This inspection took place on 19 July 2017 and was announced. Carepoint Services is registered to provide personal care and support to people living in their own homes. At the time of the inspection there were 136 people using the service.

The service has 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 last time we inspected this service in April 2016, we found a continued breach in relation to safe care and treatment. We had found that there were unexplained gaps in people’s medicine administration records (MARs), therefore people were at risk of not receiving their medicines as prescribed. We also had found staff did not take prompt actions when concerns about people’s ability to manage their medicines were identified. We had found that the registered provider did not have robust recruitment systems in place. We made a recommendation that the registered provider use a reputable source or system to monitor and check that staff had the right to work in the United Kingdom.

At this inspection, we followed up on the breaches of regulations to see if the registered provider had made improvements to the service. The registered provider had taken action to meet the regulations we inspected.

Staff managed people’s medicines safely. People’s medicine administration records (MARs) were accurate and updated by staff once people had their prescribed medicines. The registered manager completed audits of medicines management to help them identify and address any errors.

Staff were supported with appropriate training, induction, appraisal and supervision. This allowed staff to obtain skills and knowledge and share their personal and professional needs with their line manager.

People had sufficient numbers of staff to provide care and support to them. Safe recruitment processes were followed to ensure the safety of people by employing suitable staff. The registered manager had systems in place to ensure that checks on staff entitlement to work in the UK were carried out promptly and as required.

Staff understood how to protect people from risks associated with harm and abuse. Staff had guidance from safeguarding procedures and policies to identify and report any allegations of abuse to the local authority.

Risks to people’s health and well-being were identified. Staff had access to risk assessment outcomes and guidance to support them to reduce risks and keep people safe.

People were supported to have maximum choice and control of their lives and the policies and systems in the service supported this practice. People were cared for within the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) principles. People were provided with enough information to allow them to consent to care and support.

People said staff knew them well and treated them with kindness and compassion. People told us that staff respected them and protected their dignity and privacy. People had access to health care services when their health needs deteriorated. Staff provided people with meals that met their preferences and nutritional needs. Staff followed health professionals’ guidance regarding people’s specific needs.

Care assessments identified people’s needs. Care plans detailed how the service arranged care so people’s needs were met. This enabled people to maintain their health and well-being.

The registered manager sought people’s views on the service, including the quality of care provided. Staff and the registered manager monitored and reviewed the quality of care through audits, spot check visits, and reviews of the service. The Care Quality Commission was kept informed of incidents that occurred at the service.

This inspection took place on 22 April 2016 and was announced. Carepoint Services is registered to provide personal care and support to people living in their own homes. At the time of the inspection there were 136 people using the service.

The service has 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 last time we inspected this service in September 2014, we found a breach in relation to the management of people’s medicines. We found that people did not have a medicine risk assessment in place when required. People did not receive their medicines as prescribed. There was no medicine audit in place to identify and manage medicine errors promptly. We issued a Warning Notice for these breaches of the regulations. We asked the registered provider to send us a plan for improvements to meet the regulations. However, we did not receive the action plan requested.

At this inspection, we followed up on the outstanding breaches. We found evidence of improvements in some areas. There was a medicine audit tool in place and there were medicine risk assessments in place for people. However, we found there were continued breaches in relation to the management of medicines.

The management of people’s medicines were not safe. We found that there were unexplained gaps in people’s medicine administration records (MARs) therefore people were at risk of not receiving their medicines as prescribed. People who required support with their medicine management were not included on the medicine audit. People did not receive their medicines safely because staff did not follow up concerns about people’s ability to manage their medicines promptly.

People and their relatives did not have a formal way of giving feedback to the registered manager. This meant that people could not give their views on the service. The registered manager sent out annual feedback forms to people or their relatives after the inspection.

Staff protected people from harm and abuse. The registered provider had safeguarding processes in place for staff to follow to raise an allegation of abuse. Staff identified monitored and managed risks to people’s health and well-being.

There were sufficient numbers of staff to provide care and support to people. The registered provider’s recruitment processes were robust and identified only suitable and skilled staff to be employed. However, we found there were no processes in place to request renewed work permits to ensure staff maintained the right to work in the UK. We have made a recommendation in the report.

The registered provider had a training programme in place that allowed staff to obtain skills and knowledge. However these records showed that staff did not have access to regular training. The registered manager explained the suspension of staff training was because the service focussed on other areas of the service and therefore training for staff did not happen. Staff had an induction, supervision and appraisals that provided them with the opportunity to explore their professional practice.

Staff cared and supported people within the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) principles. The MCA supports people who lack the ability to make specific decisions for themselves. Staff were aware of how to care and support people that protected their rights within the values of MCA. This was because staff had completed MCA training and applied their knowledge to their daily practice. Staff supported people to consent to care by giving them choices to enable them to make decisions about their care.

People’s care and support was delivered by staff with kindness and compassion. Staff work

One inspector carried out this follow up inspection. During the visit we gathered evidence to answer our one of five questions; Is the service safe?

Is the service safe?

We found that were people required assistance with their medicines they did not always have a medicine risk assessment in place. People did not always receive their medicines as prescribed. We found that the registered manager did not complete a medicine audit, therefore the registered manager was unable identify errors, omissions or take appropriate action to rectify these errors.

During our inspections on October 2013 we found proper steps were not always taken to ensure that people were protected against the risks of receiving care or treatment that was inappropriate or unsafe.

At this inspection we found that the provider did not always protect service users against the risks associated with the unsafe use and management of medication. We found that there were not always appropriate arrangements in place for the obtaining, recording and disposal of medication. Also, medication procedures were not monitored or reviewed appropriately by the provider.

We found that some people's care records and staff personnel records were accurate, up-to-date and met the needs of people.

We spoke with five people who used the service during our inspection. They told us they received good quality care from the provider. One person told us "This is home for me".

We reviewed a sample of care records, five in total, and found that each contained an assessment of people's needs and a plan as to how to meet those needs. Consent was sought by the provider from people in regards to the support they required. Consent was reviewed if their care needs changed.

The provider had arrangements in place to assess the quality of service provision and care delivery for people.

Records were not always updated to reflect the needs of people who use the service. Staff records were not always updated to reflect staff training attended appraisal or supervision meetings. Care records were not updated and did not reflect changes to care plans.