About the service: Secure Healthcare is a domiciliary care agency registered to provide nursing and personal care to people in their own homes. At the time of this inspection the service supported 14 people with personal care and employed 15 care staff. The service did not provide anyone with nursing care support.

People's experience of using this service:

•There was not a registered manager in place at the time of our inspection visit, however, an acting manager had been appointed who had applied to be registered with CQC.

•The provider was updating risk assessments and care records at the time of our inspection visit, following their own quality assurance checks, to make them more comprehensive and person centred.

•People's safety had been considered.

•Medicines were managed safely.

•Staff had received training in relation to safeguarding and knew how to protect people from harm.

•Staff were recruited safely and in accordance with best practice to ensure they were suitable to work with people in their home.

•People needs were regularly assessed so the service could meet their individual care needs.

•People received care from well trained staff, and were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

•Where people required support with their health, people were signposted or referred to health professionals.

•People were treated kindly and compassionately by staff.

•People and their relatives were supported to express their views and make decisions about the care and treatment they received.

•Staff respected people's privacy and dignity.

•Information was provided in a range of formats to support people’s understanding.

•The provider had a complaints policy and process in place; people and their relatives told us they would feel comfortable raising complaints.

•When people were at the end of their life, the provider had policies in place to assess their wishes and preferences.

•The provider had quality monitoring arrangements through which they continually reviewed evaluated and improved people's care.

•People, stakeholders and staff had an opportunity to shape the service.

Rating at last inspection: Requires Improvement in Safe, Effective and Well Led. The last report for Secure Healthcare was published in March 2018. At this inspection we found the service had made some improvements and was rated Good in Safe, Effective, Responsive and Caring. Well Led continues to be rated as Requires Improvement.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor the service to ensure it meets its regulatory requirements. More information is in the 'Detailed Findings' below.

The inspection was carried out over three days. Calls to people were made on 31st January with a site visit taking place on 1st February and calls to staff on 2nd February 2018. The inspection was announced. We gave the service 48 hours’ notice of the inspection visit because the manager is often out of the office supporting staff. We needed to be sure that they would be in.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, younger disabled adults and children. At the time of our inspection there were 12 people using the service.

This is the first time the service has been rated Requires Improvement.

People did not always receive support from consistent staff. Medicines administration records were not always as detailed as they should be. Risk assessments and management plans lacked detail. People’s needs were assessed; however, care plans lacked detail.

The systems in place to monitor the quality of the service were not consistent in identifying concerns. A registered manager was in post; however people felt they were not easy to communicate with. Improvements were needed in how the registered manager and provider used information to drive improvements.

People were safeguarded from abuse. People were protected from the risk of infection. There were enough suitably skilled staff to meet people’s needs. The registered manager had systems in place to learn when things went wrong.

The principles of the MCA were followed but not always documented sufficiently. Staff were trained to deliver effective support to people and had their competency checked. People were supported to maintain a healthy diet. People were supported to access health professionals when required.

People were supported by caring staff that protected their privacy and dignity. People had support to make decisions and choices about their care and maintain their independence.

People’s preferences were understood by staff. People understood how to make a complaint but felt their concerns were not addressed. People received support with care at the end of their life which allowed them to have a dignified and pain free death.

There was a registered manager in post at the time of the inspection. 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.