At our last inspection, on 14 June 2018, we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because this inspection was a focused and was carried out on 04 December2018.The inspection was prompted by concerns that had been shared with us since the last inspection in June 2018 where the service was rated as good. The concerns related to the service not investigating complaints, risks not being identified, staff not staying for the time they should at peoples homes and pressure care. No risks, concerns or significant improvement were identified during the focused inspection.

The service provides a rehabilitation service and Domiciliary care service to people living in their own home. All calls to peoples home are monitor electrically, where a call in short or missed this gives an alert to the office , who then contact the staff member to establish the cause.

Care records were personal to the individual which contained detailed risk assessments including risks associated with pressure care so staff had the information to support people safety.

Complaints were investigated in full with an outcome recorded. Complaints were responded too in writing with the outcome, giving details of any lessons learnt as a result of the complaint.

Systems were in place to monitor the quality of the service provided. This ensured the service was proactive to improvement rather then reactive.

CM Community Care Services limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community and provides a service to older adults. Not everyone using CM Community Care Services 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 inspection was prompted in part by complaints shared with CQC about the service people received. This inspection examined those risks. This announced site inspection took place on 03 and 09 May 2018.

At the time of our inspection, 96 people were supported with their personal care needs by the service. 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People continued to be safe when receiving support and staff understood how to protect people from harm. People’s risks were assessed, monitored and managed to ensure they remained safe. People were supported by sufficient numbers of staff who were recruited safely. People's medicines were managed safely. Staff understood their responsibilities in relation to hygiene and infection control.

People continued to receive effective care. People continued to receive care from staff who had the skills and knowledge required to effectively support them. Support was delivered in line with good practice guidance. People's rights were protected because the manager and staff had an understanding of the Mental Capacity Act 2005 (MCA). Staff supported people to meet their nutritional needs and supported them to access health care professionals when required. People were involved in how their care was planned.

People continued to receive support from staff that were kind and caring and responsive to their needs. People's privacy was respected, and their dignity and independence promoted. People were able to make choices about their day to day lives. People knew how to raise any concerns or complaints and these were responded to in a timely manner.

The service continued to be well led, and the manager understood their role and responsibilities. Staff felt supported by the management team and were confident that they could approach the manager or provider and would be listened to. People and staff were encouraged to give feedback, and their views were acted on to develop the service. The provider worked in partnership with other agencies and teams, and there were systems in place to drive improvements.

This announced inspection took place on 25 April 2017. At our last inspection on 2 August 2016 they were rated overall as requires improvement because the provider was not meeting the requirements of the law with regards to informing us of events which had taken place. At this inspection we found improvements had been made.

C M Community Care provides personal care to people in their own homes. At the time of our inspection they were providing care to 95 people in their own homes.

There was a registered manager in place at the time of our inspection. 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 told us they felt safe with the staff who provided their care. Staff knew how to protect people from suspected abuse and what to do should they suspect abuse had taken place. People’s risks were managed by staff who had the knowledge to ensure the care they provided was safe. There were sufficient staff to meet people’s needs. Staff supported people to have their medicines when they needed them.

People told us staff had the knowledge and skills to support them. Staff told us the training they received enabled them to meet people’s needs. People had capacity to make decisions about their care. Staff supported people to meet their nutritional needs when required. Staff understood what action to take when people’s health needs changed.

People were supported by kind and considerate staff. People told us staff encouraged them to maintain their independence. People were supported by staff who respected their privacy and dignity.

People were involved in their care and supported by staff who understood their needs and respected their individual choices and preferences. When people had complained there was a system in place which meant they would be listened to and any appropriate action would be taken.

People told us they were happy with the care they received and would recommend the service to others. People had the opportunity to comment on how the service was run. Staff felt supported in their role. The quality assurance system in place meant that people received care which was safe and effective and responsive to their individual needs.

This inspection took place on 2 August 2016 and was announced. On 26 August 2015 we carried out a follow up inspection to check whether the requirements of two warning notices we had issued in respect of safe care and treatment and governance were being met. At that inspection we found that sufficient improvements had been made to meet the requirements of the warning notices. The service was rated as requires improvement. At our recent inspection we found that further improvements were being made.

CM Community Care Services Limited -30 Waterloo Road provides personal care for people in their own homes. At the time of our inspection there were approximately 279 people receiving a service.

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.

The registered manager was not always fulfilling their legal responsibility to keep us informed about any accidents or incidents that occurred whilst people were receiving a service. This is a breach of regulations. You can see what action we told the provider to take at the back of the full version of the report.

People were receiving an improved service because they were not experiencing missed calls however, improvements in the management and monitoring of the quality of the service were needed to ensure that people received a personalised service at their preferred times and with more regular staff.

People were kept safe from harm because staff were knowledgeable about the types and signs of abuse and the actions to be taken if abuse was suspected. Risks associated with people’s care had been assessed and plans put in place to manage them. Recruitment processes helped to ensure that only suitable staff were employed to support people in their own homes.

There were sufficient numbers of staff available to ensure all calls were attended.

People were supported to receive their medicines as prescribed.

People were supported by staff that received training, supervision and advice to carry out their roles.

Staff ensured that people gave consent to the care they received and supported them to make decisions and choices about their day to day care so that their human rights were promoted.

People were supported by staff that were kind, caring and respectful and that helped people to remain as independent as possible.

People were involved in planning their care and reviews so that changing needs were identified.

People were able to raise any concerns they had.

We inspected the service 26 August 2015. The inspection was unannounced. We inspected the service to make sure the requirements of the warning notices in relation to safe care and governance had been met. We found the provider had made improvements to their systems which check whether people received the calls they needed. Further improvements were needed in the way that medicines were managed.

CM Community Care Services Limited -30 Waterloo Road provides personal care for people in their own homes. At the time of our inspection there were approximately 350 people receiving the service.

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 provider had improved upon the length of time staff were spending with people, although some calls were still cut short and missed.

The provider had improved the system for supervising staff and making sure they were supported when they delivered care to people.

The provider had improved the checks they undertook as part of the quality monitoring of the service. Changes in the management of the service had taken place but improvements were still needed to make sure records were up to date, people were supported with their medicines appropriately and calls were delivered on time.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was announced, which meant we gave the staff and provider 48 hours notice that we would be inspecting the service. This was to ensure that the registered manager was at the office on the day of our inspection.

The service is registered to provide personal care to people living in their own homes. At the time of our inspection 343 people used the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At the last inspection on 12 March 2014 the provider needed to make improvements to ensure people received care calls at agreed times and improve support for workers in relation to training. The provider sent us an action plan telling us what improvements they would make.

During this inspection we found that the provider had made improvements to training records to demonstrate that staff received mandatory training to undertake their role. This was confirmed by staff that we spoke with.

We found that people received late care calls and further improvement to service delivery was required. The registered manager told us that she had implemented a call monitoring system that was being tested in one geographical area before being rolled out to the remaining three geographical areas where the service provided care. She told us this system would identify where calls took place and when calls times were not completed on time to enable her to address this.

The provider had not consistently responded to concerns people had raised. This meant that the quality of service was not consistently delivered to the satisfaction of people who used the service.

Eight out of ten staff reported low morale and did not always feel supported in their role with respect to rotas and communication from the office.

During our inspection we found there was adequate staffing to meet the needs of people who used the service.

Arrangements were in place to request heath, social and medical support to help keep people well.

Staff were kind, caring and respectful to people when providing support and in their daily interactions with them.

There were processes in place to drive service improvements.

Records showed that we, the Care Quality Commission (CQC), had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

We carried out this inspection as a result of a number of pieces of information of concern which were shared with us from different sources. These came from professionals, people who use the service and their representatives. Concerns included a lack of skills and training for some staff; missed and late visits; visits being rushed and the management team being unresponsive and dismissive of complaints and concerns raised by people.

As part of the inspection we spoke with five people and their representatives, nine staff and the provider. We looked at six people’s care records. In addition to speaking to people we posted 60 questionnaires to people who used the service to gauge their views. Seven people responded to these posted questionnaires, along with five representatives.

Most people told us they were happy with the service they received while others were less positive about their experience. The most common area of concern people expressed was about staff not arriving at the agreed times for visits.

People we spoke with were complimentary about staff. One person told us, “They’re good”. However, some people told us that newer members of staff seemed less skilled in delivering care and were not always aware of how to support people’s needs.

The provider was implementing a new system which would assist in auditing aspects of care such as the arrival and departure times of staff on visits. One person told us that the provider did respond to issues, but that matters would start to reoccur after a period of time.

During our inspection we spoke with 33 people and their representatives, five members of staff and the manager. We looked at five people’s care records.

We found that people’s consent to care was sought. One person said, “Yes, they do ask permission”.

People received the care which was outlined in their care records, which was reviewed to meet their needs. One relative told us, “X tells me they do a good job. They’re responsive”.

Staff used equipment correctly and followed guidance to minimise the risk of infection. One person told us, “They always wear gloves and aprons”.

Staff were skilled in carrying out their roles. However, we found that the provider did not maintain an up to date staff training record to assist with the identification of training needs.

The provider carried out audits of care to ensure people received safe care.

We did not speak directly with people who use the service as the actions we required focused on the improvement of documentation and paperwork produced by the organisation.

We therefore visited the agency offices as part of this review, asked for an updated action plan and looked at information we have received about this provider since our last vist in February 2011.

People told us that they were very happy with the service they received from CM Community Care. They said the staff supported them in a way which involved them. They said that staff generally helped them with tasks such as shopping, cooking, medication and personal care such as washing and dressing.

People said they were involved in developing a support plan, which told staff about them. They had a copy of their support plan, which they kept in their homes. They told us that someone from the agency did come out and talk to them about their plan.

People told us that they felt confident to make a complaint although those we spoke to said they did not really have anything to complain about. People told us that they knew the staff well and could talk to them about anything. People said that staff were always respectful and always checked with them before supporting them or delivering any personal care.

People told us that they received support with their medication when they needed it and that staff always left them feeling safe.

We undertook an unannounced inspection of CM Community Care Services Limited - 30 Waterloo Road on 22 May, 26 May and 28 May 2015. At the last inspection in July 2014 the service was meeting the regulations with all of the areas that we looked at, but was rated overall as “requires improvement”.

CM Community Care Services Limited - 30 Waterloo Road provides personal care for people in their own homes. At the time of our inspection there were approximately 350 people receiving the service.

There was a registered manager in post at the time of our inspection. 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.

Some of the people and relatives we spoke with praised the service, but some people and relatives expressed concerns about the safety and quality of the service provided.

Some people and relatives told us the service was safe, while others felt it was not. People told us about specific instances where they had not felt safe with staff.

Staff were not always on time for visits and this effected people negatively. Call times were sometimes cut short. Staff’s ability to be on time and complete full visit times was sometimes affected by them being given additional visits to complete.

We could not be assured that people always received the medicines they needed to support their health, as medicines administration records showed significant gaps in people being given their medicines.

Staff did not always use appropriate infection control procedures while providing care. However, staff we spoke with were aware of proper infection control techniques.

Some people and relatives felt staff were skilled at their jobs, while others did not. Staff told us they had received adequate training.

Most people said staff respected their rights. The registered manager demonstrated that they knew what steps to take if they suspected a person’s ability to make decisions was declining.

While some people were provided with adequate food and drink by staff, some people’s regular food intake was affected by inconsistent visit times.

Some people found staff to be caring, while others had raised concerns about staff attitude. Some people told us they felt listened to by staff and management, but others told us that the provider was not responsive to them.

Some people told us that staff respected their dignity and privacy. However, we were given examples of when staff had failed to support people’s dignity. People told us they sometimes felt rushed by staff.

Some people told us that the staff who visited them frequently changed and so staff were less aware of their needs. Other people received care which suited their needs.

The provider advertised their complaints process to people, so they would know how to raise an issue. People gave us a variety of views on how well the provider handled complaints.

People held differing views as to whether the service was well managed. We found that the provider’s auditing processes were not effective in identifying some of the issues we discovered during the inspection. We found that some care records were not always consistent or updated.

Staff told us that they were well supported in their roles by the management team.

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

The overall rating for this provider is ‘inadequate’. This means that is has been placed into ‘special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made
• Provide a clear timeframe within which the providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measure will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.