between the management team and people and their relatives.

The registered manager and care manager undertook audits of medicines and daily notes each month and had identified staff errors that had subsequently been addressed. However the lack of spot checks and lack of a staff 'log in' system meant that staff performance was not being audited robustly. In addition care plans although up to date did not always include the appropriate risk assessments and this had not identified by audit. There had been a quality assurance audit in 2016 to obtain feedback from people and their relatives. We saw actions were taken to address issues when raised in feedback from the survey.

There was a breach of the regulatio