This inspection took place on 9 and 10 October 2018 and was announced. At our last inspection in February 2018, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to Regulation 12: safe care and treatment, Regulation 19; fit and proper persons employed, Regulation 9; person centred care, Regulation 17; good governance, Regulation 18; staffing and Regulation 16; receiving and acting on complaints. The service was therefore rated as Inadequate and placed in special measures. Services that are in special measures are kept under review and inspected again within six months from the publication of the report. We expect services to make significant improvements within this timeframe. We met with the provider and asked them to complete an action plan to tell us what they would do and by when to improve the service.

At this inspection we found that improvements had been made and the provider is no longer in breach of Regulations 9, 12,16, 17, and 18. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this home is now out of special measures. We have awarded an overall rating of requires improvement. However, we found that not all the necessary improvements had been made in ensure all the required checks for newly recruited staff had been made. Therefore the provider is in repeated breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service 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 adults. Not everyone using Carers Elite 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.

There was 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.

There were enough staff to keep people safe and to meet their needs. People felt safe when receiving care and support. Systems were in place to protect them from the risk of abuse. Risks to people’s safety and individual needs and preferences were managed well.

Most of the required checks that are made to ensure potential new staff are suitable to work with vulnerable people were completed including a Disclosure and Barring Service check. The provider had not gained the full work history for three newly recruited staff as is required by the regulations. The provider did not have a system to audit that all recruitment checks were in place before applicants started employment. This was addressed and changes implemented during the inspection.

The registered manager and staff had undertaken basic training and improved their knowledge of the Mental Capacity Act 2005 (MCA) since our last inspection. Care records had been improved to include any considerations regarding the MCA although information was very basic. Further work to improve this was on going.

Staff had received training in a number of different areas to provide them with the skills and knowledge to support people effectively. Further training was to be provided to staff regarding dementia care to help them develop their skills further and gain confidence. Staff received adequate support and guidance in their roles.

People’s healthcare was monitored and any needs met. Relationships had been developed with outside healthcare professionals who visited the home regularly in response to any concerns raised.

People were offered choice and were involved in making decisions about th

This service 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 approximately 80 older adults, younger adults and disabled adults predominately in West Norfolk.

Not everyone using Carers Elite Limited receives regulated activity; The Care Quality Commission (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.

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 a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to person centred care (Regulation 9), safe care and treatment of people using the service (Regulation 12), complaints (Regulation 16), good governance of the service (Regulation 17), staffing (Regulation 18) and fit and proper person employed (Regulation 19). We are taking action against the provider for failing to meet regulations.

Risks to people's health were not always identified. Where they were identified, the service had not always taken appropriate actions to minimise the risks to people's welfare. In some cases, potential risks to people had been inaccurately assessed. People were placed at risk.

The numbers of staff available and their deployment was not effective in ensuring people’s needs were met in a timely way. People had received late and missed calls. These incidents were not recorded accurately and actions to avoid a repeat of these were not always taken.

Staff training and checks of their competency, to ensure that they could meet the needs of people, had not been fully completed. Staff did not receive supervision to support them in their role. Staff had not received appropriate levels of training in dementia awareness and end of life care. Recruitment of staff was not robust.

Staff were kind and caring but did not always respect professional boundaries. Staff sought peoples consent before providing them with support. Staff promoted and encouraged people to be as independent as possible.

People's care plans did not contain accurate, up to date or clear information for staff to help ensure that they provided a safe and good standard of care and support to people. People’s preferences had not always been identified so that staff could provide care in the way people wanted.

Complaints to the service had been not been managed in line with the provider’s stated procedure. They were not used to develop and learn and drive the service forward.

The provider's quality assurance was inadequate and auditing systems were not robust and had not identified the concerns we found during this inspection. Checks were not carried out to ensure that safe, good quality care was provided.

The registered manager had not completed an appropriate qualification as was required at the point of their registration with the CQC. The registered manager did not have sufficient knowledge and understanding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found t