We undertook an announced focused inspection of Creative Living Care Services (“Creative Living”) on 20 and 23 July 2018. This inspection was completed to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection between 30 January and 21 February 2018 had been made.

At the previous inspection mentioned above, we found repeated concerns in respect of how the service was ensuring the risks associated with people’s care was being assessed and planned. We served a Warning Notice which told the provider what they had to put right by the 29 June 2018. On this focused inspection the team inspected the service in respect of the Warning Notice only and did not inspect whether the service was effective, caring, responsive and well-led. We also did not review the rest of the safe section.

The ratings from the previous comprehensive inspection are not affected by this inspection. Therefore, the rating for all Key Questions will remain until the next comprehensive inspection. This means the service remains requires improvement overall and in the Key Questions of being safe, effective, responsive and well-led. Caring was rated as Good.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It currently provides personal care to 15 older adults.

A registered manager was employed to manage the service locally. 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.

We found improvements had been made in respect of the provider and registered manager ensuring they assessed and acted to reduce the likelihood a person could come to harm when their staff were giving personal care. The risk assessment process had been reviewed involving more people and their representative, but not everyone said this was taking place. We have recommended the provider sources reputable guidance on how to involve and record how people are active or represented in their own risk assessments.

Our full findings and the previous inspection report can be found on our website at www.cqc.org.uk.

The inspection of Creative Living Care Services (referred to as “Creative Living”) took place on 30 and 31 January and 2 and 5 February 2018 and was announced two working days in advance. On the 21 February 2018 we received information of concern that people who required two staff to move them safely were sometimes having one member of staff to complete this task. Further contact was had with the registered manager and the local authority to review this concern as part of this inspection.

Creative Living is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Not everyone using Creative Living receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’. This is help with tasks related to personal hygiene, medicines where staff a role and eating. Where people do receive personal care we also take into account any wider social care provided. The service had 20 people registered to receive personal care at the time of this inspection. However, three were currently staying in residential care for respite.

We previously inspected the service on the 14 November 2016. We rated the services as Requires Improvement overall, and in the areas of being safe and well–led. There was a breach of Regulation 9 personalised care due to the concerns that staff not having sufficient travel time was impacting on people’s personal care. Regulation 12 safe care and treatment was also found to be breached because risks to people’s health and safety were not assessed, recorded. This meant staff would not have the required information available to mitigate these risks.

Following the last inspection, the provider submitted an action plan which told us how they would make improvements. They told us they would have achieved improvements by 31 March 2017.

The service has two registered managers with one being also the provider. 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. One manager had day to day management responsibility and was the one referred to throughout the report. The provider has submitted a cancellation of their registered manager status but will retain being the nominated individual.

Following this inspection we have continued to rate this service as Requires improvement.

People’s records did not include the required level of information in respect of people’s risks and personalised care. People told us they were happy with how staff kept them safe and responded to their needs. However, we heard from people they were concerned about the skills and abilities of new staff. Also, staff did not have the details on how to meet people’s health, food and hydration needs. Without this essential information staff would not know how to support people safely, and in line with their wishes and preferences.

Staff did not have the necessary information to understand people’s health and medical needs. There was no information about what staff should be aware of if a person became ill. For example, there was no information to help staff to understand when someone with diabetes was having a low or high blood sugar episode.

People were not being assessed in line with the Mental Capacity Act 2005 to ensure their ability to consent to their own care was clearly recorded. This meant people’s human rights were not being respected or promoted.

People’s medicines records were not always accurate. The service’s medicine policy was not in line with current guidance and regulations. There was no system in place to ensure staff knew a person’s current prescribed medicines. One person had an allergy to an antibiot

This comprehensive inspection took place on 14 November 2016 and was announced in accordance with our current methodology for domiciliary care inspections. The service was last inspected on 29 September 2014 when it was fully compliant with the regulations.

The service is required to have a registered manager and there were two registered managers 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. One of the registered managers was also the provider and nominated individual for the service. They had stepped down from the registered manager role and told us they would put in an application to cancel this officially.

Creative Living Care Services is a domiciliary care agency that provides personal care and support to people in their own homes. They support adults with a variety of disabilities and health conditions. At the time of our inspection the service was providing a service to 57 people, 37 of these were receiving support with their personal care needs. The Care Quality Commission has responsibility for regulating personal care and this was the area of the service we looked at. The number of hours of support people received varied from two hours a week up to 24 hours per day.

Risk assessments were generic in nature and not accurately reflect people’s individual needs. For example, one person had been identified as being at risk of falls but there was no assessment in place to guide staff on how they could minimise this risk.

People told us they felt safe while receiving care and support and reported that staff always respected their privacy and dignity. Comments included; “They’re more like friends coming in to help”, “I feel like I’ve known them for ages” and “They’re a pleasure to have come in.”

Visit schedules did not always include travel time between consecutive visits. This meant carers had to cut visits short in order to stay on schedule. Staff felt the lack of travel time impacted on their opportunity to spend time talking with people. No-one reported any missed visits.

The service operated safe recruitment practices and all staff had received safeguarding training. The service safeguarding policy contained details of contact numbers for staff to use if they needed to raise a safeguarding concern. Policies and procedures were provided to staff in a staff handbook.

All staff received induction training when they joined the service. Training was regularly refreshed and appropriate additional training was provided to help ensure staff remained sufficiently skilled to meet people’s individual needs. Staff supervisions and staff meetings were not taking place as regularly as planned but staff told us they were well supported. The deputy manager carried out ‘spot checks’ to observe staff working practices. The service operated an on call manager system to provide staff with any necessary guidance outside of office hours. Staff told us, “There’s always someone at the end of the phone.”

Care plans lacked detail and did not reflect people's individual needs. The care plans outlined what basic care and support people required but there was a lack of information regarding people’s preferences in how care was delivered. We have made a recommendation about developing personalised care plans.

Systems for gathering the views of people, their relatives and staff were not robust. Staff meetings were held infrequently. Surveys to gather people's views had not been circulated since mid 2015. There had been no formal analysis of the results.

The registered manager valued the staff team and was keen to develop incentives to help retain staff. Staff told us they were well supported and encouraged to develop skills and work towards a

We carried out this inspection to follow up on concerns we found during our previous inspection on the 21 and 28 May 2014. During the May 2014 inspection we found concerns in relation to the recruitment of staff. We found that the provider had not checked gaps in employment history when recruiting new staff. We also saw that the provider had not in all cases received two written references for new staff although this had been a requirement within the service's recruitment policy. These concerns meant that people were not protected by the service's recruitment and selection procedures.

During the inspection on the 29 September 2014, we found that the provider had made improvements to recruitment procedures within the service.

The inspection was carried out by an adult social care inspector. During the inspection we looked at the evidence to answer one key question; is the service safe?

Creative Living Care services provided personal care and support to people within their own homes. The Registered Manager was not available on the day of the inspection. We did speak to a senior member of the staff team and looked at the recruitment records of ten staff currently working in the service.

Below is a summary of what we found.

Is the service Safe?

A senior staff member told us that since the last inspection a full review had been undertaken of the service’s recruitment records and procedures.

We saw that all new staff were required to complete a full and detailed application form, which included a health declaration and employment history. Applicants were invited to attend a formal interview with the service when further questions would be asked about their skills and experience. This provided the service with information about the person’s ability to work with and safeguard vulnerable adults.

We saw that the provider had sought evidence of previous conduct. All of the files we looked at included two written references, and where possible the provider had requested references from the applicant’s previous employer.

The ten records we looked at provided evidence that criminal records checks had been carried out. This was to ensure that staff were suitable to work with vulnerable people. The senior staff member we spoke to told us that a criminal records check had been carried out for all staff currently working in the service.

The evidence found during this inspection confirmed that the provider had an effective recruitment and selection process, which protected people who used the service.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Our inspection team was made up of two inspectors. This is a summary of what we found. The summary is based on speaking with eleven people who used the service, seven relatives of those who used the service, seven staff supporting them, the manager, the Registered Manager and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they were happy with the arrangements that had been made in relation to security and staff entering their homes. They told us that they felt safe while care was being delivered, comments included: “I feel very safe when the carers come to help me” and “safety is important to me and the carers that visit, help make me feel safe”.

Staff we spoke with had completed training in safeguarding. Staff were clear about their responsibility to report concerns and how they would do this.

Medication systems in use meant people had their medicines at the time they needed them and in a safe way. Records showed that all staff had completed medication training.

Recruitment practice was not thorough. Two staff files did not contain any evidence that a criminal record check had been carried out. This meant people may have been placed at risk of harm from staff who may be unsuitable to work with vulnerable people.

Is the service effective?

People who used the service and their relatives told us they were happy with the care they received. Comments included: “I think the carers are great, they bring a bit of sunshine to my morning” and “When I was unwell, they were wonderful, they helped me so much”. Staff told us they received individual verbal handovers that told them about each person’s needs and how to meet them. When we spoke with staff it was evident they knew people well.

Is the service caring?

When we spoke to people who used the service, feedback about the staff was very positive. Comments Included: "the staff are lovely” ; “they make sure I’m happy and comfortable.” and “The carers are first class, I’ve been quite ill recently, they have looked after me and been marvellous.” When we spoke with staff they showed genuine compassion for the people they supported and demonstrated they knew people’s needs well.

Is the service responsive?

People were assessed and information was gathered about people’s needs prior to them receiving care from the service. Comments included: “The manager is very pleasant, she came to see me, introduced herself and said if there’s anything I need, I can just call her.” and “The manager came to see me, she talked with me and listened to my thoughts, she is a very nice friendly person”.

A complaints procedure was available in people’s care plan folders in their homes. People we spoke with, and their relatives, told us they knew how to raise concerns and felt able to do so. We found that where concerns had been raised, these issues had been dealt with sufficiently.

Is the service well-led?

Staff told us they had seen improvements since the previous inspection. Comments included: “twelve months ago I would have said there was a lot I was unhappy with, but not now, I think it’s really good and I enjoy my job.” and “things have changed for the better recently, I now have my regulars, they get to know me and I get to know them, I love it and feel very supported”.

People who used the service told us they were asked about the quality of the service. People told us that their comments were listened to and acted upon. Comments included, "I’ve got no complaints” and “nothing could be better”.

Staff told us they had meetings every month with the manager. Staff confirmed that their comments and suggestions were listened to and implemented. One member of staff said, “I did not feel I had enough time to carry out all my duties in the time I had, I phoned the office, they contacted social services on my behalf and got the visit time increased, I thought this was really supportive”. This helped ensure people received a good quality service at all times.