About the service: 3 Star Health Care Limited, Leicester 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 older and younger adults, including people living with dementia and people with a physical disability. Not everyone using this service 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.

What life is like for people using this service:

•The provider did not operate effective systems to assess and monitor the service in order to identify and bring about required improvements to the service.

•The provider had not complied with their registration responsibilities with the CQC. They had not notified the CQC, in a timely manner, of changes to the nominated individual and to the address of the registered location.

•Staff understood how to safeguard people from the risk of abuse. Records did not clearly demonstrate the actions taken in the event of suspected safeguarding incidents, or the measures in place to protect people.

•People’s care plans included assessments of risks associated with their care and support. Records were not always sufficiently detailed to guide staff on the measures they needed to take to keep people safe.

•There were enough staff in place who had completed relevant training to give them the skills and knowledge needed to meet people’s needs.

•People were supported to have sufficient amounts to eat and drink and stay healthy. Staff liaised with relatives and health professionals to support people to maintain their health and well-being.

•People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Records did not consistently demonstrate staff had undertaken assessments of people’s mental capacity.

•People were treated kindly and compassionately by staff. People and their relatives were supported to express their views and be involved in making decisions about their care. Staff respected people’s privacy and dignity and supported them to maintain and develop their independence.

•People received personalised care, having their needs, preferences and wishes detailed in their care plans. Staff were responsive to changes in people’s needs and wishes.

•People and relatives were confident any concerns or complaints would be responded to and improvements made as a result.

•People, relatives and staff had confidence in the leadership of the service and felt involved and consulted in the service. They were supported to share their views and these were used to develop the care provided.

Rating at last inspection: At our last inspection in February 2018, we rated the service as Requires Improvement. This is the second time the provider has been rated as Requires Improvement.

Why we inspected: This was a scheduled inspection.

Follow up: We will continue to monitor the quality of the service through the information we receive until we return to visit as per our re-inspection programme. If any information of concern is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Leicester is a ‘domiciliary care service.’ People receive personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates the care provided, and this was looked at during this inspection. The service provides personal care for older people, people living with dementia, and people with a physical disability. This was the first inspection of the service. It was a comprehensive inspection.

The inspection took place on 16 February 2018. The inspection was announced because we wanted to make sure that the manager was available to conduct the inspection.

A registered manager was not in post. This is a condition of the registration of 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 and associated Regulations about how the service is run. The current manager said that they were in the process of making an application to CQC to become the registered manager. We will monitor this issue to ensure a registered manager is in post.

Management had not carried out comprehensive audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service.

Staff recruitment checks were not fully in place to protect people from receiving personal care from unsuitable staff. Risk assessments were not comprehensively in place to protect people from risks to their health and welfare.

Relatives we spoke with told us they thought the service ensured that people received safe personal care from staff. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Relatives told us that medicines had been prompted so that people could take their medicine safely and on time, to protect people’s health needs.

Staff had received training to ensure they had skills and knowledge to meet people's needs, though more training was needed on some relevant issues.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives. Staff were aware to ask people’s consent when they provided personal care.

Relatives told us that staff were friendly, kind, positive and caring. They said they had been involved in making decisions about how and what personal care was needed to meet any identified needs.

Care plans were not individual to the people using the service, which did not help to ensure that their needs were met.

Relatives were confident that any concerns they had would be properly followed up. They were satisfied with how the service was run.

The staff member said they had been fully supported in their work by the management of the service.

Policies set out that when a safeguarding incident occurred management needed to take appropriate action by referring to the relevant safeguarding agency. The manager was aware these incidents, if they occurred, needed to be reported to us, as legally required.