This inspection took place on 18 May 2017 and was announced. We gave the registered manager 24 hours’ notice as we needed to be sure they would be available for the inspection. New Dawn Health Care is registered to provide personal care to people in their own homes. At the time of the inspection there were 15 people using the service.

The service had a registered manager in place. 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 our last inspection of 7 and 8 April 2016, we found that the provider did not meet all the regulations we inspected. People did not always receive their medicines safely in line with good practice. Staff did not have sufficient knowledge relating to administering covert medicines. In addition, the registered manager did not carry out regular audits of the service. The service was rated requires improvement.

At this inspection, we found that the provider had made the required improvement relating to the management and administration of covert medicines. Medicines administered were recorded to show people had received their medicines as prescribed. Staff were trained in the safe administration of medicines. There was a medicine management policy and procedure in place.

The provider had improved the way they audited the service. People, their relatives and staff told us that the managers listened and acted on their views about the service. There were a wide range of methods through which the quality of the service was monitored.

The service worked in collaboration with other agencies and professionals to meet the needs of people and improve the quality of the service delivered. People’s healthcare needs were met. Staff supported people to access healthcare services. The service checked that staff employed to work with vulnerable people were suitable to do so. Criminal records were checked and references were obtained before employees started work. There were sufficient numbers of staff deployed to meet people’s needs.

Risk assessments were in place and detailed actions to reduce identified risks to people to keep them safe. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse. They also knew how to escalate concerns to external authorities if their managers failed to take appropriate actions. People’s individual needs were met. Staff cared for people in a way that met their requirements. People and their relatives were involved in planning and reviewing their care.

Staff and the registered manager understood their responsibilities within the Mental Capacity Act 2005. People consented to care and support before they were delivered. Staff were supported through effective induction, supervision, appraisal and training to provide appropriate care to people. However, staff who only delivered care duties occasionally were not always formally supported to ensure they were effective in their roles.

People were supported to eat and drink appropriately and to meet their dietary and nutritional requirements. Staff supported people to do their food shopping and to prepare meals. People told us staff treated them with kindness, compassion and respect. People’s dignity and privacy was respected by staff.

This inspection took place on 7 and 8 April 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

New Dawn Health Care is registered to provide personal care to people in their own homes. At the time of the inspection there were 19 people using the service.

The service had a registered manager in place. 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 that the provider did not meet all the regulations we inspected. People did not always receive their medicines safely in line with good practice. The service did not have robust and comprehensive policies and guidance for staff to manage people’s medicine safely. Staff did not have sufficient knowledge relating to administering covert medicines.

People’s risk assessments were reviewed annually or when new risks were identified. Identified risks were documented and gave staff guidance on how to support people when faced with known risks. Care plans were comprehensive and detailed people’s preferences, medical needs and care and support required..

People were supported by sufficient numbers of suitably skilled staff to ensure their needs were met. Staffing levels were dictated by the needs of people that was flexible and could be increased if people’s needs changed. People received care and support from staff that had the necessary training to meet their needs. Staff undertook regular training in all mandatory areas, which enabled them to carry out effectively their roles and responsibilities.

People received care and support by staff that received supervisions to reflect on their working practices. Staff received annual appraisals from the registered manager whereby they addressed areas that worked well and any support they felt they may need.

People and their families were encouraged to make decisions about the care and support provided. Staff sought people’s consent prior to delivering care and people’s choices were respected. People received personalised care that reflected their preferences. Staff were aware of people’s preferences and incorporated them into the care and support provided.

People’s privacy and dignity were respected. Staff were aware of the importance of maintaining people’s privacy and treat them with compassion and respect. People were encouraged to raise concerns and complaints. The service carried out regular audits to gather people’s views of the care provided and where appropriate action taken to address concerns raised.

The registered manager sought partnership working with other health care professionals to improve and drive forward the quality of the service. Records showed that the registered manager actively sought feedback on the service provision and took action to improve the service.

The registered manager carried out audits of the service these were not always reviewed regularly. The registered manager and the provider had devised a new audit tool, to ensure all audits were carried out and completed in line with good practice.

People were supported to access sufficient food and drink which met their preferences. Staff monitored people’s food and fluid intake to ensure they received maintained a balanced and nutritious diet. Changes to people’s health were monitored and where appropriate health care professionals were informed and action taken.

The registered manager operated an open door policy, whereby people, their relatives and staff could meet with the manager to discuss topics of their choice.

We spoke with three people who used the service during this inspection. People told us that they consented to receive care from the provider. One person told us "I have agreed to receive care, my carer helps me a lot".

The manager told us that people had an assessment of their needs. However when we reviewed a sample of care records, seven in total, we found only one had a copy of a needs assessment.

The majority of people we spoke with were happy with their care. One person told us "My carer is great". However, we found that care plans were often incomplete or not personalised.

The provider had safeguarding policies and procedures in place, we saw evidence that the provider had followed their policy when managing a safeguarding adults allegation.

Staff were supported by the provider through mandatory training, supervision and appraisals as appropriate.

At our last inspection 24 February 2013 the provider did not have robust quality assurance monitoring arrangements in place. At this inspection, we found that the service had not sufficiently addressed this issue. The provider had not notified CQC of safeguarding allegations or changes to the service as required.

People’s needs and choices were reflected in their care plans. The provider had suitable procedures in place to ensure people were involved in the development of their plans of care, and had appropriate information about their care or treatment.

Most people we spoke with told us they received the care and support they expected from their care workers, and that their care workers arrived on time and stayed for the agreed time for their care calls. One person told us, “My care has been fantastic”. Another person said, “I can not fault it”. However, people highlighted some improvements the care workers could make in the way they cared for them.

All the people using the service we spoke with told us that they felt safe with their care workers.

There were recruitment and selection processes in place, which supported the provider to employ staff with relevant qualifications, knowledge, skills and experience.

The provider did not ensure that quality monitoring arrangements were organised and implemented systematically. This was confirmed by the responses we received from people using the service and care workers, which indicated there were inconsistencies in quality monitoring activities. This meant that people using the service and care workers were not subject to regular review to make sure services were being delivered to an appropriate standard and that people’s safety and welfare were suitably maintained.

At our previous inspection on 22 July 2013 we found that the provider was non compliant with care and welfare of people using the service, assessing and monitoring the quality of service provision, notification of other incidents and notification of changes. At this inspection we found that the provider had taken steps to make improvements to the service and we now found the provider compliant.

We spoke with three people who used the service during this inspection. One person told us "My carer helps me a lot".

We found that assessments and care plans were personalised, recently reviewed and had been recorded on the ten care records we reviewed.

The provider had robust quality assurance monitoring arrangements in place for people using the service and for staff.

The provider had notified CQC of incidents and changes to the service as required.