This announced inspection took place on 25 July, 26 July, 31 July and 02 August 2018.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults. At the time of inspection, the provider was supporting five people with personal care.

Not everyone using Kare Plus Milton Keynes and Bedford receives regulated activity; 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.

There was a registered manager in post. 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 last inspection on the 16 May 2016, we were unable to rate the service. Although the service was providing support to one person, there was not sufficient information available to us to fully assess how safe, effective, caring, responsive and well-led the service was. At this inspection we found that the service 'Requires Improvement'.

The quality assurance processes in place to monitor the quality and safety of the service and drive improvement required strengthening. Audits had not identified gaps in the information provided on medicines administration record charts (MARs) or gaps in the recording of medicines administered to people.

The system in place for the management of complaints required strengthening to ensure complaints were dealt with in a timely manner.

People were not always adequately assessed for their risks and did not have plans of care in place to mitigate their known risks. People’s care plans and assessments did not always reflect the support people required to meet their health needs.

People at risk of malnutrition did not have their nutritional needs assessed to ensure that they were supported to maintain an appropriate diet. However, staff knew people well and people were provided with the support they required to prepare their meals and maintain a balanced diet.

Staff demonstrated their understanding of MCA and the need to ensure that people's care and support was provided in the least restrictive way. However, there was a lack of recorded MCA assessments and best interest decisions in place for people. The registered manager had not identified that the principles of the MCA had not been implemented appropriately; there was a risk that care would be provided to people that was not in their best interest.

Staff induction training and some on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles. However, staff would benefit from regular updates of practical manual handling training.

Staff were well supported by the registered manager, and had regular contact with them.

People received safe care. Staff understood their responsibilities to keep people safe from harm. Safeguarding procedures were in place and staff understood their duty to report potential risks to people’s safety.

There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. References and security checks were carried out as required. Staffing levels ensured that people's care and support needs were safely met.

People were involved in their own care planning and were able to contribute to the way in which they were supported. People received support from a regular team of staff, who knew them well.

This inspection took place on 16 and 18 May 2017 and was announced.

Kare Plus Milton Keynes and Bedford provides personal care to people who live in their own homes in order for them to maintain their independence.

At the time of our inspection the provider confirmed they were providing personal care to 1 person.

There was a registered manager in post. 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 were unable to rate the agency as there was not sufficient information available to us to fully assess how safe, effective, caring, responsive and well-led the service was.

Staff had an understanding of safeguarding procedures that should be followed to report abuse and risk assessments were in place to manage risk within a person’s life.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions.

People's consent was gained before any care was provided.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.

People were involved in their own care planning and were able to contribute to the way in which they were supported.

The provider had systems in place to monitor the quality of the service as and when it developed and had a process in place which ensured people could raise any complaints or concerns.