This inspection took place on 16 and 20 August 2018 and the first day of the inspection was unannounced. At our last comprehensive inspection in June 2016, we found a breach of regulation related to staffing due to staff not receiving regular supervisions. At a follow up focused inspection in May 2017, we found that the service was still in breach of this regulation for the same reason. At this inspection, we found that improvements had been made and staff were now receiving regular supervisions, however, staff were not receiving an annual appraisal.

Rivendell Care and Support 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 older adults and younger disabled adults. Not everyone using Rivendell Care and Support receives 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 consider any wider social care provided. At the time of inspection, 25 people were receiving personal care from Rivendell Care and Support.

The service did not have 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.

Risks associated with people’s care was not always assessed. Where a risk was identified, risk assessments did not provide staff with enough guidance on how to recognise risk, actions to

take or how to mitigate identified risks.

We have made a recommendation about how medicines are managed. We identified concerns with how Medicine Administration Records (MARs) were transcribed.

Although there were systems in place to check quality of care, audits were not effective in picking up concerns in a timely manner. Where an area of concern was identified, follow up and action was not documented.

Care plans were detailed and person centred. However, we found an instance of where a care plan had not been updated following changes to the person’s care needs.

People and relatives told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of the different types of abuse to look out for and how to raise safeguarding concerns.

People and their relatives told us they received kind and compassionate care and were treated with respect.

All staff had received training on the Mental Capacity Act (2005) and staff understood what to do if they had concerns around people's mental capacity.

People were supported to maintain good health and had access to healthcare services. People were supported to be independent and access the community, where possible.

The provider employed sufficient skilled and experienced staff to meet people's needs. Staff were recruited with necessary pre-employment checks carried out.

There was a complaints procedure in place and people and relatives confirmed that they knew how to complain.

We identified two breaches of regulation relating to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 22 May 2017. It was a focussed inspection to look at the Effective domain.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk.

Rivendell Care and Support is a domiciliary care agency that provides care in people’s own homes. They were registered to provide personal care to people who had a range of diagnosis. This included older people, people with dementia, learning disabilities or autistic spectrum disorder, mental health, physical disability, sensory impairment and younger adults. At the time of inspection 54 people were using the service.

There was a registered manager. The 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 was previously inspected on 25 May and 03 June of 2016 where the service was rated Good overall but Required Improvement in the Effective domain where there was a breach of regulations with regard to staffing. This was because staff had not received supervision to support them to undertake their role. The service sent us an action plan that outlined how they would meet the regulations. We found that although measures had been implemented as stated they had not been done so in a consistent manner.

During this inspection staff told us they were well supported. We found supervision sessions had taken place, but they were erratic and there had been some significant gaps in supervision in 2016. However all staff had received a supervision in 2017 and had received monitoring visits to observe their practice. There was office support and staff were encouraged to phone in or visit the office. We found however that regular supervision session were not yet embedded into the practice of the service. Therefore this is a continuing breach the regulations.

Staff told us training was provided and staff received an induction and ongoing training to support them to undertake their role.

Staff supported people to access health and social care services, including the emergency services when appropriate.

People were supported to eat well and remain hydrated. People’s meal preferences were stated in their care plans and guidance for staff prompted good hydration for people. Where people required specific support to eat staff had received the appropriate training to enable them to support people in a safe manner.

The provider understood their responsibilities under the Mental Capacity Act 2005 and staff ensured they had people’s consent before offering care and support.

We found a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation

18 Staffing

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 25 May and 03 June of 2016.

Rivendell Care and Support is a domiciliary care agency. At the time of our inspection they were registered to provide personal care to people who had a range of diagnoses. This included older people, people with dementia, learning disabilities or autistic spectrum disorder, mental health, physical disability, sensory impairment and younger adults. There were 36 people using the service.

There was a registered manager. 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.

People told us they felt safe using the service and spoke positively about staff caring for them. The registered manager had assessed the risks to people prior to offering them a service to ensure their safety.

Medicines administration records (MAR) we looked at were completed with no gaps or errors. The service audited the (MAR) to ensure safe administration of medicines.

The service had systems in place for the safe recruitment of staff.

Staff had received infection control training and they used protective disposable equipment when supporting people to avoid cross infection.

Staff had received a comprehensive thorough induction and training. However staff had not received supervision on a regular basis to support them to undertake their role. In addition there were no staff meetings to provide a forum to discuss staff concerns and share good practice.

Staff could tell us in detail about people’s health support needs and were familiar with people’s diversity support needs and assisted people to meet their needs.

Staff were aware of the Mental Capacity Act (2005) and asked people’s consent before offering care and support.

People had care plans and the care provided was person centred and they and/or their relatives were involved in their care planning.

Staff were respectful of the people they supported and maintained their dignity.

The service had systems in place for recording and addressing complaints appropriately.

Management were accessible and responsive to people who used the service and their relatives.

The service recognised and valued excellent work by their staff and offered a reward to staff in recognition of excellent work.

The service carried out audits to ensure they were offering a high quality service but had not undertaken regular spot checks; however they had identified this as a concern and had started a recruitment process to employ another manager who would undertake this role.

We found a breach of Regulation 18 (Staffing) 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 the full version of the report.