The inspection of the service took place 6 March 2018. A follow up desktop review of evidence was completed 22 March 2018. This was completed following a meeting with the registered manager of the service. The delay was due to the registered manager and the inspectors conflicting schedules.

The service was given 24 hours' notice prior to the inspection this was done as the service is small and we wanted to be sure there would be someone available to speak with us.

KTG Recruitment Ltd is managed from well-equipped offices located in central Preston. Services are provided to support people to live independently in the community. During this inspection there were 12 people who used the service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing.

Not everyone using KTG Recruitment Ltd 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 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.

At the last inspection we made a recommendation that the agency reviews it practices regarding the signing of consent forms and ensure that any discussions with people who do not wish to sign elements of their care plan, but have the capacity to do so, are documented appropriately.

During this inspection we found the principles of the MCA were not consistently embedded in practice. We found people’s capacity to consent to care had not always been assessed and information was at times conflicting. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice

This amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent). You can see what action we told the provider to take at the back of the full version of the report.

We found inconsistencies in individualised risk assessments and the plans in place to mitigate these. The documentation did not always contain information to adequately mitigate the risks to individuals.

This amounted to a breach of Regulation 12 (safe care and treatment) 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.

At the last inspection of the service we made a recommendation that care plans and risk assessments fully reflect people's current needs.

During this inspection we found care plans did not always contain up to date current needs for people. For example we saw that one person had developed a scab and redness on their bottom area and was using a pressure cushion. This change in need was not reflected in their risk assessments or care plan.

This amounted to a breach of Regulation 12 (safe care and treatment) 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.

We looked at the procedures the provider had for the administration of medicines and creams. We found that people did not always have medicine support plans in place. We found that protocols for “as and when” medicines were not always in place as per the medicines policy. Medicines audits we checked had not picked up on issues we found such as missed

This inspection took place on the 22 and 30 September 2016 and was announced to ensure that the Registered Manager was available to speak with.

The Registered Manager was present during the visit to the registered premises and was cooperative throughout the inspection process. 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.

KTG Recruitment Ltd is a domiciliary care provider that is managed from well-equipped offices located in the city centre of Preston near to the railway station. KTG Recruitment helps adults to live independently in the community by supporting them with their personal care needs and some domestic tasks. The organisations main focus is to supply qualified ‘agency’ staff to other providers of health and social care however as this is not a regulated activity this area of the business was not part of the inspection process.

The agency was last inspected on 24 July 2014 using the previously inspection methodology in place. At that time the agency was judged to be fully compliant against the eight standards inspected.

At the time of our inspection the service was delivering a domiciliary support service to 13 people. At our previous inspection the agency was delivering a service to 45 people. We asked the registered manager about the reduction in numbers and they told us that they were concentrating on the other side of the business which provided qualified staff as agency workers to other health and social care providers. The registered manager also told us that the main focus of their work was 24 hour care, palliative care and emergency or crisis care. The service had a contract in place through Marie Curie cancer care for end of life care provision and commissioned work came in via the NHS, local authority and from private funders.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Staff members spoken with said they would not hesitate to report any concerns they had about care practices. We did however find some recorded incidents and issues when reviewing care plans that should have been referred to the local authority safeguarding team. The registered manager did this immediately and kept us up to date with the outcomes of each incident. However, there were no incident and accident records on the files within the office to reflect the incidents we saw recorded within daily notes. Nor was there evidence that appropriate actions had been taken. We have made a recommendation about this.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. Prospective employees were asked to undertake checks prior to employment to help ensure they were not a risk to vulnerable people. In addition to undergoing the usual recruitment procedures of completing an application form and attending an interview prospective employees were asked to fill in a psychometric profiling tool. This helped the agency to recruit people with the right attitude and skills to work in care.

Staffing levels were not seen to be an issue from the evidence gathered at this inspection. The one person we spoke with and relatives of people had no issues regarding the consistency of staff or their competence and attitude.

We looked at the systems for medicines management. We saw clear audits were regularly conducted and detailed policies and procedures were in place. Staff were trained to administer medicines and they told us that the training given was of good quality.

We saw that staff received a thorough induction that was adap

During our inspection we spoke with six service users or their relatives and eight members of staff, who in general provided us with positive responses to the questions we asked about KTG Recruitment Limited. We gathered evidence against the outcomes we inspected, to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observation of records during a visit to the agency office, speaking with those who used the service, their relatives, support staff, the manager and the provider. At the time of this inspection there were 45 people who received care and support from KTG Recruitment and a team of 30 staff members. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with told us they felt safe when care and support was being provided and their dignity was always respected.

Records showed that people (or their relatives) were involved in making decisions about the care and support they received and assessments had been conducted, so that people were not put at unnecessary risk. Infection control protocols were being followed and medicines were being managed properly.

Is the service effective?

There was an advocacy service available, if people wished to utilise it. This meant that those who wished to access an independent person to act on their behalf, would be supported to do so. The health and personal care needs of those who used the service had been assessed. External professionals had also been involved in delivering effective health care. Systems were in place, to allow the service provided to be assessed and monitored on a regular basis.

A broad range of training modules were provided for staff, with regular mandatory updates. This helped to ensure the staff team delivered effective care and support for those who used the service.

People told us their wishes were taken into account and that staff were very courteous. We asked those who used the service about the staff team. Feedback from them was very positive. They said staff were kind and caring towards them and helped them to meet their needs effectively.

When speaking with staff it was clear they were fully aware of what people needed and were confident in supporting them.

One person who used the service commented, " It is absolutely fantastic. I have no complaints at all. They (the staff) are marvellous."

Is the service responsive?

The agency worked well with other services to make sure people received care and support in a consistent way. One person who used the service commented, "They (the staff) will do anything I ask, within reason that is. We have to think about health and safety of course. They are smashing." Another told us, "It is usually the same two girls who come to see to me, which I like, because I get to know them and they get to know how I like things to be done. Two others come sometimes, if my girls are on holiday, but they are all lovely and I never get more than the same four. I give them full marks. They are brilliant and could not be any better."

The provider had responded well following our previous scheduled inspection, by implementing systems to improve areas of none compliance. Records showed that systems were assessed and monitored with action plans being developed to address any shortfalls identified.

Is the service well-led?

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the manager of the service. People were aware of the lines of accountability within the agency and felt comfortable in contacting the office at any time, should they need any advice or to talk to someone.

People who used the service or their relatives had completed annual satisfaction surveys. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately. We spoke with the provider and the manager, who clearly wanted to provide a good quality of service for the people they provided care and support to.

Prior to this inspection we had received concerning information about the recruitment processes in place at KTG Recruitment Ltd. New employees were being allowed to work with vulnerable people before appropriate checks had been completed. We were told that new employees were allowed to work with vulnerable people without any induction training and were sent out to care for people without background information about the person they were expected to provide care for.

We found that there was new manager in place who confirmed that some of the information we had been given was correct and that he had found some of the concerns out for himself. We were assured that steps were being taken to address the concerns.

We examined records, spoke to staff and people who used the service.

People who used the service told us: “They are very willing to do anything”. “I have two carers. One is brilliant and the other only does what she has too”. And: “They are always on time. I have never had any problem”.

We found that KTG Recruitment Ltd was not operating effective recruitment procedures to ensure that staff were safe to work with vulnerable people.

There were sufficient numbers of staff on duty to provide care for people who used the service.

We found that staff we spoke with had not received appropriate induction training, support and ongoing training to allow them to perform their role and provide safe and appropriate care to people who used the service.

We spoke with a range of people about the agency. They included the manager, staff, relatives and people who received a service. We visited people in their own homes for their view of the service. We also had responses from external agencies including social services. This helped us to gain a balanced overview of what people experienced at KTG Homecare.

People who used the agency told us they provided a good service. Comments included, “A very good agency.” Also, “Mum receives excellent care from good competent staff.”

People told us they had received a visit from the manager of the agency before the service commenced. This was to introduce themselves and carry out an initial assessment. They told us their needs had been discussed and they had agreed with the support to be provided. They told us the staff provided sensitive and flexible personal care support and they felt well cared for.

We found that recruitment procedures were thorough and staff told us they had a good induction programme before they visited people in their own home.

Surveys were sent to client homes and spot checks by the manager were part of the agency’s policy to get the views of people who use the service.

We did not speak to people who used the agency as the agency did not have any people using its services. The agency was operational with a registered manager, social care coordinator and staff available to support people should a service be requested.

The agency had all the required policies, procedures and documents systems in place to support people to receive the care and support of their choice.

We saw that staff had undergone an induction and training programme and there were supervision arrangements in place to monitor staff performance.

We saw the arrangements in place to monitor the quality of the service that would be delivered once the agency was providing a service to people. The monitoring arrangements in place would include involving people and families in reviews of care and development of the quality assurance system as well as policies and procedures.