This comprehensive inspection took place on 16, 17, and 20 August 2018 and was announced. We last inspected this service in August 2017 and rated the service ‘Requires Improvement’. Four breaches of legal requirements were found. After the last inspection the provider told us what they would do to meet the legal requirements in relation to the breaches. At this inspection we repeated the rating of the service ‘Requires Improvement’.

We checked what actions the provider had taken to address the breaches and improve the service. We found the provider still needed to make improvements on risk assessments, care pans and quality assurance systems. However, we found the provider had made improvements in providing new staff with induction and shadowing opportunities when they started work.

Cornerstone Care Services Professionals Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It is registered to provide a service to adults 18-65 years old, people living with dementia, people with learning disabilities or autistic spectrum disorder and older people. At the time of the inspection, 16 people were using the service.

Not everyone using Cornerstone Care Services Professionals 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. At the time of this inspection 16 people were using the service.

The service did not have a registered manager. However, a new manager had been employed by the provider and had applied to CQC to be a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered care homes, 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 service was not always well-led. The provider did not have effective systems to manage the service. The systems for staff recruitment were not fully implemented to ensure people were supported by who were appropriately checked. Care plans were not organised in such a way that they were easily available to staff to use them effectively, and the staff rotas were not produced for people to know the times the times their support began and ended.

The service was not always safe. The provider did not complete risk assessments for some people. This meant staff did not always have enough information and guidance to ensure people were safe.

Although people's assessments of needs had been completed, care plans did not give details of how, when and for how long staff should support them to meet their needs.

Staff were aware of how to identify and report abuse, both within and outside the organisation. People knew how to make a complaint if they had concerns about their care.

The service had enough staff to meet people’s needs. The staff had attended training relevant to their roles. They had supervison and support from senior staff.

People had positive relationships with staff and their relatives. Relatives told us staff were caring, compassionate and treated them with respect. Staff knew how to ensure people’s privacy. Staff promoted people's independence.

People and relatives were involved in their care. There was a policy on equality and diversity and staff told us they did not make a discrimination in the delivery of the service.

Staff monitored incidents and accidents and drew from lessons so future similar incidents and accidents were avoided.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and people’s capacity to make decisions was assessed when required. They encouraged and promoted people's rights to make their own decisions about their care.

Cornerstone Care Services Professionals Ltd is a domiciliary care service providing personal care and support to people living in their own homes in Romford, Essex. The service provides care and support to people with health and social care needs. At the time of our inspection, 11 people were using the service.

This was the first inspection of the service and took place on 22 August 2017 and was announced. There was no registered manager at the service. The provider was managing it at the time of writing this report. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff supported people at home with their care needs and the service had assessed some risks. However, not all risks associated with personal care tasks had been assessed to ensure people were safe at all times when staff carried out personal care.

Records relating to the recruitment of new staff showed relevant checks were not always completed before staff worked unsupervised at the service. They did not always carry out relevant checks such as Disclosure Barring Service(DBS) checks and character references before they employed staff in order to make sure they were of good character and suitable to work with people who used the service.

The provider had not developed person centred care plans for people, following an assessment of people’s needs and commencement of the service.

The provider held information about complaints, compliments and comments, as well as accidents and incidents. We found this information was lacking in detail and the provider told us that no formal complaints had been received. However, we found that complaints/concerns had been made by the relatives of people who used the service which had not been recorded.

The provider monitored the quality of the service by carrying out spot checks on staff and carried out an annual stakeholder survey. Although both methods were undertaken, the results were not analysed and actions were not documented to address any shortfalls. Similarly, audits were carried out, but these were not robust and had not identified the issues we highlighted to the provider during our inspection.

The relatives of people who received support spoke highly of the provider as did the staff who worked for the provider. They felt that their family members were safe and happy with the staff who visited their homes and they felt the provider delivered a good service.

Training was provided to staff by an external training provider. The training ensured that staff did their job effectively and provided support to people in the way they preferred. Staff told us that they had received the training that was required to meet people's needs and to keep them safe.

Relatives told us that staff did not rush people when they delivered care. Staff confirmed that they generally had enough time to complete the tasks required. The provider manually devised the rotas based on her own knowledge and experience of each individual's needs, staff availability and geographical locations. We found the provider employed enough staff to manage the service effectively.

CQC monitors the application of the Mental Capacity Act (2005). We saw that staff understood their responsibilities under this act and training related to this had been provided to them.

The provider informed us that staff were not responsible for providing meals to people because they lived with their relatives who were responsible for maintaining people’s diets.

Staff had undertaken equality and diversity training and told us that they treated people individually and provided care according to their needs and wishes. Staff understood people's likes and dislikes, although these preferences w