CCK Support Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of the inspection the service was providing care for 18 older people including people with physical disabilities, mental health problems and people living with dementia. The service was provided in Canterbury, Whitstable, Herne Bay and surrounding areas.

Not everyone using CCK Support Ltd 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.

The service was run by two registered managers, both of whom were present at the inspection visit to the office. 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.

At the last inspection on 20 and 22 September 2017, the overall rating of the service was ‘Requires Improvement. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Registration Regulations 2009. People could not be assured they would be protected from abuse; medicines were not well managed; care plans were not always personalised; some records were not accurate; and the quality of the service was not checked to make sure risks to people were minimised. Furthermore, the provider had not notified the Care Quality Commission of all events and incidents as required.

We asked the provider to send us a plan setting out the actions that they would take to meet these legal requirements. The provider returned the action plan within the agreed timescale and told us they would meet all breaches of regulations by 30 January 2018.

At this inspection on 5 and 7 November 2018, we found that the provider had made improvements in protecting people from abuse, medicines, care planning, managing risk, record keeping and informing us of important events. However, the provider continued to have ineffective systems in place to monitor the quality of the service. We also found an addition breach of regulation in that not all staff that supported people with equipment had received training in how to do so safely.

This is the second time the service has been rated as RI.

You can see what action we have asked the provider to take at the end of this report.

People and relatives told us they trusted staff and felt safe. Staff had received training in how to safeguard people and knew how to follow the service’s safeguarding protocols keep people safe.

Assessments of potential risks in the environment and with regards to people’s health and welfare had been carried out. Guidance and strategies had been developed which staff followed to protect people from avoidable harm. Accidents and incidents were monitored to see if there were any trends or if lessons could be learned.

Improvements had been made to the management of medicines. Staff had received training in how to give people their medicines and knew how to follow the service’s medicines policy. Medicines were audited and investigations took place to make sure people received their medicines as prescribed by their doctor.

Suitable recruitment checks were in place for new staff. People had their needs met by regular staff who were available in sufficient numbers.

Improvements had been made to the frequency that staff received formal supervision. Staff were supported by a management team that listened and responded to their views.

People’s health and nutritional needs were monitored. Referrals were made to health care professionals and their advice was acted on. People were encouraged to eat and drink to maintain good heal

The inspection took place on 20 and 22 September 2017and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection to make sure people we needed to speak with were available.

The service provided care and support to adults with a variety of needs living in their own homes. This included people living with dementia and physical disabilities. At the time of the inspection the agency provided personal care for ten people. They also provided support for other people with their shopping and activities but this type of support is not regulated by the Care Quality Commission (CQC).

The service is run by three registered managers. 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.

This was the first inspection of the service as they had moved locations and appointed two registered managers in April 2017. The registered managers had not identified the shortfalls found at this inspection. The audits in place had not ensured that the quality of the service was checked to assess the care being provided.

Policies and procedures had not been updated in line with current practice and legislation.

Although feedback about the service had been gathered from people and staff, other stakeholders such as health care professionals had not been sent a quality survey. The results of the surveys for people and staff had been analysed but this overview had not been distributed to ensure people were aware of the outcome.

Medicines were not being managed or administered safely. In some cases medicines could not be accounted for and some medicines were being left out for people to take after the staff had left their homes without full risk assessments in place to ensure this practice was safe. Medicine records were not clear to confirm that people were receiving their prescribed medicines. The medicine policy did not have full guidance for staff to follow.

Not all risks associated with people’s care had been identified, therefore guidance about how to manage risks and keep people safe were not in place. Staff were able to tell us how they moved people safely but this guidance was not in the care plans. Some people had medical conditions such as diabetes, and the care plans did not detail what signs and symptoms would indicate that their condition had become unstable. There was a risk that staff may not recognise the signs if a person was becoming unwell and when to seek medical advice.

People and relatives told us they felt safe whilst being supported by the staff, however the safeguarding policy was not up to date and although staff had received training on how to keep people safe, this had not been updated. Staff did not have a good understanding of how to report safeguarding concerns to the local authority safeguarding team.

Staff training was being provided but in some cases training had not been updated so that staff were aware of the latest guidelines and legislation. Staff had received medicines training however; senior staff had not observed staff practice to ensure they had the skills and competencies to administer medicines safely. Staff were not receiving regular supervision in line with the company policy.

Staff completed a full induction, which included shadowing experienced staff so they were aware of people’s needs and routines. Staff told us that they checked equipment such as hoists to ensure they had been serviced and were safe to use.

People said the staff asked for their consent when they supported them with their care. However people’s mental capacity had not been assessed to ensure that staff had an understanding of how this impacted on people’s daily lives.

People told us that the staff