We carried out an announced inspection of this service on 17 January 2019.

Chosen Services UK Limited is registered to provide personal care to people in their own homes. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’. Where they do, we also consider any wider social care provided. At the time of our inspection, the service provided personal care to 25 people in their homes.

The service had 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

At our last inspection on 20 November 2017 the service was rated ‘Requires Improvement'. We found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook this inspection to check if the service had made the required improvements.

Previously, we found that medicines were not always managed safely. Medicine administration records were incomplete as they did not outline the name or the dose of the medicine being administered. This was a breach of Regulation 12 of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 for ‘Safe care and treatment.’ During this inspection we found this breach had been addressed.

Previously we found there were insufficient systems in place to maintain an accurate and complete and record in respect of each person. Policies were not always up to date. The systems to manage staff timekeeping was not robust enough to reduce missed and late visits. This was a breach of Regulation 17 of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 for ‘Good governance.’ During this inspection we found that this breach had not been fully addressed; timekeeping and policy updates were satisfactory, but we continued to find shortfalls in the systems in place to maintain accurate records about people. We also identified two further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that risk assessments were not sufficient and did not ensure people were kept safe from potential harm. This was a breach of Regulation 12 of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 for ‘Safe care and treatment.’

We also found that the service was not obtaining consent to care and support from the relevant person and was not complying with the principles of the Mental Capacity Act 2005. This was a breach of Regulation 11 of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 for ‘Need for consent.’

The service managed medicines safely. There were sufficient numbers of staff employed by the service and people received their care on time. People using the service felt safe with their carers. Recruitment systems were robust and staff had been recruited safely. People were protected from the risk of infection. Accidents and incidents were evaluated to continuously improve the service.

The service completed pre-admission assessments to ensure the service could offer them the best support. Staff undertook regular training and received regular supervision and an appraisal to enable them to provide effective care. We found that the induction process was inconsistent; a recommendation was made to review the induction processes. People were encouraged to live a healthy lifestyle and were supported to eat well and keep hydrated. People received support from various health and social care professionals.

People were protected from potential discrimination. People and their relatives felt involved in the running of the service and could have an input into the care and support provided. People and their

This announced inspection took place on 20 November 2017. Following the last inspection on 29 and 30 September 2015, we asked the provider to complete an action plan to show what they would do and by when to improve in the CQC key questions of "safe", "effective", "responsive" and "well-led" to achieve at least a "Good” rating. During this inspection we found that although improvements had been made, they were not enough to achieve an overall rating of "Good". We made further recommendations, as some areas such as record keeping and medicines management needed to be addressed. This is the second consecutive time the service has been rated "Requires Improvement.”

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. At the time of our visit there were 20 people using the service mostly from the London Borough of Barking and Dagenham.

On the day of our visit, there was a registered manager in place. 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.

During this inspection we found two continued breaches to regulations. This were in relation to medicines not always managed safely. Although there were quality assurance processes in place; the governance structures had not yet addressed the quality issues we identified on the day of inspection.

We made recommendations ensuring comprehensive risk assessments were in place for people.

There were safe recruitment systems in place. However we identified a few shortfalls in the training of staff. Staff although they were aware of consent and choice had limited understanding of the mental capacity act and had not always attended appropriate training.

Assessments took place before people started to use the service and were reviewed every six months. However care plans were not always specific or person centred. Daily care records did not always state the time of the visit in order to evidence that care was being delivered within appropriate timelines.

People told us they felt safe and trusted staff, who looked after them.

People and their relatives told us they were treated with dignity and respect and had had some involvement in planning their care. They told us they were able to raise complaints without any fears and thought the registered manager had tried to resolve any issues.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff were able to tell us of the equipment checks in place. They had access to personal protective clothing in order to prevent the spread of infection.

You can see what action we told the provider to take at the back of the full version of the report.