The inspection took place over five days. The first day, on 31 August 2018, was unannounced.

We carried out an announced comprehensive inspection of this agency on 14 June 2016, where the agency was rated as Good overall. In August 2018, we received concerns in relation to the death of a person using the agency. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. The concerns related to meeting people’s nutrition and hydration, the lack of safe care and treatment and the management of medicines. As a result, we undertook a comprehensive inspection to look into those potential concerns.

We visited the office location of Meritum Integrated Care LLP (Maidstone) unannounced on 31 August 2018 and announced on 4 and 7 September 2018.. The inspection included visiting people in their homes 4 September 2018, shadowing staff providing care on 4 and 6 September 2018 and phone calls to people and their relatives on 5 September 2018. The team inspected the agency against the five questions we ask about services: is the agency safe, is the agency effective, is the agency caring, is the agency responsive and is the agency well-led. This service was last inspected in June 2016, when it was rated as Good. At this inspection, the service was rated as Requires Improvement in safe, effective, caring and well-led, therefore the overall rating for the service is now Requires Improvement.

Meritum Integrated Care LLP (Maidstone) is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to people living with dementia, older people, people with learning disabilities and autistic spectrum disorder, people with a mental illness and people who have a physical disability.

Not everyone using the agency received a 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. There were 36 people receiving support with their personal care when we inspected.

There was a registered manager in post. However, the registered manager split their time between the provider’s other registered branches within the East Kent area. 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.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had failed to submit a notification to CQC in an appropriate and timely manner, as required by the regulation.

People were not always protected from the potential risk of harm and abuse. Some staff were unaware of the action to take if they suspected abuse. Potential risks posed to people had not been consistently assessed. Guidance was not always available to staff to inform them of the action required to minimise the risk.

Some people’s care plans were detailed and gave staff guidance regarding how to meet people’s needs. However, some care plans within people’s own homes did not contain the same information as in the registered office.

Staff had not always received the training they required to meet people’s needs and fulfil their role. Staff had not received the support, supervision and guidance from the registered manager to ensure they were working to the required standard. There was a lack of communication between the senior management team and the care staff.

People told us the staff were kind and caring. However, people were not consist

The inspection was carried out on 14 June 2016, and was an announced inspection. The provider was given 48 hours’ notice of the inspection as we needed to be sure that the office was open and staff would be available to speak with us.

Meritum Integrated Care is a family run domiciliary care agency which provides personal care and support for people living in their own homes. At the time of the inspection the service was providing personal care to 39 people.

There was a registered manager at 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 agency had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

The agency provided sufficient numbers of staff to meet people’s needs and provide a flexible service.

The provider carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the agency and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals.All staff received induction training at start of their employment.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People were supported with meal planning, preparation and eating and drinking. Staff supported people, by contacting the office to alert the provider to any identified health needs so that their doctor or nurse could be informed.

People said that they knew they could contact the provider at any time, and they felt confident about raising any concerns or other issues. The provider carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement. This enabled people to get to know the provider.

The agency had processes in place to monitor the delivery of the service. As well as talking to the provider at spot checks, people could phone the office at any time. People’s views were also obtained through annual surveys. These could be completed anonymously if people wished. The provider analysed these and checked how well people felt the agency was meeting their needs.