About the service: Elyon Healthcare is a domiciliary care agency providing personal care to people living in their own homes in Northamptonshire. At the time of the inspection three people were receiving personal care.

People’s experience of using this service:

¿ Safe recruitment procedures had not been consistently followed; at the time of the inspection this was being investigated by the police. Action had been taken by the provider following the concerns being raised to ensure that people’s support was provided in a safe appropriate way. However, the provider's own quality assurance systems had failed to identify the concerns.

¿ Governance systems and audits were not always effective in identifying where improvements were needed.

¿ Risk assessments required reviewing to ensure they were reflective of people’s current needs.

¿ The induction process for staff who had not worked in health and social care previously required strengthening.

¿ The staff were friendly, passionate about their work and caring; they treated people with respect, kindness, dignity and compassion.

¿ Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). The provider was aware of how to make referrals if people lacked capacity to consent to aspects of their care and support and were being deprived of their liberty.

¿ People were supported to maintain good health and nutrition.

¿ Information was provided to people in an accessible format to enable them to make decisions about their care and support.

¿ People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

Rating at last inspection: Requires Improvement (Report Published April 2018). The overall rating has remained the same. The service has been rated requires improvement at the last two inspections.

Why we inspected: This inspection was brought forward due to concerns raised by the police about recruitment practices at the service.

Enforcement: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed.

Follow up: We will continue to monitor this service. We will check improvements have been made by completing a further inspection in line with our re-inspection schedule for those services rated requires improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Elyon Healthcare is a domiciliary care agency providing personal care and treatment for disease or injury to adults and children. At the time of inspection they provided care for 11 people; two older persons, two younger adults and seven children (one child had complex needs).

Personal care is a regulated activity; CQC only inspects the service being received by people provided with 'personal care' living in their own homes or in specialist housing; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had 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 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 9 and 11 January 2018. Five breaches of legal requirements were found. After the comprehensive inspection, the provider was asked to provide an action plan to tell us what they would do to meet legal requirements in relation to breaches in Safe care and treatment, Safeguarding service users from abuse and improper treatment, Receiving and acting on complaints, Staffing and Good governance. We received the action plan which showed how Elyon Healthcare planned to be compliant with these regulations.

We issued two warning notices to the provider in relation to Staffing and Good governance. We undertook this unannounced focused inspection to check that the provider was compliant with the warning notices by the date we had asked them to be. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Elyon Healthcare on our website at www.cqc.org.uk

At this inspection we found the provider had made most of the required improvements and was compliant with the warning notices.

People received their care as planned from staff that had the skills and competencies to provide their care. The provider had a clear plan of action to improve and embed the rotas and ensure people received their care.

The provider had a clear oversight of the service. They had systems in place to monitor the quality of the service; however, these systems required further improvement to embed audits and evaluate their findings.

We could not improve the rating for Safe or Well Led above requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This inspection took place between 9 and 24 January, with visits to the office on 9 and 11 January 2018 and was unannounced. This was the first comprehensive inspection carried out at Elyon Healthcare.

Elyon Healthcare is a domiciliary care agency providing personal care and treatment for disease or injury to adults and children. At the time of inspection they provided care for 18 people; five older persons, nine children, four of which had complex health needs and four younger adults.

Personal care is a regulated activity; CQC only inspects the service being received by people provided with 'personal care' living in their own homes or in specialist housing; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had 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 and associated Regulations about how the service is run.

The provider Elyon Healthcare Ltd has one director, who is also the registered manager. The provider had a vision to build a service to meet the needs of three types of service users; children, young adults and older adults. In building the three areas of the service the provider had not ensured they had the systems and processes in place to assess, monitor and improve all areas of the quality and safety of the service. This service required improvements to ensure people received safe care.

The provider did not have oversight of the deployment of staff to meet older people’s needs; as a result people did not always receive their allocated time for care. People were not given the time or opportunity to have all of their meals, prescribed medicines or personal care. The provider did not identify that older people were at risk of neglect due to the inadequate deployment of staff.

People could not be assured that they would always be protected from the risk of harm or poor practice. The provider did not have systems in place to identify issues that may indicate potential abuse; or then report any issues to all of the relevant authorities immediately.

Staff did not always ensure that older people received their medicines in a safe way. Although the provider had identified that people’s medicines were not being safely managed they had not taken sufficient action to change staff practice to make people safe. We have made a recommendation about the use of emergency medicines.

People were at risk of not having their complaints responded to as not all information reached the right person to be recorded. Written information was not analysed for the potential for concerns or complaints. Where complaints had been recorded the provider had followed their procedures to manage people’s complaints.

Staff did not always understand their responsibilities under the Mental Capacity Act. The service needed to improve their existing culture to embrace the changes required to ensure people are treated with respect and working practices were carried out in line with the protected characteristics under the Equality Act. We have made a recommendation about advocacy for people who may need support to make decisions.

People were cared for by staff that had been employed using safe recruitment practices. Staff received training and supervision to support them in their roles.

People had risk assessments that were reviewed regularly; people received their care as planned to mitigate their assessed risks.

People’s (adult) care was provided by staff that had received training and support to carry out their roles.

Children received care from staff that had the skills and competencies to provide their care; they were closely supervised by a paediatric nurse who supported staff in their roles.

Wher