Care at Home is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger adults and people with a physical disability. The domiciliary care agency office is situated Newport and provides a service across the Isle of Wight.

This inspection was undertaken on the 21 and 28 June 2018. Not everyone using Care at Home received 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 nine people were receiving a personal care service from Care at Home.

Following the inspection in May 2017 three breaches of regulations were identified. At this inspection we found action had been taken to make the required improvements and the service was no longer in breach of regulation.

The provider was registered as an individual provider and therefore did not need a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 understood their legal responsibilities as a registered provider.

Improvements had been made to ensure that recruitment was safe and that staff had a suitable induction and all of the training relevant to their role. The provider’s new structures and quality monitoring systems were helping to ensure people received a safe service.

People who used the service expressed satisfaction and spoke highly of the staff. Everyone told us they would recommend the service to others.

Care staff had received safeguarding training and were clear about their safeguarding responsibilities. The provider was aware of their responsibilities and had reported safeguarding concerns when required.

There were sufficient numbers of care staff to maintain the schedule of visits and ensure a high level of continuity for people.

There was an infection control policy in place and protective equipment such as gloves and aprons were provided to staff to minimise the spread of infection.

People who used the service felt they were treated with kindness and said their privacy and dignity was respected. Staff knew the people they provided care for well and understood their physical and social needs.

Individual and environmental risks to people and staff were managed safely and plans were in place to mitigate these risks.

People and, when appropriate, their families were involved in discussions about their care planning and given the opportunity to provide feedback on the service. There were safe medicines administration systems in place and people received their medicines including topical creams when required.

There were processes in place to enable the provider to monitor accidents, adverse incidents or near misses. The learning from these drive improvements within the service.

Staff asked for consent from people before providing care and understood the implications of the Mental Capacity Act 2005 for their role.

People were able to raise complaints should they wish to and the provider actively sought their views about the service they were receiving.

At the time of the inspection no one using the service was receiving end of life care. However the provider assured us that people would be supported to receive a comfortable, dignified and pain-free death.

The inspection was carried out on the 17 and 26 May 2017. Twenty-four hours’ notice of the inspection was given to ensure that the people we needed to speak with were available.

Care at Home provides personal care to older adults living in their own homes. At the time of our inspection 17 people were receiving personal care from Care at Home.

Following the previous inspection in November 2015 we found improvements were needed to ensure all pre-employment checks were completed before new staff commenced working for the agency. We also found improvements were needed to ensure care staff received regular structured supervision. We also found improvements were needed to ensure the provider notified CQC of incidents. Providers are required to notify CQC of certain incidents which occur, so we can monitor the safety of services and take regulatory action where required. We identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 and made a requirement telling the provider they must make improvements. We identified a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made a requirement telling the provider they must make improvements. We received an action plan in response to these requirements. However at this inspection, whilst improvements had been found in staff supervision and notifying us of incidents, we found there was a continuing breach of Regulation 19 and a need to improve recruitment procedures remained.

Recruitment and selection processes did not ensure that all essential pre-employment checks were completed, including references and a full employment history were obtained, before new staff commenced working with vulnerable people. Care staff had not completed essential training or received a comprehensive induction meaning they may not have had the necessary skills to meet people’s needs safely.

The provider’s quality assurance procedures were not sufficiently robust. The quality assurance systems had failed to address recruitment problems and had also failed to identify that staff were not completing the induction training package and that other essential training was not being provided. Therefore the quality assurance procedures and audits had not been effective.

Medicines administration training and assessment of staff competency had not been undertaken for most care staff. Risk assessments related to people’s individual needs had been completed, however, these had not been updated when a person’s needs changed.

Action had been taken to ensure staff received formal supervision. Staff were confident to approach the provider and felt supported in their work.

People said they felt safe with care staff. Staff knew how to recognise and report suspected abuse. Systems were in place to respond to emergency situations.

People said staff were caring. People and their relatives said they were very happy with the service and care they received. They told us care was provided to them with respect for their dignity by a consistent care staff team. There were sufficient staff to provide people with the care they required.

People’s care plans were person-centred and their preferences were respected. Care plans were reviewed regularly and people felt involved in the way their care was planned and delivered. Care staff always asked for consent from people before providing care.

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 this report.

The inspection was carried out on the 4 November 2015. Forty-eight hours’ notice of the inspection was given to ensure that the registered provider we needed to speak with was available.

Care at Home provides personal care to older adults living in their own homes. At the time of our inspection four people were receiving personal care from Care at Home.

Providers are required to notify CQC of certain incidents which occur, so we can monitor the safety of services and take regulatory action where required. We identified incidents which had not been reported to CQC although the registered provider had taken appropriate action to report the concerns to the relevant authorities.

Staff had completed all training appropriate to their role but were not receiving formal supervision. Recruitment processes had not ensured all essential pre-employment checks were undertaken.

There were sufficient staff to provide people with the care they required. People said staff were caring. Staff spoke to people in a kind and patient manner. We observed staff supporting people with respect whilst assisting them to maintain their independence as much as possible.

People and their relatives said they were very happy with the service and care they received. They told us care was provided to them with respect for their dignity by a consistent care staff team. Care staff, and the registered provider, knew how the Mental Capacity Act 2005 affected their work. They always asked for consent from people before providing care.

Staff were knowledgeable about how to spot the signs of abuse and report it appropriately. People said they felt safe with care staff and were complimentary about the staff caring for them. Medicines were managed safely and people received their medicines when they needed them.

People’s care plans were person-centred and their preferences were respected. Care plans were reviewed regularly and people felt involved in the way their care was planned and delivered.

Staff said they worked well as a team and that the registered provider was supportive and provided guidance when they needed it. Formal quality monitoring systems were not yet in place however, the registered provider was developing these.

We found 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 this report.