We undertook an inspection of Kumari Care on 10 and 11 September 2018. The inspection was announced, which meant that the provider knew we would be visiting. This is because we wanted to ensure that the provider, or someone who could act on their behalf, would be available to support the inspection.

At our last comprehensive inspection of Kumari Care in December 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, person centred care and good governance. The service was rated requires improvement.

Following this inspection, the provider sent us a fortnightly action plan around the changes being made in the management of medicines within Regulation 12, safe care and treatment. We undertook a focused inspection in the domains of safe and well-led in April 2018 to check the provider’s progress. At this inspection we found some actions had been taken but not all those as detailed in the provider’s action plan. This meant the provider was still not meeting the regulations.

At this inspection we reviewed the action the service had taken to meet previous breaches in regulations. You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Kumari Care’ on our website at www.cqc.org.uk

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care provides a service to 107 people.

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 this inspection the service was not consistently safe as improvements to recruitment checks were still needed. We identified shortfalls in the timing and duration of calls during the night that could put people at risk if care was not given as planned.

Improvements had been made to governance systems. This had identified some outstanding actions and areas for further improvement. However, further improvements were needed due to the findings of this inspection.

Care plans guided staff in supporting people with their decision making. People told us consent to care was sought. However, legislation and guidance in relation to the Mental Capacity Act 2005 had not always been followed in relation to capacity assessments.

The provider had made improvements in the safe management and administration of medicines. Care plans gave guidance about people’s medicines. Environmental risk assessments were now in place to guide staff and keep people safe.

The service had made improvements that had been noted by people, relatives, staff and health and social care professionals. People spoke positively about the changes they had noticed around staffing consistency and that missed visits were rarely occurring.

Staff were supported by an effective induction, supervision and regular training. Care plans that had been updated gave guidance about people’s food and fluid requirements. People told us staff supported them with their healthcare needs.

People were supported by staff that were kind, caring and respectful. People had developed good relationships with staff members. People’s privacy and dignity was maintained. Improvements had been made to ensure people’s care plans gave guidance around how people’s independence should be promoted and supported.

A systematic review of care plans was being undertaken. Care plans that had been updated and reviewed now contained person centred information. This included details about people’s background, histories and communication preferences. People’s preferences were now being met around choices of carers. People knew how to raise a com

We carried out a comprehensive inspection of Kumari Care on 11 and 12 December 2017. At this inspection the service had not met the regulation relating to Safe Care and Treatment in regards to medicine administration. Following this inspection the provider submitted an action plan detailing the steps that would be taken to meet this regulation. The provider had been submitting fortnightly reports to inform the Care Quality Commission of the progress made to address the areas identified in medicines administration.

We undertook a focused inspection on 9 April 2018 to check the provider had completed the areas set out in their action plan. You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Kumari Care’ on our website at www.cqc.org.uk

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care provides a service to approximately 200 people.

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 this inspection, we found the provider had taken action to progress towards meeting the warning notice. However, further elements of the regulation needed to be met.

We found two breaches 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 this report.

We undertook an inspection of Kumari Care on 11 and 12 December 2017. The inspection was announced, which meant that the provider knew we would be visiting. This is because we wanted to ensure that the provider, or someone who could act on their behalf, would be available to support the inspection.

At our last comprehensive inspection of Kumari Care in April 2017 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations and the service was rated inadequate. Following this inspection, we served two Warning Notices for a breach of regulation 17 and 18 of the Health and Social Care Act 2008. This was because we found that staff had not been provided with suitable induction, supervision or training to enable them to be effective within their roles. There were also ineffective systems in place to monitor and review the quality of the service.

We undertook a focused inspection in August 2017 to check the provider was meeting the legal requirements in regards to one of the regulations they had breached and had complied with the Warning Notice. The focused inspection looked at the breach of regulation 18. The induction, supervision and training which staff received. At this inspection, we found the provider had taken action to progress towards meeting the warning notice. However, further elements of the regulation needed to be met.

At this inspection we reviewed the action the service had taken to meet previous breaches in regulation and to ensure the provider was meeting the areas set out in the warning notice in regards to Regulation 17.

You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Kumari Care’ on our website at www.cqc.org.uk

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care provides a service to approximately 130 people.

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.

The service was not safe as medicines were not managed safely. There were widespread shortfalls found relating to the recording and administration of people’s medicines. Risk assessments had been reviewed and changed since the last inspection and people’s risk were identified. Further guidance to staff was needed. There were no environmental risk assessments in place to keep people and staff safe. Recruitment procedures had been improved although some shortfalls were identified in document verification.

Staff received an induction, training and supervision to support them in their role. Staff were aware how the Mental Capacity Act (MCA) 2005 applied to their role. However, capacity assessments had not been consistently completed.

Positive feedback was received about the care and support received from staff. Staff were caring and respectful. People’s privacy and dignity were upheld.

Care plans were not always person centred as people’s background and histories were not consistently completed. Care plans did not always give sufficient detail and guidance into people’s support needs around communication, health and food and fluids. People’s preferences were not always able to be met around choices of carers.

Improvements had been made into how complaints were recorded, investigated and responded to. Staff knew how to identify and report any safeguarding concerns. Concerns were investigated and responded to appropriately.

Systems to monitor and review the quality of the service had been introduced. However, further improvements were required to ensure identified shortfalls were progressed. Regular meetings had been introduced to staff to promote better communication an

We carried out a comprehensive inspection of Kumari Care on 04 and 06 April 2017. Following this inspection, we served two Warning Notices for a breach of regulation 17 and 18 of the Health and Social Care Act 2008. This was because we found that staff had not been provided with suitable induction, supervision or training to enable them to be effective within their roles and systems in place to monitor and review the quality of the service were not effective at identifying shortfalls.

We undertook a focused inspection on 15 August 2017 to check the provider was meeting the legal requirements in regards to one of the regulations they had breached and had complied with the Warning Notice. This focused inspection looked at the breach of regulation 18. The induction, supervision and training which staff received. This report only covers our findings in relation to this area. The second warning notice will be followed up in due course. You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Kumari Care’ on our website at www.cqc.org.uk

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care provides a service to approximately 200 people.

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 this inspection, we found the provider had taken action to progress towards meeting the warning notice. However, further elements of the regulation needed to be met. New systems had been introduced to mitigate against the risk of the regulation being breached again. However, these systems have not yet been embedded or fully completed.

Progress had been made towards staff completing mandatory training such as medicines administration, manual handling, first aid and safeguarding. However, not all staff were fully up to date. Staff had not yet completed training in the Mental Capacity Act 2005, The Deprivation of Liberty Safeguards or areas specific to the needs of individuals. For example, particular health conditions. Systems were being developed to plan for all appropriate training.

Since the last inspection staff had received a minimum of one supervision with their line manager. An appraisal system had been introduced. Spot checks had been recommenced. However, these were not yet occurring regularly.

New staff now received an induction aligned with the Care Certificate. Previous staff who had not completed the Care Certificate had been registered although had not yet completed it. All staff were undertaking the new induction process.

The provider had communicated with staff about the changes and expectations around induction, supervision and training. Peer support meetings had been introduced so staff could raise any concerns.

We found one breach 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 this report.

The inspection took place on 4, 5 and 6 of April 2017. The provider was given 24 hours notice of our inspection. This is because the service provides care to people in their own homes and we needed to make sure the registered manager or their representative would be available to support the inspection.

The service provides domiciliary care to approximately 200 people in the Bath, Bristol and South Gloucestershire areas.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 found shortfalls in relation to the safety of the service. Information about medicines was unclear in people’s support plans. We also found some poor practice in the recording of medicine administration. This meant there was a risk that people would not receive their medicines in line with their prescribed needs. We also found that risk assessments were not sufficient to ensure that staff had clear guidance about how to manage risks associated with people’s care.

Recruitment procedures were not sufficiently robust to ensure that new staff were safe and suitable for their roles. Disclosure and Barring Service checks were not always completed for office based staff; references and gaps in employment history were not always investigated fully.

People were supported by staff who did not receive adequate supervision and training. This was found to be a breach of regulation at our last inspection and the concerns had not been addressed since that time. People were at risk because staff did not have the specialist training required to ensure they were confident and able to meet people’s complex needs. Staff performance and development needs were not regularly assessed through supervision. Staff confirmed with us that there were gaps in their training and support.

People’s support plans were not sufficient to guide staff in meeting people’s needs. Where people had complex health needs, there was no clear information in care plans to guide staff in meeting those needs.

There was an inconsistent approach to managing and addres

The inspection took place on 8 August 2016. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be available at the office.

Kumari Care provides personal care to people in Bath and surrounding areas. They offer a range of services to individuals who live in their own homes and need support or care. .At the time of this inspection there were 200 people receiving service from Kumari Care. People who used the service had a variety of care needs. Some had 24 hour live in care staff, some very complex needs with several care calls a day and others required one call a day.

At the last inspection of the service in 20 October 2014 we found the service was meeting the regulations.

The service had 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 and associated Regulations about how the service is run.

There were mixed comments from people about staff timeliness. The majority of people told us care staff arrived on time. However some people told us care staff didn't always arrive on time and people were not told if there was to be a change in care staff. They told us they were not always informed if care staff would be arriving late.

People’s care needs and risk assessments were not regularly reviewed. However care staff knew the people they cared for well. There were gaps in training for staff and this also included important training updates. Staff had not received regular support to help them understand how to deliver good care in line with the provider’s policy. Staff completed an induction when they started work.

There were policies and procedures in place in relation to the Mental Capacity Act 2005.People’s consent was always sort when offering care and support. However staff showed a lack of understanding of how to ensure their practice was in line with the Act.

Most of the people we spoke with told us they were very happy with the care and support they received from the service.

We saw the provider had a quality assurance monitoring system; however the system was not always effective because it had not identified the shortfalls that were found at the inspection

There was a risk that people may not have their medicines as prescribed due to lack of detail when recording administration. People who used the service told us they felt safe with the staff and the care and support they were provided with. We found there were systems in place to protect people from risk of harm There was a reporting process in place to record accidents, incidents and near misses for people who used the service.

Complaints were welcomed and were investigated and responded to appropriately.

Some people who used the service said their visit times suited their wishes and staff in the main always stayed the agreed length of time. However, some people told us their care worker timekeeping was not good, and they could be late.

Recruitment procedures were effective with checks made on people’s employment histories and with the Disclosure and Barring Service (DBS).There was enough staff to meet the needs of people who used the service.

People’s care plans contained sufficient information to provide consistent, care and support. People received good support which ensured their health care needs were met. Staff knew how to respect people’s privacy and dignity.

We identified that the provider was not meeting all regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the ful

This inspection took place on 20 October 2014. This was an announced inspection which meant the provider knew two days before we would be visiting. This was because the location provides a domiciliary care service. We wanted to make sure the registered manager would be available to support our inspection, or someone who could act on their behalf.

We carried out an inspection in December 2014. During which we found the provider to be in breach of Regulation 23 supporting workers. The provider wrote to us with an action plan of improvements that would be made. During this inspection we found the provider had taken steps to make the necessary improvements. Staff had received appropriate training for their role.

Kumari Care is a domiciliary care agency that provides personal care for people aged 18 and over who have a range of needs. At the time of this inspection 143 people were receiving the service within the counties of Bath and North East Somerset, North Somerset and Bristol. The service operates from a well equipped office building in the centre of Bath.

There is a registered manager in post at Kumari Care. 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 registered manager was accessible and approachable. Staff, people who used the service and relatives felt able to speak with the manager and provided feedback on the service.

Staff were knowledgeable of people’s preferences and care needs. People told us the regular staff they had provided them with the care and support they needed and expected. However there were frequent inconsistencies in times of calls and changes to staff which meant some people didn’t always feel safe.

People using the service, and the relatives we spoke with described the staff as being “caring”, “knowledgeable” and appeared “professional.” Staff explained the importance of supporting people to make choices about their daily lives. Where necessary, staff contacted health and social care professionals for guidance and support.

Staff had received training in how to recognise and report abuse. All staff were clear about how to report any concerns they had. Staff were confident that any concerns raised would be fully investigated to ensure people were protected. However the staff we spoke with were less knowledgeable about the requirements of the Mental Capacity Act 2005. Staff said they “felt supported”, however five out of seven staff said they “did not receive regular supervision.”

The registered manager had systems in place to monitor the quality of the service provided, and was working towards action plans where some shortfalls had been identified. However we found some records which were illegible. Communication between people and staff was apparent, however opinions varied regarding the reliability of contact with the office staff. Staff were aware of the organisation’s visions and values and spoke about being ‘pleased’ to work for Kumari Care.