This announced inspection took place on 20 and 28 November 2018.

Flexserve UK 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 adults of all ages, including people with dementia, learning disabilities or autistic spectrum disorder, mental health needs and physical disabilities.

Not everyone using Flexserve UK Limited receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is 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 the inspection there were 39 people using the service in this respect.

The service had a registered manager. This 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 of this service, in March 2018, we found four breaches of legal requirements. These were in respect of staff deployment and training, safeguarding people using the service from abuse, notifying CQC of allegations of abuse, and good governance. The service was rated ‘Requires Improvement’ and we served the provider an enforcement warning notice for the staffing breach. The provider sent us an action plan in respect of the breaches. We undertook this inspection to check that the action plan had addressed the breaches. This was also a comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs and well-led.

At this inspection, we found improvements had been made in all our previous areas of concern, and so there were no longer breaches of regulations. This has helped to improve the service’s overall rating to ‘Good.’

The service was now ensuring sufficient numbers of suitable staff were deployed to support people

to stay safe and meet their needs. Reasons for this improvement included better scheduling of staff visits and through ensuring staff visit times were being electronically monitored. Staff visits to people’s homes were therefore more punctual and people’s preferred visit times were being more respected.

The service was now making sure staff had the skills, knowledge and experience to deliver effective care and support. New care staff now completed all parts of a national training program, and established staff received regular refresher training. Staff capability was starting to be practically assessed on key topics, as well as through knowledge tests. Staff were also now receiving regular developmental supervision, support and annual appraisal.

Processes and practices had now been improved to minimise the risk of people being abused and ensure staff responded appropriately if abuse was suspected or reported. The service was also now reporting allegations of abuse to CQC as legally required, which helps with ensuring appropriate regulation of the service.

Governance processes and audits were now effective as they were identifying service delivery shortfalls. The provider was acting on these, to improve on outcomes for people using the service and ensure the service’s sustainability.

However, the rating for ‘Is the service safe?’ remains ‘Requires Improvement.’ This is primarily because where people had more complex needs, assessment of risks was not always comprehensive. Additionally, medicines support plans did not fully reflect the support required for people with highest needs, and administration records were not consistently accurate and comprehensive. The service was taking steps to address these matters.

Most people fed back positively about the service. Some rated it as, “Ten out

This service 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 adults of all ages, including people with dementia, learning disabilities or autistic spectrum disorder, mental health needs and physical disabilities.

This was the first inspection of this service at this location. Not everyone using Flexserve UK Limited receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the start of our inspection there were 56 people using the service in this respect.

The service had a registered manager who had been in post since 2011. This 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.

We found the service was not ensuring sufficient numbers of suitable staff were deployed to support people to stay safe and meet their needs. This was because of occasional missed visits and due to staff sometimes being assigned to attend to two different people at the same time. The service was not ensuring staff followed the visit schedules supplied, but those schedules did not consistently provide staff with enough travel time. People sometimes therefore received shorter visits than planned for.

The service was not making sure staff had the skills, knowledge and experience to deliver effective care and support. Most new staff started but did not complete the provider’s induction process before working with people. Some established staff had not completed relevant training or undertaken timely updates. Training test scores showed some staff could not demonstrate sufficient competency in aspects of their care roles. Staff did not receive regular developmental supervision.

There were a number of ways in which systems, processes and practices were not effectively safeguarding people from abuse. This included insufficient staff training, an incomplete record of all safeguarding cases, failing to embed an action arising from a safeguarding case and shortfalls in assessing the risk presented by information of concern relating to a new staff member.

The service had systems for ensuring the proper and safe use of medicines, but there were inconsistencies with the completeness of records of supporting people to take medicines.

Providers and registered managers must notify CQC about certain changes, events and incidents that affect their service or the people who use it. However, we found four allegations of abuse in connection with the service that were not notified to us. This meant we did not have full oversight of the risks associated with the service.

Governance processes and audits were not consistently effective as they had not identified the concerns and service shortfalls that we found. Office records were not always easily accessible and accurate.

Nonetheless, most people and their relatives said they would recommend the service; none said they would not recommend it. Community professionals reported similar feedback from people. They mostly provided positive feedback about how service worked with them. The majority of staff felt they received good support from the management team.

We found the service treated people with kindness, respect and compassion. People were generally supported by a consistent staff team who knew them well, responded to their needs and preferences, and promoted their independence.

The whole service worked well with other organisations and people’s relatives to deliver effective care and support. This including for supporting peo