This inspection took place on 28 January 2019 and was announced. We gave the provider 72 hours' notice of our visit because the location provides a domiciliary care service and we needed to make sure that there would be someone at the office at the time of our visit. On 28, 29 and 30 January 2019 we made telephone calls to people using the service, relatives and staff for their views on the service.

The overall rating for the service awarded at the previous inspection which took place on 27 July 2017 was ‘Requires Improvement’. The provider was not meeting two of the regulations that we checked and was in breach of Regulation 17 and 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to take action to make improvements to promote people's safety and to improve systems and processes to monitor the quality of the service. The provider submitted an action plan outlining their plan for improvements.

At this inspection we found further improvements were still required. This is the third consecutive time the service has been rated ‘Requires Improvement’. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive.

Home from Home Care Services Limited Services – 168 Burton Road Derby is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The service caters for older people with needs relating to dementia, learning disabilities, mental health, physical disabilities, and sensory impairment. The registered location is situated in Derby city, providing care to people around Derby. There were 19 people using this service at the time of our inspection.

At our last inspection during July 2017 the provider was not meeting all the regulations we checked. Recruitment procedures did not ensure all the required pre-employment checks were completed prior to staff commencing employment. We also found the leadership and management of the services and its governance systems were not robust. The provider was also required to make improvements under effective and responsive. At this inspection we found that the provider was still not meeting all the regulations we looked at and improvements were still required under safe, responsive and well-led.

The service had a registered manager. 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.’

We have made recommendations the provider implements procedures for late calls to ensure the risk of missed visits or late calls are minimised, keep medication training updated in line with relevant guidance and having procedures for renewing DBS checks in place.

The provider continued to have ineffective quality assurance systems which failed to identify area’s which required improvements.

There were processes in place for people to raise any complaints or concerns about the service provided. However, people did not feel listened to and complaints had not always been resolved to the complainant's satisfaction.

People told us they felt safe with the care provided by staff. Staff we spoke with understood their responsibility in protecting people from the risk of harm. Staff told us they had received training and an induction that had helped them to understand and support people.

Staffing levels were adequate to meet people’s needs who were currently receiving support from the agency. However, people raised concerns that they did not always receive their calls at the agreed times and when staff had been delayed they were not notified.

Staff had received training in infe

This inspection took place on 27 July 2017 and 3 August 2017 and was announced. The provider was given 48 hours' notice. This meant the provider and staff knew we would be visiting the service’s office before we arrived. At our previous inspection during June 2016 the provider was not meeting all the regulations we checked. We found that the leadership and management of the service and its governance systems were not robust. The provider was also required to make improvements under safe, effective, caring and responsive. At this inspection we found that improvements were still required under safe, effective, responsive and well-led. We also found that the provider was not meeting all the regulations we looked at.

Home from Home Care Services Limited - 168 Burton Road Derby is a domiciliary care agency providing personal care. This included people living with dementia, older people, people with mental health and physical disability. At the time of this inspection there were 23 people who received personal care. The agency office is located close to Derby city centre.

There was a registered manager in post; they were also the service provider. The registered manager was not based at the Derby office which they visited a couple of times each month. A registered manager is a person who has registered with the Care Quality Commission. 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.

We found that the provider's quality assurance systems had not picked up the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvements.

The provider's arrangements for staff recruitment were not always safe and did not ensure suitable people were employed. We found that all the required pre-employment checks were not in place before staff commenced employment.

People and relatives knew how to raise concerns. However some relatives felt that complaints were not always well managed and they did not feel listened to. This demonstrated that complaints were not resolved satisfactorily.

People were not happy that they were not always contacted by the office staff, advising them if staff were going to be late attending their call.

The Mental Capacity Act (MCA) 2005 (MCA) helps to ensure that people are supported to make their own decisions wherever possible. Where people were identified as not having capacity there were no records of best interest decision making to show the care and support provided was in the person’s best interests.

Staff told us the training received was adequate to support people. Staff told us they felt supported and that they received regular supervision.

People received appropriate support to manage their meals when required. This was done in a way that met with their nutritional needs and choices. People’s health needs were met, staff confirmed if they were concerned about people’s health they would notify the office or contact the relevant service as required.

People told us staff treated them in a caring way and respected their privacy. Staff supported people to maintain their dignity. People's independence was promoted.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 13 June 2016 and was announced. We gave the provider 48 hours’ notice of our office visit. This was to make sure that there would be someone in when we visited.

Home from Home Care Services Limited - 168 Burton Road Derby provides personal care to people in their own homes in Derby. This included people living with dementia, older people, people with mental health and physical disability. At the time of this inspection there were 90 people using the service, which included 63 people who received personal care.

There was a registered manager in post; they were also the service provider. The registered manager was not based at the Derby office. Office staff told us the registered manager visited the office a couple of times each month. 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 previous inspection on 24 July 2014 the provider was not meeting all the regulations that we checked. We asked the provider to make improvements to care records as they were either not in place or were not kept up to date. At this inspection we found that some improvements had been made and care plans were up to date. However, some care plans did not provide specific guidance for staff about how to provide care to meet people’s needs in the way they required and preferred.

Whilst staff told us that they felt supported by the office manager and coordinators, the leadership and management of the service and its governance systems were not robust. Systems to monitor and review the quality of some areas of the service people received were not in place.

People using the service and relatives told us they felt safe. Staff we spoke with understood their responsibility in protecting people from the risk of harm, however we had not been notified of all incidents of a safeguarding nature. Overall, staff were available to cover care calls, however care was not always provided at the agreed times and in a consistent way.

Recruitment procedures were not thorough. For example not all the required pre-employment checks were completed. This did not provide assurance suitable staff were employed to work with the people who used the service.

The provider did not fully understand their responsibilities under the Mental Capacity Act 2005. Staff were not clear about people’s individual capacity to make decisions.

Complaints were not always well managed and communication with the office had been inconsistent and not resolved issues satisfactorily.

People told us that staff treated them in a caring way and respected their privacy and supported them to maintain their dignity.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with 19 people and/or their relatives that used the service. We also spoke with seven members of staff.

The majority of people that we spoke with were happy with the care provided. One person told us they were “very satisfied”, another stated that the provider was “very good and that staff are “nice to me, all very pleasant”. We found that care plans lacked detail and did not offer staff sufficient information to ensure that care needs were met.

Staff had received training in protecting vulnerable adults. Staff had an understanding of what abuse was and what action to take should they have concerns.

The provider had carried out sufficient pre-employment checks on staff members. This helped to ensure that staff were of good character.

The majority of staff were up to date with mandatory training in key areas such as moving and handling and first aid. However staff had not received regular supervision in line with the provider’s guidelines.

The provider had quality assurance systems in place to help monitor the service provided.

Although appropriate action had been taken the provider had not informed the commission about all allegations of abuse.

As part of this inspection we spoke with four people who used the service and their relatives, three professionals who had knowledge of the service and four members of staff.

One person who used the service stated that it was “excellent”. Another told us that staff were “cheerful and efficient”. People we spoke with felt that the staff listened to what their needs were and responded to these.

One professional stated that the service had been “quite exceptional with one case”.

We found there was some concerns around care plans and pre employment checks carried out on staff members.

We spoke to three people who were using the service and two relatives. All of the people we spoke with told us that a member of staff had been to assess their needs and they were able to be fully involved in this process. People also confirmed they were happy that staff treated them respectfully.

The people using the service and relatives we spoke to told us “The staff are almost always on time but will phone if running late. It is usually the same members of staff that attend and they do everything I need. They make sure I am ok before they leave.”

The relatives we spoke to also confirmed this, “I am happy my relative is in safe hands and let the staff get on with it. We received all essential information when we first signed up, including how we could raise concerns.”

We carried out this inspection in response to concerns that one or more of the essential standards of quality and safety were not being met. At the time of our visit 79 people were using the service. Below is a summary of our finding based on speaking to four people using the service, two relatives, and five members of staff and by reviewing care records.

Is the service safe?

People we spoke with told us that the carers understood their needs and that most of the carers were very good. One person stated “some carers are nicer than others, but I get on with them all.” Another person stated “I feel safe with the carers they are very good.”

Systems in place for responding to emergencies that could affect the delivery of peoples' care were not always effective.

Is the service effective?

Care plans were not always in place at the service or up to date. This meant that staff did not have sufficient information available to them to ensure people's individual needs were being met and that people were supported safely.

Is the service caring?

Care plans were not detailed. Care planning did not always take account of people’s wishes, preferences and routines relating to their care to ensure they received personalised care that met their needs.

Is the service responsive?

People said that they could make a compliant if they wanted to.

Is the service well-led?

The provider was aware of incidents that affected the welfare, health and safety of people using the service, which required reporting to the Care Quality Commission.

Care planning was not adequately detailed to ensure people received personalised care that met their needs.