This unannounced comprehensive inspection was carried out on 30 and 31 October 2018. This was our first inspection of the service since it registered with the Care Quality Commission (CQC) in July 2017.

Care and Share Associates (CASA) Liverpool is a domiciliary care agency. At the time of our inspection it was providing personal care to 132 people living in their own homes across Liverpool. CASA was established in 2004 and now operates domiciliary care services across the North West, North East and Yorkshire.

Not everyone supported by the service 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 personal care is undertaken we also take into account any wider social care provided.

During this inspection we identified a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because the service had failed to adequately monitor, assess and improve the quality and safety of the service provided. You can see what action we told the provider to take at the back of the full version of the report.

The service did not have a registered manager at the time of our inspection. However, a new manager had been appointed since the previous registered manager had left the service. We noted that the new manager was in the process of registering with CQC. 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We reviewed seven staff rotas and found evidence of ‘call cramming’. This is when carers are scheduled to complete more calls than is physically possible within the timescale provided. For example, we saw that the times of carers’ calls were scheduled ‘back-to-back’ and allowed no time for carers to travel between calls, regardless of the distance between their calls. We also saw evidence on the service’s electronic records system to show that staff did not always stay for the scheduled amount of time, known as ‘call cutting’. We acknowledged that there were several reasonable explanations for some of these instances. However, there was a lack of documented evidence to support these explanations nor could they reasonably account for every instance. This potentially left people at risk of not receiving all the care and support they need at the times they need it.

We discussed these concerns with the manager who acknowledged that they were not aware of this problem and explained that this had been the historical approach to rota scheduling at the service. During the days that followed our inspection the manager provided us with evidence to demonstrate that action had been taken to resolve these issues.

The service had systems in place to protect people from abuse and staff were able to explain what actions they would take in the event of a person being at risk of harm. Records showed that safeguarding concerns were promptly and effectively managed by the manager. However, we had not always been notified of safeguarding concerns as we should have been.

Medicines management systems were in place. All staff had undertaken medicines training and had their competency regularly assessed. People told us they received their medicines correctly and on time. However, when we reviewed the service’s electronic medication administration records (MARs) we saw that there were numerous gaps where staff had failed to confirm they had given people their medication or record any reasons a medication was not given. This meant that the service could not be assured that people always received their medicines as prescribed.

We found that the service’s quality assurance and audit