This inspection took place on 24 October 2018 and 1 November 2018. This was the first time the service had been inspected, and the first day of our inspection was announced. We gave the provider two days’ notice of our inspection visit. This was to make sure we could meet with the manager of the service and talk with staff on the day of our inspection visit.

Harmony Care is registered to provide personal care and support to people living in their own homes. There were 77 people using the service at the time of our inspection.

A requirement of the provider’s registration is that they have a registered manager. A registered manager is a person who had registered with the Care Quality Commission to manager the service. Like registered provider’s 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 the time of our inspection visit there was not a registered manager in post, they had stepped down from their role on the 22 October 2018. An acting manager had been appointed by the provider, who had commenced their employment on 22 October 2018. The newly appointed acting manager was supported by a director of operations during their probation and induction.

The provider had not ensured that effective quality assurance procedures were in place to assess and monitor the quality and safety of the service people received. Following the first day of our inspection visit we asked the provider what actions they planned to take to improve their service. When we visited on the second day of our inspection visit, we saw the provider had taken action to immediately mitigate the risks to people, from receiving unsafe care.

We initially found risk assessments were not always in place to manage the risks associated with people’s safety, health and well-being. Medicines were not administered to people safely, as we could not always determine whether people received their prescribed medicine as they should. In addition, staffing levels were not sufficient to ensure people always received their care and support at agreed times.

Following the first day of our inspection visit the provider had taken action to update procedures and care records, to improve risk management and medicine administration procedures, and ensure there were sufficient staff available to meet people’s agreed care packages.

Accidents and incidents, and safeguarding concerns had not been consistently recorded, investigated, and analysed to ensure lessons were learnt from such events, and risks to people were mitigated to prevent future occurrences. The provider had not always ensured CQC were notified of incidents as they were required to. By the second day of our inspection visit procedures were in place to ensure future events were recorded, investigated, and notified to CQC.

Staff completed training to meet people’s needs, however staff training was not up to date, and we identified not all of the training was effective. Mental capacity assessments had not always been completed for people who needed them. This meant decisions that were made in people’s ‘best interests’ were not always accurately recorded. The provider had plans in place to review staff training, and all care records for people who used the service.

We received mixed feedback from people about how the service was run. People told us they felt individual staff who supported them were kind.

Prior to using the service people were assessed so that the service could meet their needs and people told us they usually felt involved in decision-making about their care and support. However, information about how people could be supported with their communication needs could have been more detailed.

Staff enjoyed working at Harmony Care, however, they did not always feel supported by the management team. There was an ‘out of hours’ call system in place to provid