Mears Care Torbay and Devon is registered with the Care Quality Commission (CQC) to provide personal care to people living in their own homes. It provides a service to adults with a range of health and social care needs.

On 17 September 2018 the service took over the care visits of an agency that had closed down, this equated to 156 people having care visits. Prior to the transfer, Mears Care Ltd worked with Devon County Council and the provider of the agency that was closing, on a transition plan to ensure safe transfer.

At the time of the inspection and again following the inspection, we asked senior management how many people they now supported with personal care and how many care visits they carried out a week, including those people from the new contract. We did not receive this information.

There was no registered manager in post; however, the operations manager had made an application to register with us but this was withdrawn on 13 September 2018. 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 had been inspected on three previous occasions. In October 2016, the service was rated ‘Inadequate’ in all five key questions. We identified eight breaches of the Health and Social Care Act 2008 and associated regulations. The Care Quality Commission (CQC) took enforcement action against Mears Care Limited and imposed a condition on the provider's registration.

We inspected this service again in June 2017 when we found improvements had been made. No breaches of the Health and Social Care Act 2008 Regulations were identified, and the service was removed from special measures. During this inspection we rated the service ‘Requires Improvement’ overall as improvements were still needed to protect the rights of people who lacked the mental capacity to consent to care and treatment as well as to the service's quality monitoring systems.

The service was last inspected between October and December 2017 in response to concerns raised that the service was not able to provide care visits to people as planned. The service was rated as ‘Requires Improvement’. We identified one breach of the Health and Social Care Regulations (Regulated Activities) 2014 and made one recommendation for improvement.

On Monday 24 September 2018 we received information of concern from two relatives and one member of staff that a significant number of people were not receiving care visits as planned. We were also made aware that the local authority, Devon County Council, had been working with the service in crisis management over the weekend, as there were multiple missed care visits. We undertook this focused inspection on 2 and 4 October 2018 to look into the concerns raised.

At this inspection, we found serious shortfalls in the management of risk, insufficient staffing levels and leadership and governance. The overall rating for this service has deteriorated from 'Requires Improvement' to 'Inadequate' and the service is therefore placed 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.

The leadership and management of the service was inadequate. We looked at how the provider had managed the transfer arrangements of the care packages between themselves and the care provider who had ceased business. We found governance systems to ensure smooth transfer between providers, safety and continuity of care and consistency of staff had not bee

Mears Care Torbay and Devon is registered with the Care Quality Commission (CQC) to provide personal care to people living in their own homes. It provides a service to both older and younger adults. It also provides a rapid response service to people who require care and support at short notice. At the time of this inspection the service was providing care to over 230 people and carrying out over 3500 care visits each week.

This announced comprehensive inspection took place on 31 October 2017, 9, 14, 17 and 23 November 2017 and 4 December 2017. The inspection was undertaken in response to concerns raised with us by South Devon and Torbay NHS Foundation Trust (The Trust) about the service not being able to provide care visits to people as planned. The Trust also provided us with feedback from a Healthwatch consultation with people using the service, some of whom were dissatisfied with the care and support they received. Healthwatch is an independent consumer champion for health and social care.

The service has been inspected on two previous occasions. In October 2016, the service was rated inadequate in all five key questions. We identified eight breaches of the Health and Social Care Act 2008 and associated regulations. The Care Quality Commission (CQC) took enforcement action against Mears Care Limited and imposed a condition on the provider's registration. This required the provider to send a fortnightly progress report on the areas of greatest concern and risk. The service was put in 'special measures'.

We inspected this service again in June 2017 when we found improvements had been made. No breaches of the Health and Social Care Act 2008 Regulations were identified and the service was removed from special measures. However, at our previous inspection in June 2017 the Mears Care Limited service at Torquay relocated to Mears Care Torbay and Devon. The Torquay service had an ongoing breach of regulation in relation to complying with the Mental Capacity Act 2005 (MCA) to protect the rights of people who lacked mental capacity. We therefore rated the service Requires Improvement overall as improvements were still needed to protect the rights of people who lacked the mental capacity to consent to care and treatment as well as to the service’s quality monitoring systems. We rated three key questions, (is the service safe, caring and responsive?) as Good.

At this inspection we found improvements had been made. However, the overall rating of the service remains Requires Improvement. This is the second consecutive inspection where the service has been rated Requires Improvement.

Since the inspection in October 2016, the service has continued to provide CQC with the required progress reports.

The service did not have a registered manager. The registered manager who was in post at the time of the previous inspection left the service in August 2017. The providers had appointed a new manager who told us it was their intention to apply to register with the Care Quality Commission. 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.

Prior to this inspection, we were informed by the Trust that the service had been unable to provide care to a number of people due to insufficient numbers of staff available over the October 2017 half-term week. Although the majority of these care visits were undertaken by the service, it was necessary for the Trust to provide staff to undertake 12 of these visits. The shortfall in the availability of staff to provide care visits was as a result of more staff taking annual leave than normally agreed and a number of staff reporting sick. In addition, there were other times when people’s visits were late or missed.

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This announced comprehensive inspection took place on 7 and 9 June 2017. Mears Care Torbay and Devon (formerly known as Mears Care Kingsteignton) is registered with the Care Quality Commission (CQC) to provide personal care to people living in their own homes. The provider is Mears Care Limited. We previously carried out an inspection on the 3 and 4 October 2016, and found eight breaches of the Health and Social Care Act 2008 and associated regulations. The overall rating for the service at that time was Inadequate in all five domains; Is it safe? Is it effective? Is it caring? Is it responsive? Is it well led? The Care Quality Commission (CQC) took enforcement action against Mears Care Limited and imposed a condition on the provider’s registration. This required the provider to send a monthly progress report on the areas of greatest concern and risk. The service was put 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.

Concerns at that time related to staffing levels, skills and knowledge; staff not receiving the support they needed; the service not always being caring; late and missed visits, resulting in risks to people's welfare and safety; lack of care planning and poor systems for listening and responding to people’s concerns. The service was not well led and governance systems were not effective.

The provider sent an improvement plan outlining the immediate steps being taken to protect people and improve the service. They transferred most people’s care packages to other care providers. Representatives of CQC held a meeting with the provider on 22 November 2016 to discuss their improvement plan. By January 2017, the people cared for by Mears Care Kingsteignton had reduced from 143 people to one person. The provider has continued to send monthly progress reports to CQC which showed continuing improvements at the service.

Following the inspection, a whole service multiagency safeguarding process was convened to protect people's safety and well-being. Devon County Council suspended contracting new packages of care with the agency. Health and social care professionals visited the service as part of a safeguarding investigation and in a protection role. The provider worked with the local authority quality and improvement team to improve their quality monitoring arrangements. In January 2017 feedback from multiagency meetings confirmed care had improved and risks had significantly reduced; the whole service safeguarding process was closed.

Devon County Council commission Mears Care Torbay and Devon under the ‘The living well at home’ scheme to identify personal care services for people in Devon who need them. Most of those services are sub contracted to other agencies and the service is no longer offered to any new privately funded people. Mears Care Torbay and Devon has a small response team that provides personal care for small numbers of people. This team provides care for people for short periods, whilst waiting for other services to set up people’s long term packages of care. At the time of the inspection the agency was providing care and support to 10 people in Tavistock, Exeter and East Devon.

The service has a registered manager who was registered on 12 June 2017. 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 people felt safe using the service and said it was reliable,

Mears Care Limited is registered with the Care Quality Commission (CQC) to provide personal care to people living in their own homes. At the time of the inspection the service was providing care and support to 143 people.

There was a registered manager in post however the provider notified us they were off work for at least 28 days. There was a branch manager in post who was managing 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.

This location was registered in July 2016 and has been operating a service since that date. The provider had transferred the care delivery for South Devon from the location in Torquay to this location. They had taken on additional work for the Exeter and East Devon area.

During August and September 2016, we received concerns from people, staff, local authority safeguarding, and the ambulance service in relation to the quality of care being provided. In response to those concerns we undertook this unannounced inspection which commenced on 3 October and ended on 13 October 2016.

We found significant concerns which meant some people did not always receive their care as planned and were placed at risk of harm.

The service did not employ enough staff to meet people’s needs. This meant some people had not always received their planned visits or visits were late. This resulted in risks to people’s welfare and safety. For example, some people missed their medicines and missed their meals. People who needed two care staff at each visit had one staff member arrive. This meant care could not be carried out as required, or safely; relatives/representatives were supporting the care staff to deliver care. This placed people and staff at risk of injury or harm.

Staff providing care and support did not always have the skills and knowledge they required to care for people. When updates in staff training were required these had not been provided. Staff had not received regular supervision and appraisals. The majority of staff had not had any recent observations of their work. This meant the provider could not be assured staff had the skills and knowledge they needed to meet people’s needs safely and appropriately.

Some people did not receive support in a caring way, particularly when care was delivered by staff they didn’t know well. People told us they were unhappy with the lack of continuity of care staff. This had caused distress, especially for people living with dementia who needed to see familiar faces. People said they had been unable to speak with managers and did not receive a return call when they requested it. Some people told us they were ‘fobbed off’ and found out that information given to them was untrue. Other people found staff to be caring and had built good relationships. People told us they were happy when they received care from staff they knew well.

Care plans had not been in place for some people before their package of care started. People's individual plans of care did not always contain enough information for staff to deliver care safely or in a person centred way. Where risks were identified, these were not fully assessed or sufficient action was not taken to ensure people received care in a safe way. People received inconsistent levels of care and support that was not provided according to their individual preferences. People told us care staff did not always stay for the allocated time and their care was sometimes rushed.

Information management systems were not used to support the delivery of a safe service. Reports about visits, time critical visits, visits where two care staff were needed could not be accessed by staff who had responsibility to plan and monitor visits. This me