Italia House is a domiciliary care agency which provides care and support to people living in their own homes in the community. The care agency offers a variety of services, including assistance with personal care, meal preparation and domestic tasks. Not everyone using Italia House receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

This was the first inspection of this service, which had registered with CQC in July 2017. At the time of our inspection Oldham Metropolitan Borough Council (OMBC) had cancelled all their care contracts with the service. This was following a number of concerns raised by people who used the service and their families about aspects of the care they had received. These included concerns about late and missed visits, poor record keeping and poor medicines documentation. Although OMBC had cancelled all its contracts it should be noted that not all people were dissatisfied with the care they had received. At the time of our inspection the service was providing care to one person through a care package which was privately funded. However, we looked at the information held by the service about all the care provision since they started providing support since December 2017 to allow us to gain a view about the service.

We carried out this announced inspection on 14 February and 12 March, 2018. The service had a registered manager. A registered manager is a person who has registered with CQC 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 breaches of four of the regulations of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. These are in relation to medicines management, risk assessments, staffing, need for consent and quality assurance.

You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not managed safely. The limited medicines documentation that was available for us to check was poorly and incorrectly completed. There was also no information available for staff to guide them when giving ‘as required’ medicines.

Many concerns had been raised with OMBC about late and missed visits. These are currently being investigated as part of OMBC’s safeguarding investigations. From the information we have received we consider the service did not have sufficient staff to provide the care it had agreed to undertake.

Although some risk assessments had been carried out, particularly in relation to people’s environment, we found that individual risk assessments, for example for moving and handling and nutrition, had not always been undertaken.

Recruitment checks had been carried out to ensure staff were suitable to work with vulnerable people. However, references had not been checked or validated to ensure they were genuine.

Staff employed had received an induction to the service and essential training. Staff had received supervision.

There was no evidence that people’s mental capacity had been assessed. There was no information to show who was involved with making decisions about peoples’ care and no evidence to show that care plans had been discussed and agreed with people using the service or their family member/legal representative.

The systems in place to ensure care was provided in a safe way were not sufficiently well established. No auditing or checking of the service had been carried out. The inspectors found there was a significant lack of documentation available to them during the two day inspection. This absence of key information was of concern because they were unabl