We undertook an announced inspection of Eleada Care Services on 7 December 2016. We contacted the service before we visited to announce the inspection so we could ensure that the registered manager would be available.

The service was registered with CQC on 30 November 2012 and was last inspected on 26 June 2014, at which time the service met the regulatory standards inspected.

Eleada Care Services provides a domiciliary care service that delivers personal care and support to people in their own homes. The service is also registered to carry on the regulated activity nursing care but the provider told us that currently the service did not involve nursing care. At the time of our inspection there were 39 people using the service. Most people using the service were older people some of whom were living with dementia.

The service has a registered manager in post. 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.

People using the service and their relatives informed us that they were satisfied with the care and services provided. They told us they had been treated with respect and they felt safe when receiving care and support from the service. There was a safeguarding adults’ policy and suitable arrangements for safeguarding people from abuse. People told us they felt safe when receiving the service. Staff had received training to make sure they knew how to recognise and report any concerns.

The organisation carried out appropriate checks to reduce the risk of employing staff that were not suitable to work with people using the service. There were sufficient staff to meet people's needs and people told us they received the care that had been planned. Staff received the support they needed to carry out their role and responsibilities.

Risks to people's environment and well-being were assessed and recorded. Arrangements were in place to make sure medicines were managed safely and people received their medicines as prescribed.

People informed us that care workers were very kind, they were treated with dignity and their privacy was respected. People benefitted from the caring relationships they were able to build with care workers because they received consistency of care from regular care workers who were familiar with their needs. The service understood the importance of encouraging and promoting people's independence.

People, who received support with their meals, had their nutritional needs and their individual dietary preferences assessed and met.

People had care plans that were up to date and included information staff needed on how to best support them. People told us they received care and support in the way they wanted and staff respected their privacy and dignity.

Management staff including the registered manager had a good understanding of the Mental Capacity Act (MCA) and care workers applied its principles in their daily work practices. People receiving care told us they were supported to make choices and were involved in all decisions about their care. Care workers understood the importance of obtaining people’s consent before supporting them with personal care and other tasks. People told us their consent was always sought when being supported with their care and in other areas where they received support.

The provider had a complaints procedure. People knew how to raise complaints or concerns and were confident they would be addressed appropriately by the registered manager. The registered manager ensured people's feedback was sought and acted on where required.

People using the service, relatives and care workers had the opportunity to feedback their views about the quality of the service to the registered manager a

During our inspection on 9 January 2014 we found the provider non-compliant with regulations 9, 11, 17, 20, 21 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. During our inspection on 26 June 2014 we found that the provider had taken appropriate action and achieved compliance with the above regulations.

A single inspector carried out the inspection on 26 June 2014. We assessed the regulated activities of personal care and nursing care however the provider told us that currently they did not provide nursing care. The service currently provided personal care to one person. We visited the person at their home with their permission to obtain their view about the care they received.

The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Is the service safe?

The provider vetted staff before they started work to ensure they were not barred from working with vulnerable adults. Staff received training in appropriate techniques to reduce the risk and spread of infection, and they followed these. Risks associated with people's support were always assessed, and measures were put in place to reduce risks, these were updated when people's needs changed.

Is the service effective?

The care plan for the person using the service was fit for purpose and included appropriate guidelines for their support. Feedback from the person who used the service and their advocate was positive. They told us, "The care workers are excellent and have a great sense of humour". An advocate told us "The person has improved a lot since Eleada started providing care.” The person told us, "I receive the care I need, I couldn't do without them." We found that support for staff had improved. The provider carried out more frequent on site supervisions for care workers, and planned to conduct appraisals with the care workers.

Is the service caring?

Feedback from the person who used the service and their advocate was positive. They told us, "They are always very nice".

We observed that care workers asked the person for their consent before they provided care and support, and followed the requirements of the Mental Capacity Act 2005. The person who used the service told us that staff were, "Kind, caring, courteous, respectful, excellent and friendly.

Is the service responsive?

Since our last inspection the provider had commenced regular spot checks to ensure that staff provided the care and support that was required. The person who used the service told us, "The manager visits me regularly to discuss any issues, but I never had any problems." We found that staff had reviewed and updated the person’s care plan since our last inspection.

Is the service well-led?

Since our previous visit on 9 January 2014 the provider reviewed their complaints procedure and system to respond and deal appropriately with complaints. The provider recruited additional staff to support the care workers and to monitor the care that they provided. The provider designed a quality assurance questionnaire and sent it to the person who used the service to obtain feedback about the care they received. the person who used the service told us, "Things are much better now, the office staff responds very quickly if I have any issues."

We spoke with one person who used the service, and two relatives. People told us they were satisfied with the care they received. One person "I always have the same worker. She comes three times a day, every day. She is very good and cares about me a lot".

Additionally, we received feedback on the service from a relative of someone who no longer uses the service, through the commissioning local authority. They reported that staff did not turn up when they were supposed to, and their relative was left in an undignified state.

We found that people were not involved in decisions about their care and support, and were not provided with basic information about the service they received.

We found that people's care and support was not planned and delivered in ways that met their needs, nor were they safeguarded from the risk of abuse.

We saw that the provider did not conduct appropriate checks before staff started work, and were not aware of their obligations as employers of people working with vulnerable adults.

We found that there were not enough staff to meet people's needs, and that records relating to the management of the service were not kept or retained for an appropriate period of time.