This announced inspection took place on 10, 15 and 24 January 2019. We gave the service 48 hours’ notice of the inspection visit. This is because it is a small domiciliary care agency and the provider works as part of the management team. Carrington provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Not everyone using Carrington Home Care receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’. This includes help with tasks related to personal hygiene and eating; we also consider any wider social care provided.

At the time of our inspection, the service was providing personal care and support to 38 people living in their own homes. The last CQC inspection took place in June 2016 when it was rated as Good. However, on this inspection we judged improvements were needed in how the provider managed and ran the service. The provider has registered with CQC as an individual and therefore does not require a registered manager.

There were aspects of the service which were not well led. The registered provider had not carried out regular quality assurance audits to ensure the service was providing good quality care.

During our inspection, we found a number of areas needed to improve to maintain the safety and well-being of people; these had not been addressed by the provider. Quality assurance systems were not effective in recognising areas for improvement and there was not a timely response to initiate changes.

People were supported by staff who treated them with kindness, respect and compassion. Staff had a good understanding of the people they cared for and supported them in decisions about how they liked to live their lives. People were supported by staff who respected them. However, there were gaps in staff training and records relating to observations of staff practice and supervision.

People said the staff made them feel safe because they were kind and reliable. The management team understood their safeguarding responsibilities. Staff ensured there was a consistent approach to involving people with their care plans.

Systems in place for the recruitment and selection of staff were poorly managed by the provider. They did not ensure new staff had appropriate documentation in place to confirm they were suitable to work with people using the service. Recruitment checks were not routinely carried out before staff started their employment at the agency.

Action was needed to improve medicine training and auditing staff practice to ensure they worked in a safe manner. Potential risks to people’s health and well-being were assessed and documented.

Equality and diversity was understood to support people’s individuality. There were systems in place to gain people's views and to address concerns and complaints. People were supported to access health care professionals to maintain their health and wellbeing. The service was reliable and staff understood the importance of good infection control practice.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

We undertook an announced inspection of Carrington Home Care Domiciliary Care Agency (DCA) on 15 and 16 June 2016. We told the provider one day before our visit that we would be coming as it is a small agency and we needed to ensure there would be staff available to assist with the inspection. Carrington Home Care DCA provides personal care services to people in their own homes. At the time of our inspection 36 people were receiving a personal care service. There were 25 employed staff.

When we inspected in January 2015, we found staff had not always had the right support to do their job effectively. At this inspection, we found this had improved but further training was still needed to ensure all staff had the right skills to do their job safely and effectively.

The service has a registered manager who is also the registered provider. 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 and associated Regulations about how the service is run.

People were happy with the service they received from the agency. Comments included ‘‘I am quite happy, the girls who visit are all lovely.’’ And ‘‘I am happy with the service; they are usually on time and do what they need. Some offer to do more than required and I appreciate that.’’

People confirmed the visits were for the expected timeframes, unless staff were running late due to an emergency or traffic. People said they were usually informed if there would be a delay in their visit. People said they were aware of which staff would visit and usually this information was available via a written rota. People said they could make any concerns known to the agency and were confident that issues would be addressed. One person said ‘‘I complained about one particular carer and they were removed from visiting me…so quite happy the office listened to me.’’

Staff had support via meetings, one to one supervisions and weekly newsletters. Staff confirmed they felt supported and had enough information to understand people’s changing needs. There were some improvements needed to ensuring staff had regular updated training in key areas. The registered manager was aware they had needed to improve this. He had arranged a meeting with a training provider and gave assurances that any gaps in training needs for staff would be addressed.

Care and support was planned with the person and their relatives where possible. Where commissioning teams had contracted the support package for an individual, their care plan was available. This was used to develop the agency care plan for staff to follow. Plans were simple, clear and gave instructions to staff about how and when to deliver care and support. Risks had been identified and included details for staff about how to mitigate such risks. For example where people had moving and handling risk assessments, the plan included what equipment and how many staff were needed to ensure safe moving and handling of the person.

Recruitment of new staff ensured they were only employed once all checks had been completed to ensure they were suitable to work with vulnerable people. Staff were aware of how to protect people from potential abuse. Staff knew what types of abuse to look for and who they should report and concerns to.

The agency had auditing systems to review how the care was being delivered and how well this was recorded. People had access to the complaints policy and those we spoke with were confident their views were listened to.

We carried out this announced inspection to follow up concerns identified at our last visit in January 2014. We gave short notice of this inspection as the agency is small and we wanted to be assured we could have access to the registered office.

The purpose of this inspection was to follow up the warning notice issued to the provider. This required improvement with planning care in line with people's needs and assessment of risks to ensure people's care and support was being delivered safely.

During this inspection we spoke with two staff and the provider at the agency office. We looked at the care records for four people. We spoke with three people who use the service and a relative over the telephone.

People using the service told us the staff delivered the care and support they needed. For example, one person commented “They know very well what my needs are” and “A team leader came and asked a lot of questions. They left a folder for staff to follow, which has all the information about my medical condition and other information in it”. Another person said “We had a talk about my care plan”. The same person told us potential risks such as falls had been discussed and staff followed the agreed plan, which they found “Very reassuring”.

In four care files, we saw needs assessments had been carried out at recent reviews. This covered risks to the person and care workers in the home environment, moving and handling, a ‘pen picture’ about the individual and a daily task sheet.

We found the service compliant with the warning notice because improvements had been made with risk assessing and care planning processes. Staff were following the information in care files when they delivered care and support for people. This meant the potential risk of people receiving unsafe care and support was reduced. We have made a compliance action specifically about records to further promote improvement of person centred care planning. We will carry out a further visit to check whether the provider has complied with this compliance action and others made at the last inspection regarding recruitment practice and quality assurance systems.

When this agency was inspected in February 2013, we found non compliance in two outcome areas, care and welfare and quality assurance. We asked the provider to send us an action plan about how he intended to achieve compliance. We were not sent the action plan in the required timeframe. We contacted the provider and we were told had not received a copy of their report. This was because they had failed to tell us their email address had changed. The the provider was sent a further copy of their inspection report and we received an action plan in which the provider said they would be fully compliant by the end of November 2013.

We gave short notice of this inspection as the agency is small and we wanted to be assured we could have access to their registered office. We visited the agency's registered office on 17 January 2014. We looked at the care files and care plans of five people who recieved services. We also looked at the recruitment files of three staff as well as staff meeting minutes, surveys completed by people and records relating to complaints.

Following the office visit we rang six people who received services and spoke with four staff. People were generally positive about the care and support they received. One person told us ''I am completely satisfied, the staff are lovely.'' Another person said ''You do get the odd one (staff) who you don't get on with, but mostly they are good, very kind.''

We found the agency had not planned care in line with people's needs and had not assessed risks to ensure people's care and support was being delivered safely. We also found non-compliance in their quality assurance systems, which had failed to pick up the fact there were gaps in their risk assessing and care planning processes. This meant people were at potential risk of receiving unsafe care and support.

Although we found the agency had sufficient staff, recruitment processes were not robust. This meant people may have been at risk of being cared for by staff who were unsuitable to work with vulnerable people, because the agency recruitment processes did not make the relevant checks.

At the time of the inspection Carrington Home Care were providing personal care and/or domestic assistance to 59 people. We spoke to five people who were using the service to get their views on the care provided and to one person's relative.

Some people’s comments about the agency as a whole were “I can’t fault it”, “they’re very good”, “I’m pleased with them” and “generally ok”.

In particular people were complimentary about the care staff who visited them. People told us they were “very kind” and “always offer to go beyond the call of duty”. People told us staff did not always have sufficient time to travel between appointments.

People told us how staff worked with them to meet their needs. One person told us "they come in, shower, dress me, help me with breakfast. My health's deteriorated and they help me with whatever I need that day".

We found inconsistency in the way people's care was planned and in how staff planned to manage risks.

People told us that staff offered them choices and staff did “anything I want them to do”.

There was a clear safeguarding procedure in place and people told us they felt safe with the “trustworthy” staff who visited them.

We did not see evidence of a quality assurance system being in place to monitor the quality of care provided. People felt able to approach staff at the office with concerns but had mixed feelings about whether they felt the agency responded to their views and requests.

We undertook an announced inspection of Carrington Home Care Domiciliary Care Agency (DCA) on 12 and 29 January 2015. We told the provider two days before our visit that we would be coming as it is a small agency and we needed to ensure there would be staff available to assist with the inspection. Carrington Home Care DCA provides personal care services to people in their own homes. At the time of our inspection 40 people were receiving a personal care service.

When we inspected on 7 October 2014 we found people were not also fully protected from unsafe care and support. This was because staff had not always received the training they needed to do their job safely and effectively. We also found some newer people to the service had not had their needs fully assessed including any risks to themselves or staff and care plans were not always in place in a timely way. As this was a repeat failure to meet this regulation we issued a warning notice in relation to regulation 10, which set out why the service was failing to meet this regulation.

During this inspection we found people were kept safe and free from harm. There were appropriate numbers of staff with the right skills to meet people’s needs. Improvements had been made to ensure staff were receiving the necessary skills and training to do their job safely and effectively, although they were not always being offered supervision and support in a one to one meeting.

Staff recruitment processes were robust to help ensure only staff who were suitable to work with vulnerable people had been employed. New staff received an induction, but this was not always fully documented.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place at the point a service was started. These detailed how people wished to be supported and showed people were involved in making decisions about their care. This was an improvement from the previous inspection. Staff confirmed they were no longer expected to visit new people without first having detailed information about their assessed needs and preferred routines. This had been a particular issue when we last inspected. The registered manager had made the decision not to take on any new people until they had systems in place to ensure the care plans could be developed and reviewed by staff with the right skills to do this effectively.

People told us they liked the staff and looked forward to the staff coming to their homes. People said staff were kind and respected their privacy and dignity and that they usually turned up at the time they were expected.

People were supported to eat and drink and staff had skills to assist people with complex healthcare needs. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. Where needed health care professionals had been consulted to ensure staff were using the right equipment to meet people’s needs safely.

People and staff working for the agency were confident their views were listened to and systems were in the process of being set up to ensure people’s care and support was reviewed with them on a regular basis.

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 and associated Regulations about how the service is run. The registered manager was ensuring he was more accessible to people and staff. There had been some changes to the office management and this appeared to have a positive outcome. Staff felt more able to voice their views and understood the management structure. Staff said there was a clearer vision about the service and how they provided care and support. Staff acknowledged there had been more training and meetings to help them feel more like part of a valued team.