This inspection visit took place on 01 March 2018 and was announced. The provider was given 48 hours’ notice because the service delivered domiciliary care to people who lived in their own homes. We needed to be sure staff in the office and people the service supported would be available to speak to us. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. For example it provides a service to older people, people with physical disabilities and people with mental health needs. At the time of our inspection there were 17 people receiving a service from the agency.

At the last inspection in June 2016 we asked the provider to take action to make improvements because breaches of legal requirements were found. The provider had failed to ensure there

were effective systems in place to monitor the safety and quality of all aspects of the service.

At this inspection visit carried out on 01 March 2018 we have rated the service Good.

During this inspection we found the management team had addressed the issues and had implemented systems to ensure people were safe. For instance we looked at how the service protected people from avoidable harm. We found risk assessments were now more robust and completed as part of people's care plans.

During this inspection, we found the management team completed a range of quality audits including improvement of auditing medication processes. These were now taking place monthly. Any issues found on audits were quickly acted upon and any lessons learnt to be implemented to keep people safe.

A new system was now in place for the administration and recording of medicines. Staff we spoke with told us it was much better and more accurate. One staff member said, “It is a really good system much more accurate with little chance of mistakes.”

We looked at care records of two people we visited in their home. Care records had been improved and were now informative and organised so staff could identify what support and tasks were required for the person.

People who used the service and their relatives/carers told us staff were caring and kind towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

The management team deployed sufficient staffing levels to provide support people required in their own homes. There was evidence by talking with people who used the service and relatives they found staff showed concern for people’s wellbeing. They responded quickly when people required their help.

The service had systems in place to record safeguarding concerns, accidents and incidents and took necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We found there was an appropriate skill mix of staff to ensure the needs of people who used the service were met. New staff worked alongside experienced staff members and shadowed them to ensure they understood their role in people’s homes.

The management team planned visits to allow staff members enough time to reach people and complete all allocated tasks safely.

Care plans were organised and had identified the care and support people required. We found they were personalised and informative about care people received. They had been kept under review and updated when necessary. They reflected any risks and people’s changing needs.

Where appropriate in people’s care plans, meals and drinks were prepared for them. Staff had received food and hygiene training to ensure they were confident when preparing meals in people’s homes.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People were supported to have maximum choice and control of their lives and staff support them

This inspection took place on 21 June 2016. The provider was given 24 hours’ notice of the inspection so that arrangements could be made to have the necessary information available for us.

Community Life Choices is a domiciliary care agency, which provides support to people in their own home. The agency operates from a well-equipped office in the docklands area of Preston. At the time of this inspection there were 33 people who used the service.

At the time of the inspection, a new management team had been appointed. One of the new managers had submitted an application to the Commission to become 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 2008 and associated Regulations about how the service is run.

The last inspection of this service took place on 25 January 2016. During this inspection we found breaches of regulations relating to dignity and respect, safeguarding people from abuse, safe care and treatment and governance. There were also breaches identified at an earlier inspection in November 2015, in relation to medicines management, receiving and acting on complaints and staffing. During the inspection carried out on 25/01/2016 the service was rated as inadequate in the areas of safe and well led, which led to an overall rating of inadequate and the service being placed in special measures.

During this inspection we found significant improvements had been made in all areas we assessed. However, there were some areas identified as requiring further improvement. As the overall rating for this service is no longer Inadequate the service will no longer be in special measures.

People who used the service told us they felt safe and that care workers were able to meet their needs. Risks to the health, safety and wellbeing of people were assessed. However, identified risks were not always addressed by robust care planning. This meant that staff did not always have the information they needed to care for people in a safe manner.

Improvements to the way people’s medicines were managed were demonstrated. We found improvements in relation to record keeping and staff training. However, arrangements for managing medicines required further development to ensure people were protected against the risks associated with unsafe medicines practice.

Systems for monitoring the quality and safety of the service provided were significantly improved. However, we identified some areas that required further development to ensure they were fully effective.

We found that the provider took appropriate action to ensure that any restrictive practices were carried out in accordance with the Mental Capacity Act and associated legislation. People we spoke with reported being asked for their consent before care was provided. However, we found some examples where consent to care had been given on behalf of people who used the service, without it being determined that they had legal authority to give consent.

The care plans we viewed varied in quality. Some provided a good level of person centred information and were based on the individual needs and wishes of the person they belonged to. However, others were found to lack personalised guidance and did not always provide clear guidance to care workers about how people’s care needs were to be met. We also found some examples of care plans, which contained confusing and conflicting information.

Good improvements were noted in relation to safeguarding. Since the last inspection all staff had been provided with updated training in safeguarding and knew how to report concerns. Staff were confident that any issues they did report would be dealt with appropriately by the management team. Records showed that safeguarding concerns were identified and rep

Community Life Choices is a Domiciliary Care Agency providing care and support to people in their own homes. The agency provides services to people with a range of care needs including older people, people with physical disabilities and people with mental health needs. At the time of the inspection the agency was providing approximately 250 hours of care and support per week and employed 20 care staff.

The agency is managed from a well-equipped office in the Docklands area of Preston. The last inspection of the service took place on 18th November 2015. At this time the service was awarded an overall rating of ‘Requires Improvement.’ We found breaches in regulations relating to safe care and treatment, safeguarding people from abuse and improper treatment, receiving and acting on complaints, good governance and safe staffing. We told the provider to take action to address these issues and provide us with an action plan stating when and how they intended to achieve compliance with the regulations. At the time of this inspection, the provider was still within the allowed timescales for developing the action plan. As such, it had not yet been provided.

Following the inspection carried out on 18th November 2015, we received concerns from four people who used the service and a community professional. As a result of the concerns received, we carried out a further inspection on 25th January 2016. This inspection was unannounced.

This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Community Life Choices Head Office on our website at www.cqc.org.uk

The registered manager assisted us throughout the 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. The registered manager of this service was also the provider.

People who used the service raised a number of concerns regarding the service. These included concerns about care workers arriving late or in some cases, not arriving at all. All four people also told us that care workers often cut their visits short and didn't stay for the right amount of time.

People also expressed concerns about the competence of some carers to move and handle them safely. Two people told us they had experienced situations where care workers had caused them discomfort because they hadn't moved them in the correct way. Both people told us they had reported their concerns to managers at Community Life Choices but didn't feel appropriate action had been taken.

People told us they didn't feel comfortable when expressing concerns about the service to members of the management team. Some described receiving unhelpful responses and said at times they had been treated disrespectfully or in an unkind manner by managers. However, all those we spoke with told us that there were some care workers who were very kind, helpful and caring.

We found evidence that allegations of abuse were not always reported in line with the correct procedures and managers did not always take the appropriate action to safeguard people who made allegations. During this inspection we found evidence that three allegations of abuse or neglect had been made by people who used the service but had not been reported.

We found evidence that complaints made by people who used the service were not always taken seriously or investigated properly.

Evidence was also found to support the concerns people had raised with us about the way the management team communicated with them. We saw examples of very poor communication, which was unhelpful and unprofessional.

We identified serious concerns about the management of staff rotas. We found a number of examples of badly organised staff rotas which were unmanageable because care staff were frequently rostered to be supporting more than one person at the same time. This supported the information we received from people regarding the unreliability of their service.

We found ongoing breaches of the Health and Social Care Act 2014 relating to dignity and respect, safeguarding people from abuse and good governance.

Following this inspection the overall rating for this service is ‘Inadequate’ and the service has been placed in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The concerns identified during this inspection were reported to the Local Authority Safeguarding team and the Local Authority Contracts Commissioning team.

You can see what action we have taken at the end of the full version of this report.