This comprehensive announced inspection took place on 19 and 24 October, 1 and 6 November 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 older adults and younger disabled adults. Not everyone using the service received 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.

Service provision was in the Leeds and Durham area at the time of the inspection. There were eight people using the service.

At the last inspection in August 2017 we rated the service as Requires Improvement. At that inspection we found the provider was in breach of Regulation 12, Safe care and treatment, Regulation 17, Good governance and Regulation 18, Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the provider did not have systems for the proper and safe management of medicines and they were not doing all that was reasonably practicable to militate against risk. We saw systems in place to manage, monitor and improve the quality of the service provided were not effective. We also found suitably competent staff were not consistently provided to meet people’s care and support needs and staff were not always provided with appropriate support and training to enable them to carry out the duties they were employed to perform.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in all the domains to at least Good. During this inspection, we saw some improvements had been made. However, continued work was required to ensure the provider was meeting all regulations.

The provider had improved their arrangements for managing people's medicines but needed to make sure the records were accurate at all times. Risk management plans were in place and had improved. They described the risks people faced and the actions needed to keep people safe.

The provider had improved the support given to staff but still needed to develop this further to make sure there was a consistent approach to training and to ensure supervision was recorded. Training records did not indicate what the provider considered mandatory training for staff or the expected interval between refresher training. Staff training records showed some staff had not completed some training courses such as infection prevention and control, food hygiene and the Mental Capacity Act. Staff told us they felt well-supported and had regular contact with the provider. However, this support was not always recorded which meant we could not be sure staff received supervision in line with the provider’s policy.

We have made a recommendation about the on-going the management and recording of staff training and support.

The provider had introduced audits for monitoring quality and safety, however, these were basic and did not always drive improvement. Systems and processes around governance and records needed to improve further. Audits of medicines had not identified the issues with records that we found. No formal audits of training and staff support were in place to check staff’s training equipped them for their role. Care records audits had not identified a person who used the service did not have a completed care plan in place. No records of checks on staff’s performance were made when they completed shadowing (working alongside an experienced staff member) or when spot checks were carried out by the registered manager.

There was a registered manager in post. 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

This was an announced inspection carried out on the 15 and 17 August 2017. This was the first inspection of the service.

Love In Care is registered to provide personal care to people in their own home.

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 and associated Regulations about how the service is run.

We found medicines were not managed safely. Records of people’s medications were not clear and it was not therefore possible to be sure people had received their medications as prescribed. This put people’s health at risk.

Risks to people who used the service and staff were not fully assessed and risk management plans in place did not always contain the information staff needed to support people safely and manage all risks identified.

Three people told us they could not always communicate in their preferred language of English with some staff. This mean suitably competent staff were not always provided to meet people’s care and support needs and this had led to errors when providing people’s care. Records did not show staff were provided with appropriate support and training to enable them to carry out their job effectively.

There were no effective systems in place to monitor and improve the quality of the service provided. This had resulted in some areas not being monitored and managed properly. This included records of recruitment, medication and care documentation.

Most people who used the service or their relatives told us they or their family members were provided with safe care. People told us staff were caring. However, one person said they were not satisfied with the service and hadn’t always found staff to be respectful. They also said they did not receive satisfactory support with their meals.

People said they received care from familiar and consistent care workers who were punctual and spent the required amount of time with them. The service worked flexibly to ensure people received support at the times they needed it.

The manager had an understanding of the principles and their responsibilities in accordance with the Mental Capacity Act (MCA) 2005. People told us they were asked to consent to their care. Records indicated people were encouraged to be as independent as possible.

Care plans had information that helped staff get to know the person such as their life history, their preferences and what was important to them. We saw some care plans did not give full guidance to staff on how to meet people’s needs. The manager said they would be reviewing care plans to ensure there were no gaps or omissions.

There were procedures in place for responding to people’s concerns and complaints. The provider had not received any formal complaints in the last 12 months.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 with regard to safe care and treatment, staffing and governance. You can see the action we have told the provider to take at the end of this report.