The inspection took place on 16 and 18 October 2018. The inspection was announced.

This service is a domiciliary care agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. Not everyone using Figtree Care Services Limited may receive 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. At the time of inspection, the service only supported people who required regulated activities. Approximately 25 people were receiving personal care in their own homes. The majority of people receiving care and support needed two staff to provide their care at each visit. People had varying needs, some had physical difficulties with their mobility, some had received treatment in hospital for serious health conditions and others were receiving care to support them at the end of their life.

A registered manager was employed at the service. 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.

At our last inspection, on 24 and 25 August 2017, the service was rated ‘Requires improvement’. We found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to, the provider had not provided care that met people’s needs and preferences; systems had not been established to assess, monitor and improve quality effectively and accurate and contemporaneous records had not been kept. The registered manager sent an action plan dated 3 November 2017 stating they would meet the regulations by June 2018.

At this inspection, on 16 and 18 October 2018, the service continues to be rated ‘Requires improvement’. This is the third consecutive time the service has been rated Requires improvement. The provider and registered manager had made improvements in some areas. People’s care plans had improved, setting out their needs and preferences, the breach of regulation 9 was now met. However, we found that accurate recording continued to be an issue. Although some small improvements had been made to quality monitoring, these were not robust enough to identify and sustain improvements. Records had not been maintained to ensure people always received the care and support they needed; Records showed some people had received shortened and late care visits by staff.

We found further areas of concern that needed to be improved. Safe recruitment practices were not followed; the policy for medicines administration was not clear to ensure people’s safety; staff did not always receive the training required to meet people’s needs.

People and their relatives were asked their views through a questionnaire survey. The results were not analysed to provide an opportunity for the provider and registered manager to make improvements following the feedback. We have made a recommendation about this.

The provider had commenced management meetings where they met with the registered manager every three months to keep up to date. The meetings did not show a clear oversight and direction of the provider in order to provide continuous improvement. This is an area identified as needing improvement by the provider.

Individual risks were identified to ensure measures were put in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were documented to keep people and staff safe from identified hazards.

A safeguarding procedure for staff to follow should they have concerns about people was available to staff. People told us they felt safe and knew

We inspected Figtree Care Services on the 24 and 25 August 2017. The inspection was announced. Figtree Care Services provides support for older people living in their own homes. There were 35 people using the service at the time of our inspection.

There was not a registered manager in post who was registered with the Care Quality Commission (CQC). 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. The registered manager had left the service since our last inspection and a new manager had been appointed. The acting manager was going through the processes to become registered with the CQC.

We previously inspected this service on 7 and 8 July 2016 when we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. The breaches of the regulations related to safe recruitments practices, assessing risk, care plans did not set out the needs of people, records were poorly written and no effective auditing systems were in place. We found on this inspection that improvements had been made but there were still areas where the service was in breach of regulations.

The provider had systems in place to identify individual risks to people. However, formal environmental risk assessments had not been completed. We have made a recommendation about this in our report.

People were protected from abuse by trained staff who understood how to recognise the signs of abuse and how they should report it. Staff received training that gave them the confidence and knowledge to provide effective care.

The provider had safe recruitment practices in place. All staff had a safety check to ensure they were safe to work with vulnerable adults. All staff received regular supervisions and yearly appraisals. The acting manager was carrying out spot checks of staff performance to ensure they were working in line with the provider's policy and procedures. There were enough staff to provide care and support for the people. However, we found that there were some occasions when staff were late to calls and people had not been informed. We have made a recommendation about this in our report.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Mental capacity assessments were being carried out and these were decision specific. Staff and the manager demonstrated good knowledge of the Mental Capacity Act 2005.

People were supported to have a healthy and nutritious diet. Staff would support people when needed. People and relatives told us they were given choice over what meals they would have.

People and relatives we spoke to spoke positively about the staff and the care they received. Staff were seen to be communicating to people in a kind and caring way. Staff protected people’s dignity and encouraged independence. Staff demonstrated good knowledge of people and the care they required.

Care plans were detailed and identified each person’s needs. However, reviews were inconsistent and were not being reviewed in a timely manner following changes of people’s needs. Care plans identified people’s preferred likes and dislikes when receiving personal care and staff were aware of these. Staff ensured that people were given choice over their care.

People, relatives and staff told us that the acting manager was having a positive impact on the service. The acting manager had identified that the current auditing systems required improvements but new methods had not been embedded within the service. People’s records were not being consistently updated when required.

We found breaches in the regulations and you can see what action we t

The inspection was carried out on 7 and 11 July 2016. We gave short notice before the first day of the inspection because the manager was often out of the office supporting staff. We needed to be sure that they would be available to speak with us.

Figtree Care Services Limited provides personal care and support to people who are living in their own home. At the time of the inspection the service was providing support to 15 people, in the Dartford area. The service is able to provide a range of visits to people, from one visit a day, up to several visits per day. Support is primarily given to older people who are receiving continuing health care. The support provided aims to enable people to live as comfortably as possible.

The registered manager had recently left in June 2016. 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. A new manager had been employed, but had worked at the agency for less than two weeks when we inspected. The manager said she was in the process of completing an application to become the registered manager.

The service had recruitment practices in place. However, improvement was needed for example, checking validity of references, checking any gaps in employment history, ensuring return of DBS check and providing all staff with a contract of employment.

The manager had started to implement individual risk assessments for each person and the environment in which they lived on the second day of our visit, but further improvement was needed. Care was planned and agreed between the staff and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

Management involved people in planning their care by assessing their needs on their first visit to the person, and then by asking people if they were happy with the care they received. There was an emphasis on person centred care. People were supported to plan their support and they received a service that was based on their personal needs and wishes. However, no care plan records were seen on the first day of the inspection visit and the manager on the second day of the inspection had started to address this issue. The service was flexible and responded positively to changes in people’s needs. People were able to express their opinions and views and they were encouraged and supported to have their voices heard.

The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in relation to the whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the manager, or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.

Staff were trained in the Mental Capacity Act 2005. Staff understood the processes to follow and knew who to contact, if they felt a person’s normal freedoms and rights were being significantly restricted.

All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding people and infection control. They worked alongside experienced staff and had their competency assessed by the manager. Refresher training was provided at regular intervals. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

People were supported with meal planning, preparation and eating and drinking. People had positive relationships with staff who knew them well. There were enough