The inspection took place on 03 May 2017. We gave the provider 24 hours’ notice to ensure someone would be in the office to facilitate the inspection.

At our inspection in August 2015, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in regards to the following regulations, consent, safeguarding service users from abuse and improper treatment, good governance, staffing and fit and proper person’s employed.

The service was rated as inadequate in the safe domain and rated as requires improvement in all the other domains and key lines of enquiry (KLOE’s) which meant the service was rated as requires improvement overall.

We undertook a focused inspection in January 2016 to establish whether the provider had addressed the breaches previously identified at the inspection in August 2015. At the focused inspection, we found the service was meeting all the legal requirements but the rating remained unchanged at that time. This was because to change the rating, the provider would need to demonstrate consistent good practice over time. We also only looked at aspects relating to the breach of regulations, rather than looking at the whole question relating to the KLOE.

Homecare Solutions is a domiciliary care agency that is registered to provide support to people in their own homes. The service offers care to people living with a diagnosis of dementia, people who require help with personal care and daily tasks. At the time of the inspection there were two people receiving support.

There was a registered manager 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.

The service had a robust recruitment process to help ensure people employed were suitable to work with vulnerable people.

Safeguarding policies and procedures were in place and the staff demonstrated a good understanding of safeguarding concerns and the process to follow if they suspected abuse.

Comprehensive risk assessments were in place and support plans devised to mitigate the risks. We saw that people or their representatives had been involved in planning the care provided.

Staff told us they were well supported and we saw they received regular supervision and an annual appraisal of their work. Staff were inducted in to the service and received ongoing training to support them to undertake their role.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA).

People’s relatives told us they valued that only a couple of staff supported their family member. We were told bonds had formed between their family member and staff. People’s relatives said staff were kind and caring and paid particular attention to detail which reassured their relatives that their family member was being well cared for.

People who used the service were fully involved with decisions about their care and we were told they were given choices in relation to their care delivery and their personal preferences were taken into account.

There was a complaints policy in place and although at the time of the inspection there had not been any complaints received, there were systems in place to track complaints.

The registered manager covered care shifts to ensure they maintained oversight regarding the care provided.

People’s relatives and staff spoke highly of the registered manager and stated the service was well –led and that they wouldn’t hesitate to recommend the agency to others.

The registered manager sought the views of people who used the service and their relatives by undertaking reviews. We also saw questionnaires had been sent to ascertain people’s feedback regarding the quality o

We carried out an announced comprehensive inspection of this service on the 10 and 17 August 2015. During that inspection we found five breaches of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Homecare Solutions Ltd is a domiciliary care agency, which provides personal care to people in their own homes, who require support in order to remain independent. The office is located in Salford Innovation Forum, which provides adequate parking facilities. At the time of our inspection, the service had two clients.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Homecare Solutions Limited on our website at www.cqc.org.uk.

At our last inspection we found that the registered person had not protected people against the risks associated with safeguarding people from abuse and improper treatment. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safeguarding people from abuse and improper treatment. We found the provider was now meeting the requirements of the regulation. All staff had undertaken safeguarding training, which we verified by looking at training records. Policies and procedures adopted by the service provided clear guidance on identifying and reporting safeguarding concerns.

At our last inspection we found that the registered person had not protected people from the risks associated with the safe recruitment of staff. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the employment of fit and proper persons. We served a warning notice on the service at that time, which required them to become compliant with Regulations by 12 October 2015. We had not visited the service sooner as they did not have any clients at that time. We found the provider was now meeting the requirements of the regulation. We looked at staff personnel files and found that the provider had sought references and undertaken suitable checks before employing new staff. Relevant documentation was now in place in individual personnel files.

During our last inspection we found that staff were not effectively supported to undertake training, learning and development to enable them to fulfil the requirements of their role. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of staffing. During this inspection, we found the provider was meeting the requirements of the regulation. All staff had attended external training in a number of key areas such as basic life support, safeguarding, fire safety, infection control, Health and Safety and manual handling.

During our last inspection we found that the service were unable to demonstrate clearly how they ensured that they had obtained consent before providing care and support. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulations) 2014, need for consent. During these inspection, the service currently had two clients who had capacity and were able to provide written consent to care provided by the service. The service had introduced documentation, which enabled them to demonstrate that formal and written consent had been obtained.

During our last inspection we found that the provider had not implemented systems to assess, monitor and improve the quality and safety of the services provided in the carrying out

This unannounced inspection took place on 10 and 17 August 2015. The service, which registered with the Care Quality Commission (CQC) in July 2014, had not been previously inspected.

Homecare Solutions Ltd is a domiciliary care agency, which provides personal care to people in their own homes, who require support in order to remain independent. The office is located in Salford Innovation Forum, which provides adequate parking facilities. At the time of our inspection, the service catered for one person who used the service.

There was a registered manager in place. 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.

During the inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering our enforcement options in relation to these breaches.

As part of our inspection, we checked to see how the service protected vulnerable people against abuse. The registered person confirmed they did not have any information about local safeguarding protocols with the local authority they had been working with in order to progress any concerns appropriately. We spoke to the two members of staff about their knowledge and understanding of protecting vulnerable adults. Both members of staff were able to demonstrate an understanding of the principals of safeguarding people. However, both confirmed that they had not received any training in safeguarding, which we verified by looking at their training records. We found that no induction training had been provided to either member of staff.

We found the registered person had not ensured they had systems in place to protect people from abuse and improper treatment. This is a breach of Regulation 13 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safeguarding people from abuse and improper treatment.

We found people were not protected against the risks of abuse, because the service did not have robust recruitment procedures in place. Of the current members of staff, both personnel files contained criminal records bureau (CRB) disclosures. The service recruitment policy stated that certain official documents should be obtained from potential employees, such as proof of identity in the form of a photo driving licence or passport. There was no evidence of these documents within the personnel files. Additionally, there was no application forms, previous employment history or suitable references. Nothing was documented to indicate when the member of staff started working for the service. The service’s recruitment policy, which stated that an interview should be undertaken for all candidates, had not been followed.

With regards to the member of staff who no longer worked for the service, we found information that the individual had started working for the service in January 2015. The CRB disclosure in the file was dated September 2013 and listed previous convictions. We found a completed application form, which provided details of previous employment. The application form contained details of two referees, however we found that the references had not been obtained. When we spoke to the registered person about this matter, they provided a further document containing a reference from a person. The document was not dated and did not contain details of who the referee was and what company they represented.

We found the registered person had not protected people against the risk of associated with employing fit and proper persons. This is a breach of Regulation 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to fit and proper persons employed.

We looked at the training and professional development staff received to ensure they were fully supported and qualified to undertake their roles. We found that staff had not undertaken any induction training as part of an induction programme to the service. Limited on-line training had been undertaken, which we verified by looking at personnel files.

One member of staff told us that they did not deliver any personal care and attended calls only where meal preparation was required. This meant that in the event of an incident such as a fall or where a person need physical support, this member of staff was not adequately trained to provide such support. We found that the person who used the service was living with dementia, yet two members of staff had not received any training in supporting people with dementia.

We found one member of staff had received some formal supervision, whilst the other had not received any documented supervision since commencing employment with the service. When we spoke to the registered person about this, they explained that as they worked with the person all the time they were constantly supervising the person, but confirmed no records of supervision had been maintained. We looked at a supervision log for the member of staff who no longer worked for the service. The log was neither dated nor signed. We saw no evidence of any annual appraisal for staff.

We found that staff were not effectively supported to undertake training, learning and development to enable them to fulfil the requirements of their role. This is a breach of Regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of staffing.

We found the service were unable to demonstrate clearly how they ensured that they had obtained consent before providing care and support. In the care files we looked at including the care file of the sole person who used the service, we found that consent forms had not been completed. We found no policy at the service that covered consent. For the one person who used the service who was living with dementia, we found no record of mental capacity assessments or best interests decisions within the care files. On our subsequent visit, we saw that a mental capacity assessment had been undertaken.

We spoke with registered person and staff to ascertain their understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The registered person was able to demonstrate an understanding of the principals of the MCA and DoLS and confirm they had received training. The other members of staff had only a very limited understanding of the principals of the MCA and had no knowledge of DoLS. Both member of staff confirmed that they had received no training.

We found the registered person had not protected people against the risk associated with care and support only being provided with the consent of the person or their representatives. This was a breach of Regulation 11 (1) of the Health and Social Care Act 2008 (Regulations) 2014, need for consent.

We found no evidence of any formal documented audits, such as care plan audits for documented consent, medication, spot checks, personnel files, safeguarding, training and development, which were areas of concern we identified during our inspection.

We found that the provider had not implemented systems to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity. This was a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance.

Providers are required by law to notify CQC of certain events in the service such as serious injuries, deaths and any allegations of abuse. Records we looked together with consultation of a local authority, confirmed that CQC had not received two required notifications of allegations of abuse. This is an offence under 18 (2) (e) of the Care Quality Commission (Registration) Regulations 2009 (Part 4). This matter will be dealt with outside the inspection process.

At the time of this inspection, the service was supporting one person in their home. As the person who used the service was unable to speak to us about the service, we were able to speak to a close family member instead. They told us they had only been with the service for six weeks, but were happy with the quality of care and support their relative received.

We looked at how the service managed people’s medicines. We looked at a general policy for managing service user’s medicines. We looked at one medication risk assessment, which provided instructions to staff on completing medication administration records and to ensure they were filed monthly. It provided no information on where medicines were located, who was responsible for collecting and ordering medicines and there was no list of current medicines being used. The record related to a person who did not have capacity, we found there was no instruction to staff on how to deal with this individual.

We spoke to the registered person about these concerns, they told us that presently only they administered medicines. They explained that due to the small numbers of people they supported, all relevant information about medication was retained mentally, though they accepted that such information should have been documented in the care file.

We spoke to the relative of the one person who currently used the service, they told us that they believed staff were kind and caring. 

The service policy on compliments and complaints provided instructions on what action people needed to take and a summary was contained within the service users guide. The service did not currently maintain a complaints log as they told us they had not received any formal complaints since registration.

We also established that the service had not circulated questionnaires to seek feed-back from people who used the service, their families and health care professionals as a means of monitoring the quality of service delivery. The service subsequently sent out a questionnaire following our first visit.

The registered person recognised the need to implement improvements in respect of recruitment, staff development, issues of consent, notifications and good governance and told us that they would not accept any new clients until these matters had been addressed.