About the service: Options Home Care Limited is a domiciliary care service which was providing support to seven people in their own homes on the day of our inspection.

People’s experience of using this service:

¿ The service had improved overall since our last inspection and is no longer in special measures.

¿ The service met the characteristics of good in three out of five domains and requires improvement in two out of five domains.

¿ People were assisted to have maximum choice and control over their lives.

¿ People who used the service and staff members gave us positive feedback about the service and the management.

¿ Systems and processes within the service ensured people were safe.

¿ Staff knew people well and had built positive relationships.

¿ People had an active say in how the service was operated and managed through surveys and reviews.

¿ In the main, effective governance systems and processes were in place to ensure the service improved.

¿ Whilst improvements had been made in the service, these needed time to become embedded into everyday operational processes and need to be sustained.

Rating at last inspection: The service was rated inadequate at our last inspection and was placed into special measures. Our last report was published on 7 July 2018.

Why we inspected: This inspection was part of our scheduled plan of visiting services rated as inadequate and in special measures, to check the quality of care people received.

Follow up: We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates.

This comprehensive inspection took place on 2 and 3 May 2018 and was announced. We last inspected the service on the 4 and 5 April 2017 when we found a number of concerns.

Options Home Care Limited is a domiciliary care agency and is based in Accrington, Lancashire. The service provides personal care and domestic support to people over the age of 18 years with a variety of health and social care needs who live in their own homes. On the day of our inspection there were seven people using the service.

The service had a registered manager in place, who was also the provider. 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 inspection of 4 and 5 April 2017, we found breaches in the regulations; these related to the failure to adequately assess risks to people, recruitment processes were not sufficiently robust, a lack of auditing systems and policies and procedures did not reflect when the service were doing in practice. We therefore asked the provider to make improvements. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements.

During this inspection we found no improvements had been made and the service was in breach of five regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included shortfalls in the effective management of risks of harm and abuse within the service, failure to ensure the recruitment of staff was safe, inadequate staffing levels, shortfalls in staff training, supervision and appraisals and failure to demonstrate oversight and compliance with the regulations by the registered manager.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals are concluded.

The risk assessments that were in place did not accurately reflect current risks and had not been reviewed. Those risk assessments did not direct staff on how to manage these or how best to support people. People who had been deemed as at risk of falls did not have a falls risk assessment in place to show how these risks were being managed.

Recruitment systems and processes in place were not sufficiently robust to ensure appropriate people were employed to work with vulnerable people. We saw the registered manager had not undertaken relevant risk assessments when employing people and gaps in employment had not been explored.

The provider had not employed sufficient numbers of suitably qualified, competent and skilled people. Records we looked at showed the only member of staff with previous experience in social care was the registered manager. New staff members without any experience in care had not received an appropriate induction.

The only training all the staff had received was a one day course which covered 12 different topics. The staff member we spoke with could not recall any of the information they learned during this course. Other online training courses were available but staff had struggled to pass these courses and no competency checks had been undertaken. Staff had not received any supervision to discuss issues related to their role and any learning and development needs.

Care plans we looked at did not reflect people’s current health care needs such as those at risk of falling. None of the care plans we looked at were person centred. They were basic and did not always direct staff on how to provide support to people. Many of the care plans had been handwritten and we struggled to read them. There was no evidence to suggest that people using the service had been involved in developing care plans or the reviewing of these.

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Options HomeCare Limited is based in Great Harwood, Lancashire. The service provides personal care and domestic support to people over the age of 18 years with a variety of health and social care needs who live in their own homes.

This was the first comprehensive inspection for the service since registering with the Commission on 5 April 2016. The inspection took place on the 4 and 5 April 2017 and was announced. Two days prior to the inspection, we contacted the provider and told them of our plans to carry out a comprehensive inspection of the service. This was because we needed to be sure that someone would at the office.

The service was providing personal care and support to two people on the day of our inspection (one person permanently and the others for respite/temporary purposes).

At the time of the inspection there was 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. The registered manager was also the director of the company.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.

Risk assessments that were in place within the service were not designed on an individual basis but were generic. They also did not direct staff members on the action to take to keep people safe.

The provider was not meeting the requirements of Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure that all persons employed, who had previously worked in a care setting, were fully checked to protect people from being cared for by unsuitable staff.

We found audits in place within the service were not sufficiently robust to identify concerns/issues we found during our inspection. Policies and procedures did not relate to the service and did not reflect what was happening in practice. Records we looked at contained a number of documents that had not been completed and were blank.

One person who used the service told us they felt safe when the registered manager entered their home. Safeguarding training had been completed by the registered manager and staff member and both knew their responsibilities to report concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The service supported people to attend any healthcare appointment they may have, if and as required. On occasions this was done outside of any paid support time. The registered manager told us they liked to support the families as much as possible.

We saw that the service had a system in place that people and relatives who used the service could use which would inform them who was visiting each day and the times they would be visiting. This promoted family involvement.

People were encouraged to remain as independent as possible when the service was providing support.

The service completed a pre-admission assessment prior to providing support to people to ensure they were able to meet individual’s needs.

One person who used the service, their relative and the staff member all told us the registered manager was approachable and supportive.

Surveys had been sent out in July 2016 so that the service could gain some feedback. The registered manager told us the response from these had been minimal. We saw all the feedback received was positive.