This inspection took place on 8 and 9 June 2017 and was unannounced. CareXL is registered with the Care Quality Commission (CQC) to provide personal care and delivers a domiciliary care service to people living in their own homes. At the time of the inspection CareXL was providing 137 hours of care and support each week to 16 people.

There was a registered manager in post. 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.

Since our last inspection in November 2016 the provider had strengthened the quality assurance processes that they used to monitor the care and support that people received. People could now be assured that a system of quality assurance was used that was well coordinated and effective at levering improvements in people’s care and support. However. These systems had been recently introduced and were not yet embedded into practice. The leadership, governance and provider oversight had improved and the registered manager was now well supported by a visible provider. However. when we inspected in November 2016 the well-led domain was rated as inadequate. The provider has provided evidence that improvements have been in place since March 2017 and we have rated well-led as requires improvement because the provider has not demonstrated a sufficient track record of compliance to reflect a rating of good.

The provider had also made improvements to the way in which people’s medicines were managed. People could now be assured that they would receive their prescribed medicines safely.

People were safeguarded from harm as the provider had effective systems in place to prevent, recognise and report concerns to the relevant authorities. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.

People’s care records contained risk assessments and risk management plans to mitigate the risks to people. They gave information for staff on the identified risk and informed staff on the measures required to minimise any risks.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make an informed decision and encouraged people to make their own choices.

Staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Training records were up to date and staff received regular supervisions and appraisals. Staff were clear about their roles and responsibilities in caring for people and received regular support from the provider.

Staff were vigilant regarding people’s changing health needs and sought guidance from relevant healthcare professionals.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The provider and senior management team were visible within the service and were accessible to staff and people receiving care and support.

This announced inspection took place over three days on the 15 and 17 and 18 November 2016.

CareXL is registered with the Care Quality Commission (CQC) to provide personal care and delivers a domiciliary care service to people living in their own homes. At the time of the inspection CareXL was providing care and support to 24 people.

Following the last inspection of CareXL in June 2016 the provider was rated as inadequate and placed into special measures. During this inspection we found that the provider had implemented improvements in a number of areas however, the systems implemented to ensure that people consistently received safe care were not robust enough. There was a lack of oversight of people’s care and support from the provider. This inspection found that there was not enough improvement to take the provider out of special measures and that the well-led domain remained inadequate.

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 to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was not a manager in post registered with CQC however; the provider had recruited a new manager who had submitted an application to CQC to become the 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.

People could not be assured that they would receive their prescribed medicines safely. The records of people’s prescribed medicines were not always accurate and we found examples where people’s prescribed medicines had not been administered by staff.

Staff had not received all of the training required to equip them with the skills and competencies to provide safe care to people. A formal system of supervision had not been implemented and staff did not always receive the support that they required to work effectively in their role.

The provider had failed to implement an appropriate system of quality assurance audits in order to identify and address shortfalls in the service. When shortfalls had been identified timely action to rectify these was not always taken by the provider or manager. The provider had not provided adequate support of resources to the manager to enable improvements to be made in all areas of the service.

People’s care records contained risk assessments and risk management plans to mitigate the r

This unannounced inspection took place over two days on the 20 and 23 June 2016.

CareXL is registered with the Care Quality Commission (CQC) to provide personal care to people living in their own homes. At the time of the inspection CareXL was providing care and support to 26 people.

There was not a registered manager in post however the provider had just recruited a new manager who told us that they would submit an application to CQC to become the 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 service did not have systems in place to protect people from harm. Appropriate pre-employment checks and references were not sought for new staff prior to commencing their employment. Some staff had been employed with no previous skills or care experience in relation to providing care to people. People received care from staff that had not received any training or supervision to enable them to carry out their roles to meet people’s needs.

Staff were unaware of their responsibilities of safeguarding vulnerable people and did not know how to report any concerns. There was no system in place for people to complain and the provider did not recognise or respond to situations where people had complained.

There were not enough staff to meet people’s needs. People did not always receive the care that the service had been commissioned to provide. People did not always receive their personal care, medicines or meals as staff did not always turn up to provide their care.

There was no system in place to assess people risks or plan care to mitigate their risks. Some people did not have care plans to instruct staff on how to meet their needs, where care plans were in place they had not been reviewed for over a year. Staff were not aware of people’s care needs as there were no care plans that related to their current needs.

People’s medicines were not managed safely. Staff had not received training in managing people’s medicines and people could not be assured that they had received all of their prescribed medicine.

Staff did not receive an adequate induction prior to delivering care and support unsupervised and did not have adequate access to ongoing supervision support or personal development. Staff did not have access to training in key areas such as moving and handling, food hygiene or medicines administration. This placed people at risk of receiving inappropriate care and support because staff did not have sufficient skills, knowledge or experience to care for people safely.

People’s needs were not assessed before their care and support was delivered by staff and a number of people had no individual plans of care in place for staff to follow. This placed people at risk of receiving inconsistent care and support.

There were no quality monitoring systems in place and the provider was not aware of all of the shortfalls in the service that we have identified.

At this inspection we found the service to be in breach of eight regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 and one regulation of the Care Quality Commission (Registration) Regulations 2009. The actions we have taken are detailed at the end of this report.

The overall rating for this service is 'Inadequate' and the service is therefore 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 to have been providing inadequate care should have made significant improvements within this timeframe. If not enough impr