We undertook this unannounced comprehensive inspection on 05 March 2018.

At the last comprehensive inspection on 03 and 10 August 2017, we found breaches of Regulations 9, 12, 17, 20A of the Health and Social Care Act (Regulated Activities) Regulations 2014. We gave the provider an overall rating of Inadequate. The breaches related to the provider’s failure to ensure people received care at the right time and in the right way so people’s safety was maintained. In addition, the provider had not made sure people’s care was consistently focused on each person and the provider’s quality checks had not assisted in people receiving high quality care. The provider sent us an action plan setting out the improvements they intended to make.

This service has been in 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 provider showed 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.

At this comprehensive inspection, we found the provider had made improvements to the services people received in their homes, and they were now meeting the Regulations. People received care centred on each person, shaped around their individual safety needs, choices and preferences due to improvements in care call scheduling and monitoring. The provider had improved the effectiveness of their checking systems to monitor the quality of the service people received. This included a planned rolling programme of checks targeted on key aspects of the service, such as monitoring care calls, incidents and accidents and people's care plans. Based on the outcomes of the last comprehensive inspection, the provider had increased their oversight of the services provided to support the registered manager in driving through improvements.

Evolving Care Limited 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, younger disabled adults and children. At the time of this inspection 60 people were provided with ‘personal care’ in their own homes.

Not everyone using Evolving Care Limited 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.

There was a registered manager in post at the time of our inspection. 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.

People told us they felt safe in the knowledge staff knew how to meet their individual needs. Staff knew people well and the management of care calls supported staff to arrive at people’s homes at the right times so people’s safety was not impacted on. The provider’s management arrangements relevant to scheduling and monitoring people’s care calls now needs to be sustained together with gaining people’s views of their care.

The provider had arrangements in place to make sure there were enough staff to meet people’s assessed needs and risk plans had been developed further. Staff had undergone recruitment checks so the provider could assure themselves potential new staff were not barred from supporting people who used the service.

People were supported by staff who had the knowledge to make sure all safety precautions were taken. This included supporting people with the right equipment so cross infections were reduced. The provider had developed a system whereby the manage

This inspection took place 3 August 2017 and 10 August 2017. The inspection on 3 August 2017 was unannounced. We returned to the service on 10 August 2017. This was announced.

Evolving Care Limited provides personal care for people in their own home. There were 111 people receiving services for which CQC registration was required at the time we inspected.

A registered manager who was also the provider was in post at the time of our inspection. 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 was run.

We found improvements evidenced at the last inspection had not been sustained.

Plans were in place to manage people’s safety but people did not benefit from receiving care based on their assessed needs which was managed in ways that reduced risks to their safety. This was because people did not always receive the care they needed at the time they needed it for the duration required. Some people did not have regular carer staff who knew their safety risks well. Risks to some people were increased because staff did not consistently provide the care they needed to have their medicines as assessed.

Other people did benefit from being regularly supported by the same carer staff. Staff had received training in how to administer people’s medicines. People were comfortable with the staff that regularly supported them and staff understood what actions to take to protect people from the risk of potential abuse.

People did not always benefit from receiving a service where the systems and procedures needed to support their care worked effectively. This included how people’s care calls were managed. The systems used to monitor people’s care had not driven through improvements needed in the care people received in a timely way. The registered manager had not notified us of some important things they are required to do, in law. Staff understood how the registered manager and senior staff expected people’s care to be given, and some of the systems used to monitor the quality of the care people received were working effectively.

People and their relatives let staff know how they wanted their care to be planned, however, people did not always receive their care as it had been agreed. Other people did receive the care they wanted in the ways they preferred. People had been given information on how to raise any concerns or complaints. Processes for managing complaints were in place, but we found there were instances such as missed calls where improvements required were not always sustained.

Staff had not always been given the support required in order to care for some people, including information about people’s needs and regular meetings with their line manager. Other people did receive care from staff with the knowledge and skills they needed to care for them. Further training and one to one meetings with their managers were being planned, immediately after our inspection so staff would be supported to provide good care.

Staff checked people were in agreement for care to be provided and the actions they needed to take to promote people’s rights. Where people received the care that had been planned for them people were encouraged to have enough to drink and eat by staff who respected their preferences and dietary needs. There was a risk some people would not have the care they needed to maintain their health because there care was not always provided as agreed. Staff who cared for people regularly understood risks to people’s health and well-being and worked with people and health professionals to support people to maintain their health.

Some people had not been able to develop meaningful relationships with staff as they were not always supported by the sam

The provider registered this service with us to provide personal care to people who live in their own homes. Services provided are for children and adults who may have a range of needs which include mental health, physical disability or sensory impairment.

The inspection visit was undertaken on 22 June 2016 and was unannounced. At the time of our inspection visit 55 people received care and support services in their own homes.

There was a registered manager in post at the time of our inspection visit. 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.

People told us they felt safe with the staff who came into their homes and they knew how to provide the care people required. Staff were able to describe in detail the needs of people they supported and how to promote people’s safety from potential harm or abuse. Staff showed an awareness of the risks to people as these had been identified, assessed and were regularly reviewed. Staff had specific details of all the potential risks to people accurately recorded in their care records to inform staff when supporting people in their own homes to manage these. This was an improvement which had been made following our last inspection in April 2016.

People received their care on time and if staff were going to be late, people were informed of this. Efforts had been made to ensure wherever possible people were provided with care and support from staff they knew well in order to promote continuity of care for people.

People were prompted and supported with their medicines when needed, by staff who had received the training to be able to do this.

People were supported by staff whose backgrounds had been checked before they started to work with people. This was to make sure they were suitable to provide care to people in their own homes and keep them safe. All staff received an induction, training and on-going support in order to support people’s individual needs effectively.

People said they felt the staff and management were approachable and listened to their views about the care they received. They told us that nothing was done without their consent. Staff told us all care was centred on each person and could only be given if the person consented.

People, who needed assistance at meal times, were provided with this by staff who knew their individual dietary needs and recorded the support provided within daily notes. Staff referred people to other health and social care professionals when this was required for advice and support so people’s health needs were effectively met.

People told us they had developed good relationships with staff who they had become to know well and felt staff were caring. The registered manager had listened to people’s views to ensure the care they received was responsive to their particular needs. This included ensuring the planning of staff was based on people’s own expectations of the times they needed their care.

People knew how to raise any concerns and or complaints they had but had not needed to do this. They felt if they did need to raise any complaints these would be listened to with action taken to resolves the issues. The registered manager had acknowledged and taken action when any complaints had been received to ensure people were satisfied with their care.

People benefitted from a service which was well managed by a management team who were responsive to the aspects of the service provision which required to be improved following our last inspection. This included the development of a more consistent approach to regularly monitoring the quality of the service by completing a range of checks. They had also gained regular feedback from people who used the se

We undertook an announced inspection on 10 April 2015. We gave the registered manager 48 hours notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be available at the office.

The provider registered this service with us to provide personal care to people who live in their own homes and this was the provider’s first inspection since they registered with us. At the time of our inspection 29 people received care and support services in their own homes. Services provided are for children and adults who may have a range of needs which include mental health, physical disability or sensory impairment.

There was a registered manager in post at the time of our inspection who had returned to have a daily oversight of the management of the service provision. 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.

The arrangements in place to monitor and improve the quality of the service provided had not consistently been effective in identifying areas requiring improvement. These arrangements needed to be strengthened further so that people could be confident the service was well led. This included further establishing opportunities for people to contribute their views about the service.

Although people and their relatives had no specific concerns about how risks to their health or wellbeing were being managed; the arrangements did require strengthening. This is because the risk assessments to meet people’s individual needs which included risks associated with fragile skin, eating and drinking and any equipment required were not detailed. This meant staff did not have all the written guidance they needed to support people safely.

The registered manager had been responsive to the improvements that had been identified and had begun to take action to make sure they could provide a care service to people in certain geographical areas. They were also recruiting new care staff to ensure there were sufficient care staff particularly in the evenings.

People told us that they felt safe with the staff who supported them in their own homes. Care staff had received training on how to keep people safe from harm and knew what to look out for and the procedures to follow, if they felt that someone was at risk from abuse.

When people needed support with their prescribed medicines they received this from care staff who were trained to do this in the right way for each person.

Care staff had been recruited following checks about their suitability to provide care and support to people who lived in their own homes. They had been provided with an induction into the service and on-going training and support to enable them to do their job well and carry out their roles effectively.

People told us they received care and support at the agreed times, and were provided with choices when they were assisted by staff so that they received care in a way they preferred.

People told us they were always asked for their consent before care staff assisted them with their care and support. When people did not have the capacity to consent to their care and support the provider had arrangements in place to ensure the staff worked within the guidance of the law so that people’s rights were upheld.

For people who needed assistance at meal times, care staff provided this to enable people’s dietary needs to be met and this was recorded in their daily notes. People were supported to access healthcare professionals when this was required.

People told us that they had developed good relationships with care staff who supported them in their homes. They said care staff were kind and caring towards them and respected their privacy and dignity.

People knew their complaints would be listened to and action taken to resolve any issues. Records showed the provider made improvement to the service in response to complaints.