The inspection took place on 9 October 2018 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

This service is a domiciliary care agency based in Wellington, Telford. It provides personal care and support to people living in their own homes throughout the Telford area. It provides a service to older adults and younger disabled adults with a range of health and social care needs including physical disabilities, learning disabilities and people living with dementia. At the time of our inspection there were 5 people receiving a personal care service.

At our last inspection of the service 26 April and 2 May 2017 we found that some improvements to risk management and governance were necessary. At this inspection the service demonstrated to us that improvements had been made regarding risk management and individual quality monitoring. However, we found the oversight for governance could be improved further. We have made a recommendation about this.

The service had a registered manager in place. A registered manager is a person who has registered with the 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.

Medicines were managed and prompted safely. The provider did not administer medicines to anyone at present.

People were supported to take risks safely and personalised risk assessments were in place to ensure people were protected against a range of risks. Staff had received safeguarding training. They could describe types of abuse and what they could do to report concerns and protect people from harm.

Staff recruitment was carried out safely with the required checks in place for new staff before they started work.

New staff received induction training and were accompanied and supported by the management and senior staff to enhance their induction and extend if necessary.

People were supported to have choice and control over their own lives from being supported by person centred care approaches. Person centred care is when the person is central to their support and their preferences are respected.

There were sufficient staff to meet people's needs safely. Staff received regular supervision checks to ensure they completed care visits as agreed. Staff were trained in safeguarding, first aid, moving and handling, Mental Capacity Act, infection control and food hygiene.

Staff had a good knowledge of people's likes, dislikes, preferences, mobility and communicative needs. We received positive feedback regarding staff and how peoples’ needs were met. People were supported to maintain their independence by staff that understood and valued the importance of this.

Care plans were sufficiently detailed and person-centred, giving members of staff and external professionals relevant information when providing care to people who used the service. Care plans were reviewed regularly and with the involvement of people who used the service and their relatives.

The registered manager displayed an understanding of capacity and the need for consent on a decision-specific basis. Consent was documented in people's care files and people confirmed staff asked for their consent on a day to day basis.

A programme of individual quality monitoring was carried out by the registered manager and these were effective in identifying any deficits in current service provision. The oversight of quality auditing could improve further. We have made a recommendation about this.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Infection control measures were in place for staff to protect people from the risk of i

At the last inspection in November 2016, we found the provider was not meeting fundamental standards and we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked them to make improvements regarding management of risks, protecting people from abuse, staffing levels, staff skills and knowledge, maintaining people’s privacy and dignity, person centred care, managing complaints, quality assurance, staff recruitment and the reporting of incidents to CQC. Following the last inspection the service was rated as inadequate and placed in to special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We undertook this unannounced comprehensive inspection on 26 April and 2 May 2017 to check that the required improvements had been made. At this inspection, we found some of the required improvements had been made and the provider was no longer in breach of the regulations. However, some improvements to risk management and governance were still required.

Essence Telford Ltd provides personal care to older people, people living with dementia, people with physical disabilities, and people with sensory impairments, living in their own homes. At the time of our inspection the service was providing personal care to eight people. There was a registered manager in post at the time of the inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to the management of risks to people; however further improvements were required to ensure staff had the information and guidance they required to support people safely. The provider had established safe recruitment practices to ensure staff were safe to work with vulnerable people. People received support from staff at the time and for the duration arranged and felt safe when receiving support. People received their medicines as prescribed.

People felt staff had the skills and knowledge to support them. The provider had recruited a member of staff who took the lead on delivering practical training in moving and handling, which ensured staff knowledge was up to date and people were supported safely. Staff were aware of people’s capacity to make their own decisions and supported them to do this. People received support with food and drink where required and this enabled them to maintain their health. Staff were aware of people’s healthcare needs and worked alongside other agencies to ensure these needs were met.

People told us they felt staff were kind and caring. Staff spoke about people with kindness and compassion. People were encouraged and supported to make their own decisions about the day to day care they received and staff were aware of their responsibilities to maintain people’s dignity and privacy.

Information available to staff did not always reflect people’s current needs. People told us they were involved in the assessment and planning of their care; however this information was not always recorded clearly in people’s care records, meaning they may be placed at risk of not receiving care in the way they preferred . The provider had made improvements to the system used for identifying and managing complaints and people knew how to raised concerns if they were unhappy about the service they received.

The provider had introduced some systems for monitoring the quali

This inspection took place on 22 and 28 November 2016 and was announced. Essence Telford Ltd Care provides personal care to older people, people living with dementia, people with physical disabilities, and people with sensory impairments, living in their own homes. At the time of our inspection the service was providing personal care to 15 people. This was the agency’s first inspection since registration.

There was a registered manager in post at the time of the inspection. 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 did not always receive support at the time they needed it, as staff were not effectively deployed. Risks to people had not been assessed or shared with staff. Recruitment processes were not effective and therefore did not protect people from the risk of potential harm. Not all staff knew how to identify possible signs of abuse or report any concerns to the relevant authorities.

People were at risk because staff did not always receive moving and handling training that was delivered by people competent to do so. People were asked for their consent before care and support was provided.

People were not always supported in a dignified manner. People and relatives told us staff were friendly and kind. People were involved in decisions about their care and support.

People and relatives did not know who to contact if they were unhappy about the care they received. Some people felt complaints had not been dealt with appropriately. The provider did not have an effective system in place to monitor or respond to complaints. People’s care did not always reflect their needs and preferences.

The provider did not have any systems in place to monitor the quality of care provided. The provided had failed to notify us of significant events as required by law. People expressed mixed views about whether they had been asked to give feedback on the service they received. Staff told us they felt the service was well managed and they received support from the registered manager and provider.

Staff were aware of people’s capacity to make decisions and supported them in a way that did not restrict their rights. Most people were happy with the food and drink provided and staff were aware of people’s dietary needs. People were supported to access healthcare professionals when required.

We found the provider was not meeting all of the regulations required by law. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 a