The inspection took place on 24, 26 April and 1, 2 May 2018 and was announced.

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 people of all ages with complex health needs.

Not everyone using the service receives 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. At the time of the inspection, the service was providing personal care t0 12 people.

At the last inspection, the service was rated Good. At this inspection we found the service required improvement.

People and their relatives were involved in developing people’s care plans which helped ensure staff understood people’s needs. However, care plans did not always reflect people’s preferences for how their care and support was provided, the routines they liked to follow or their wishes and aspirations. People received support from a staff team who knew them well but may not have acted consistently with the person’s wishes, as these were not always clear.

Information collected by the registered manager and provider, such as feedback from people and relatives, complaints and incidents was analysed to help ensure the service and the organisation could learn from them. However there was not a clear plan to ensure people’s records, such as care plans and risk assessments were regularly monitored. This meant gaps in quality found during the inspection had not been previously identified.

People told us they felt safe using the service. Information was available to staff about people’s risks and how to mitigate them but this was not always in the form of a risk assessment. One person who sometimes experienced anxiety told us staff knew how to support them at this time; however information about what caused them anxiety, how staff could recognise they were feeling anxious and how to reassure them, was not detailed in their care plan.

Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously. There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The recruitment process of new staff was robust. People and staff were matched carefully and staff training was designed around people’s individual needs. Staff treated people as individuals and respected their diverse needs.

Staff were required to comply with the provider’s expectations regarding equality and diversity. Staff approach was regularly monitored by senior staff. Staff told us they felt supported by the registered manager and could easily request support or advice.

People and their relatives spoke highly of the staff and the support provided. Staff spoke about people with compassion and were keen to ensure people were in control of their own care. This included tailoring leisure activities to meet their wishes. Staff shared information with each other and external professionals, where appropriate to help ensure people’s needs were met.

We found a breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.