About the service:

Care 24 (UK) Limited is a domiciliary care agency registered to provide personal care and support to people in their own homes. At the time of our inspection, 70 people were using the service. Of those 70 people, 61 received personal care and the remainder received help in the home or companionship services. We only looked at the service for people receiving personal care as this is the activity that is registered with the Care Quality Commission (CQC).

During our inspection visit we were informed by the registered manager that they had suspended a staff member due to allegations of financial abuse. The Greater Manchester Police were investigating these concerns. At the time of publication this outcome was not yet known. However, the provider and registered manager were dealing with the concern in an appropriate and professional manner.

People's experience of using this service:

People who received care from Care 24 (UK) Limited told us they felt safe and well supported by staff who visited them. Staff were punctual and consistent at carrying out visits with people in a person-centred manner. People were supported to continue living at home in a way that enabled them to be as independent as possible.

The registered manager had not ensured that certain areas of the service were always safe. We found that medicines were not always managed safely because records were not always correct or audited.

Recruitment checks of new staff had not been completed consistently. We found gaps in records in respect to the safe recruitment of four staff, which meant they had not been recruited safely in line with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Schedule 3.

Some aspects of the service were not consistently responsive as people's care plans did not always fully reflect their physical, mental, emotional and social needs. We have made a recommendation about developing person-centred care.

Some aspects of the service were not consistently well-led as the quality checking systems had not identified and addressed the issues we found regarding the safe management of medicines, safe recruitment of staff and inconsistencies in care planning.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). We found the service ensured staff received training in respect of the MCA.

People and relatives described staff as caring and kind towards them. Staff were approachable and friendly with people they cared for and knew them well.

Staff enjoyed working at the service and said the registered manager and coordinators were approachable.

We identified three breaches of the regulations. Safe recruitment practices were not always followed, people’s medicines charts were not appropriately checked for inconsistencies and governance systems were not effective. You can see what action we told the provider to take at the back of the full version of the report.

Rating at last inspection:

We rated the service "good" at our last inspection. We published our last report on 11 October 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

Following on from the inspection the registered manager responded to the concerns we raised regarding medicines records, staff recruitment, care planning and audits. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this service on the 21 September 2016 and followed this up with phone calls to people using the service, relatives, staff and healthcare professionals on the 29 September 2016. This was our first inspection of the service since it was registered with the Commission in May 2014.

Care 24 (UK) Limited is a domiciliary care service based in Manchester. It provides personal care and support to approximately 50 people in their own homes whose needs range from elderly care, to people living with dementia and physical disabilities. Care and support services included a sitting service, respite for families, outings in the community, help with domestic tasks and emotional support.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since May 2015. They were not present on the day that we visited the office of the service and so we did not meet them on this occasion. 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 they felt safe when receiving care from the service and their relatives said they had no cause for concern based on the observations of care that they had made. Risks that people were exposed to in their daily lives and those within their own home environments, had been appropriately assessed and measures had been put in place to mitigate these risks as much as possible. The provider had considered emergency planning and a business continuity plan was in place to be followed in the event of any unforeseen circumstances occurring such as a loss of staff or IT failures. Accidents and incidents were appropriately recorded and policies and procedures were in place to protect vulnerable people in receipt of care from being exposed to abuse.

Medicines were managed appropriately within the service and care plans about medicines were in place. Some records would benefit from more detail around the levels of support that people needed with medicines and their abilities to administer their own medicines safely.

People and staff told us that staffing levels were appropriate and continuity of care was evident, in that staff were organised into small teams delivering care to the same individual. Staff had received training in key areas relevant to their roles and this was regularly updated. A supervision and appraisal system was in place which meant staff were supported to maintain their skills and deliver effective care. People were supported to eat and drink in sufficient amounts if this was needed as part of the care package delivered. People were also supported to maintain their health and wellbeing, if they needed support to arrange or attend appointments with external healthcare professionals such as GP's and dentists.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The care co-ordinator was clear about their responsibilities in line with the Mental Capacity Act 2005 and decision making for those people who may lack the capacity to make decisions for themselves. We discussed the needs of people currently supported by the service and the care co-ordinator informed us that no person lacked the capacity to make their own decisions at the present time. They also confirmed that to their knowledge, no person currently using the service was subject to a court of protection order to deprive them of their liberty in a domiciliary care setting. They were clear about the application of the MCA within the service and said they would arrange any best interest decision ma