This inspection took place on 22 and 23 August 2017 and was announced. As part of the inspection process we contacted people who used the service and staff for feedback on the 23 August 2017. Hertsmere Valley Care Limited is a domiciliary care service which provides personal care and support to people in their own homes. The service was supporting 12 people at the time of our inspection.

There was a registered manager in place who was also the provider. 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.

When we last inspected the service on 02 and 03 May 2017 we found that although the service had made some improvements further improvements were required. The overall rating for the service was Requires Improvement at that inspection. Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements.

At this inspection we found that the provider had made the necessary improvements and was meeting the regulations of the Health and Social Care Act. People told us they received care and support that met their individual needs and preferences. People were involved in the development, planning and review of their care. Care plans were personalised and contained detailed information about people’s support needs and risk assessments were detailed and specific providing staff with all relevant information to help ensure risks were both identified and mitigated where possible

Staff knew people well, supported them to retain their independence and treated them with dignity and respect. Staff were able to demonstrate a good knowledge of safeguarding procedures and knew how to recognise and respond to any allegations of abuse. Medicines were managed safely, staff had received training in the safe administration of medicines and had their competencies checked.

People were supported by sufficient numbers of staff and these were recruited through a robust process which helped to ensure staff were suited for the roles they employed. Staff had received an induction and received on-going training and support. Staff had opportunities to attend team meetings and had individual meetings with their line manager to discuss any concerns.

People were supported to make their own decisions, and to retain where possible everyday living skills and abilities and their choices were respected. Their views were obtained through various systems in place to obtain feedback. People’s views were taken into account and acted upon appropriately.

There were systems and processes in place to monitor and improve the service to achieve a consistently good standard of care and support for everyone who used the service. There was a call monitoring system in place and spot checks were completed to help monitor the visit times.

The inspection took place on 2 and 3 May 2017 and was unannounced due to concerns we found at the previous inspection in January 2017. The inspection was undertaken by two inspectors. As part of the inspection process we contacted people and staff for feedback on the 3 and 23 May 2017. Hertsmere Valley Care Limited is a domiciliary care service which provides personal care and support to people in their own homes. The service was supporting 12 people at the time of our inspection. People had various needs including age related fragility and chronic medical conditions.

There was a registered manager in place who was also the provider. 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.

When we last inspected the service on 19 January 2017 we found breaches of regulations 11, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People’s consent was not routinely or consistently obtained. Although there was a complaints process in place, we found that the complaints log did not have any complaints recorded. The provider’s quality monitoring and governance was inadequate, as there were no systems in place to monitor the safety and quality of the service. The provider was unable to demonstrate that people received their visits at the agreed times. There was no call monitoring system in place at the time of our inspection. Staff did not always have a DBS check completed before they started working with people using the service. Staff did not always have training and support to assist them in their roles. References were not validated in accordance with the providers own recruitment policy.

We took action using our regulatory powers and urgently imposed a restriction to ensure Hertsmere Valley Care Limited did not start providing a service to new people and sought urgent assurances to ensure existing people were kept safe. The overall rating for the service was ‘inadequate’. The service was put in special measures which meant that the service was kept under regular review. We also shared our findings with the local authorities safeguarding and commissioning teams.

Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made some improvements. Further improvements were required to achieve full compliance with the regulations, and the restriction on taking on new people will remain in place until we are satisfied that the improvements are sustained.

People told us they received care and support that met their individual needs. People were involved in the development, planning and review of their care.

People and their relatives were more positive about the service they received than they had been previously. They told us things had improved in recent months. However staff still did not always arrive at the planned time. The people we spoke with had not experienced any missed visits. People told us staff supported them and completed the tasks they were required to do.

Since our last inspection the provider had put a call monitoring systems in place to monitor staff arrival or departure times. Staff had received some training on how to use the system effectively, and this was being further developed to ensure the system provided timely information to senior staff to enable them to take action to manage the service effectively.

People told us the staff who supported them were respectful and maintained their dignity and privacy. We saw that people’s care plans and risk assessments had been reviewed since our last inspection and did contain sufficient detail to in

This inspection took place on 19 January 2017 and was unannounced due to concerns we had about the service. As part of the inspection process we contacted people and staff for feedback on the 19, 20 and 24th January 2017. Hertsmere Valley Care Limited is a domiciliary care service which provides personal care and support to people in their own homes. The service was supporting 17 people at the time of our inspection. People had various needs including age related fragility and chronic medical conditions.

There was a registered manager in place who was also the provider. 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.

People and their relatives were not always positive about the service they received. Staff did not arrive on time and people told us they had experienced missed visits. People told us staff did not always stay the prescribed time and sometimes provided very little support to people. There were no systems in place to monitor staff arrival or departure. People told us they had concerns about some of the staff and visits were often provided later or earlier than the expected time. Three of the five people we spoke with gave positive feedback in relation to one member of staff who had recently stated to provide their care.

People told us the staff were not always very kind or caring. The provider was not able to give us any evidence that people were involved in the development or review of their care plans and times of visits. People’s likes and dislikes and personal information were not included in care records.

Staff did not always understand their responsibility to protect people from harm and abuse. Although the provider told us they had received training in how to safeguard people from harm they were not able to demonstrate they understood what constituted abuse or how potential referral should be managed. There was a policy in place in relation to safeguarding people but staff were not aware of its existence.

People had a pre service assessment in place completed by commissioners but there was no provider assessment undertaken. We saw that risk assessments were basic and lacked the level of details to inform staff how to manage risks effectively. The provider told us care plans were on the system however did not show us these when requested as part of the inspection. Consent was not obtained or recorded on people’s care records and staff did not understand when we asked them about the arrangements for obtaining consent and also did not understand how this related to MCA legislation.

We could not be assured that there was a process in place to monitor the process to check that people received their medicines appropriately and safely. Audits had not been completed in respect of people’s medicines.

People were supported by a small team of staff. However we found that the recruitment process was inadequate and checks were not completed before staff started working. We could not be assured that the staff were suited to work with people in their own homes.

Staff received some training. However, the provider was only able to give us a certificate covering up to 12 topics on one day. Staff were unable to demonstrate that they understood the learning and the provider was not able to provide evidence of any competency checks. There were no systems were in place to monitor and check the training and skills of staff. Staff’s abilities and care practices were observed by new staff who had not had their own competency checked. We found that staff had not received training in some subjects such as end of life care and mental capacity. The provider told us staff received some supervision although they were unable to provide any evidence