This announced inspection took place over three days on 31 October and 1 and 2 November 2017. This service is a domiciliary care agency which supports people with their personal care needs in their own homes; some people received twenty four hour care. At the time of our inspection there were eighteen people receiving personal care. At the last inspection, in March 2017, the service was rated Requires Improvement. At this inspection we found that the rating for the service remained Requires Improvement.

At the last inspection we found that recruitment procedures required strengthening, training had not been updated as required in some areas, staff had not received sufficient training in MCA 2005 and the provider had not ensured that notifiable incidents were reported to CQC as required.

There was a registered manager in post at the time of our inspection. 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 provider was also the registered manager; they did not have sufficient oversight of the service. Ineffective quality assurance systems were in place to monitor the care and support people received. The improvements that were required to the service had not been identified, and there had been on-going shortfalls as a result.

Staff did not always have the skills that they needed to provide people's care safely. Arrangements in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support were not sufficient. Staff had not been provided with sufficient training in key areas such as safeguarding, mental capacity and manual handing. There was a lack of oversight of staff training.

The provider had not consistently followed safe recruitment procedures; they had not ensured that all necessary risk assessments had been completed as part of the staff selection process. People could not always be assured that their care visits would be attended by the appropriate number of staff needed to meet their care needs appropriately.

The systems in place for responding to people's feedback required strengthening. People had mixed views regarding how the service had responded to concerns and complaints. Some people and their relatives were dissatisfied with the manner in which the provider had handled their feedback.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible. The risk assessments in place would benefit from regular auditing to ensure that they remain current.

People were protected from harm arising from poor practice or abuse; there were clear safeguarding procedures in place for care staff to follow if they were concerned about people’s safety. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns.

There were systems in place to manage medicines safely and people had specific care plans relating to the provision of their medicines. Medicines were audited regularly.

Care plans were written in a person centred approach and detailed how people wished to be supported and where possible people were involved in making decisions about their care. People’s care plans would benefit from regular auditing to ensure that they remain current.

People were actively involved in decisions about their care and support needs as much as they were able. Staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA2005) and there were formal systems in place to assess people's capacity for decision maki

This announced inspection took place on 30 March, 4 April and 6 April 2017. The service is registered to provide personal care to people living in the community. At the time of our inspection there were 26 people receiving personal care.

There was a registered manager in post at the time of our inspection. 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.

Arrangements in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support required strengthening. Staff had not been provided with sufficient training in key areas such as Mental Capacity. Some staff with responsibility for medicines administration had not had their competencies reviewed regularly.

The provider was also the registered manager; they were closely involved in the day to day running of the service and routinely monitored people’s care. However, as the service had grown there was a need to develop the quality assurance processes in place to ensure the quality and safety of the service. Policies and procedures were not always followed; staff recruitment processes needed to be strengthened to ensure that all necessary risk assessments had been completed as part of the staff selection process.

Staff received an induction into the service and did not work with people on their own until they understood the care needs of each person. Staffing levels ensured that people received the support they required safely and at the times they needed.

The provider had values and a clear vision that was person centred and focussed on enabling people to live at home. All staff demonstrated a commitment to providing a service for people that met their individual needs. People had positive relationships with staff.

There were systems in place to manage medicines safely and people had specific risk assessments and care plans relating to the provision of their medicines.

People were protected from harm arising from poor practice or abuse; there were clear safeguarding procedures in place for care staff to follow if they were concerned about people’s safety. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns.

People were actively involved in decisions about their care and support needs as much as they were able. Staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA2005) and there were formal systems in place to assess people's capacity for decision making under the Mental Capacity Act 2005.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were written in a person centred approach and detailed how people wished to be supported and where possible people were involved in making decisions about their care.

Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.