This inspection took place on 30 May 2018 and was announced. At the time of our inspection 67 people were using the service.

ICCM Ltd - Telford is a domiciliary care service providing complex and clinical care to older adults, younger adults and children with profound disabilities, spinal cord injuries, acquired brain injuries and other neurological disorders. It is registered to provide personal and nursing care to people living in their own homes throughout England. It is also registered with us to provide treatment of disease, disorder and injury.

A registered manager was in post and was present during our inspection. 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.

Registered providers are required, by law, to notify the CQC when any details affecting their registration change. The provider had failed to notify us of a change to their company address which happened in March 2018. They took action during our inspection to ensure this was rectified.

People raised concerns about the consistency of the staff that supported them. Each person had their own team of staff who provided up to 24-hour care. Where people did not have a full staff team, they were supported by the provider’s rapid response team or agency nurses. People did not always feel safe when the supported by these staff, because they did not know their care needs as well as their own staff team.

Despite the provider having safeguarding procedures in place, these had not been followed by managers in one instance. This placed people at risk and meant investigations had not been carried out as required.

Risk assessments reflected how care should be provided to the person to minimise any risks to them; they were regularly reviewed to adapt the level of support needed in response to people's often rapidly changing needs. However, where staff had raised concerns about one person the provider had failed to assess the risks associated with those concerns.

Systems were in place where managers monitored and reviewed the quality of the service provided to people. However, they had not identified that action had not been taken in response to the one safeguarding incident or staff concerns. The provider was already aware of the inconsistency of staffing for some people and was taking action to address this.

Some people felt communication from managers needed improvement, because they were not informed when there were changes to their care provision and staffing arrangements.

People received their medicines when they needed them. Staff were recruited safely to ensure they were suitable to work with people within their own homes. People were protected against the risk of infection.

People’s care and support needs were assessed and the provider followed good practice guidance to help ensure the care provided was effective and current. People were involved in the planning and review of their care and were encouraged to express their views, preferences and wishes regarding their care, support and treatment. This included any end of life wishes they had.

The training staff received was specific to people’s individual needs. Staff practice was assessed and continually monitored to ensure they were competent to meet people’s complex and specific needs.

People were supported to eat and drink enough and risks associated with these were assessed and monitored to ensure people’s safety. Staff worked in partnership with other professionals and people confirmed they received the support and treatment they needed to maintain their health.

People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible. Staf