This inspection took place over three days on 13, 19 and 20 June 2018. The first day was unannounced which meant the service did not know we were coming. The second day was by mutual arrangement.

Sedgeborough House is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, people living with dementia and people with physical disabilities. Not everyone using Sedgeborough House receives a regulated activity; the Care Quality Commission (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 the inspection the service was providing personal care to eight people.

At the last inspection we found continued serious systemic failures in the overall management of the service. This meant the service continued to be in breach of multiple regulations. In response to this, we took urgent enforcement action to prevent the service from accepting any new packages of care. Since our last inspection, the directors of Westwood Homecare (North West) Limited, set about to recruit a new management team. At the time of this inspection, the newly recruited management team was fully operational and now included a new operations director, service manager and compliance manager.

The purpose of this inspection was to ascertain the effectiveness of the new management team introduced to the service in April 2018 and to determine if all the regulatory breaches identified at previous inspections had been met. We found there had been improvements which were sufficient for the service to be rated as ‘requires improvement’ overall and good in caring and responsive, with no inadequate domains. This means the service can come out of special measures.

The service manager was in the process of applying to become registered manager. A registered manager is a person who has registered with the CQC 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.

We reviewed how the service sought to ensure people's medicines were managed safely. At the last inspection this had been an area of concern. During this inspection we found improvements had been made and medicines were safely managed.

We found improvements had been made by the provider to ensure newly recruited staff were suitable to work with vulnerable people. We looked at a sample of recruitment records and found the appropriate checks had been undertaken to ensure staff were suitable for the role.

The provider had ensured that all staff completed the required training to effectively fulfil their role. We found safety critical training such as moving and handling and first aid was now delivered by an external professional training provider. Newly recruited staff now received a five-day induction programme that was aligned to the Care Certificate.

People were protected from abuse and avoidable harm. People and relatives we spoke with told us they were happy with the support received from the service and they felt safe with staff. Staff knew how to identify abuse, the different types of abuse and how to report abuse.

Since the last inspection the new management team introduced a new electronic care planning system. Care plans were now personalised and reviewed to ensure people received the right care and support. People were assessed prior to receiving personal care to determine if the service could provide care and support to people.

Although the provider was aware of the Accessible Information Standard (AIS) they had not yet taken action to implement this further into people's care plans. The operations director confirmed they would ensure the agency introduc

This inspection took place over two days on 12 March 2018 and 13 March 2018. The first day was unannounced which meant the service did not know we were coming. The second day was by mutual arrangement.

Sedgeborough House is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, people living with dementia, and people with physical disabilities. Not everyone using Sedgeborough House receives regulated activity; the Care Quality Commission (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 to 10 people.

The purpose of this inspection was to ascertain the effectiveness of the service improvement plan submitted to CQC in February 2018 and to determine if all the regulatory breaches identified at previous inspections had been met. However, at this inspection, we found continued multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of; safe care and treatment; person-centred care; need for consent; good governance; staffing; and fit and proper persons employed.

The overall rating for this service continues to be 'Inadequate' and therefore the service remains in 'special measures'. We are currently considering our enforcement options in response to the regulatory breaches identified. Full information about CQC's regulatory response to any serious concerns found during inspections are added to the report after any representations and appeals have been concluded.

We reviewed how the service sought to ensure people’s medicines were managed safely. At the last inspection this had been an area of concern. During this inspection we found improvements had not been sustained and medicines were not always managed safely. Issues identified included Medicines Administration Records (MARs) not always being available in a person's own home and medicines risk assessments not always being completed when support with medicines was part of an assessed care need.

We looked at how the service sought to ensure newly recruited staff were suitable to work with vulnerable people. We looked at a sample of recruitment records and found a variety of issues including unaccounted gaps in employment history; failure to carry out a risk assessment when an employee was known to have criminal convictions; and, a failure to ensure the validity of employment references. This meant the service was not able to consistently demonstrate the suitability of candidates to work with vulnerable groups before an offer of employment was made.

In order for care to be delivered safely it is fundamental that staff receive an appropriate level of training and their skills and competency are checked. However, the service used unsupported online e-learning as the primary source of training for staff. This raised serious concerns regarding the ability of staff to process, retain and reflect upon training completed as some staff spoken with lacked awareness of the training courses they had completed and course content. Furthermore, we found serious issues in respect of moving and handling training. This training was not fit for purpose and was also delivered solely via a one hour, unsupported online e-learning and did not involve any practical sessions.

We checked to ensure staff were receiving regular supervision sessions. Staff supervision provides a framework for managers and staff to share key information, promote good practice and challenge poor practice. We found the completion of supervision sessions to be ineffective, inconsistent and not in line with company policy.

Since our last inspection the provider had introduced a mental capacity assessment tool. However, a blanket approach had

This inspection took place on 26 and 27 July 2017 and was announced. This meant we gave the provider 48 hours’ notice of our intended inspection to ensure that the registered manager or a representative would be available in the office to meet us.

Sedgeborough House is a domiciliary care service providing personal care and support to people living in their own homes including, older people, people living with dementia, and people with physical disabilities. The support hours varied from one half an hour call a day to four calls a day, with some people requiring two members of staff at each call. At the time of the inspection the service was supporting 12 people within the local community.

At the last inspection in March 2016 we identified three breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to systems not being in place to fully assess and monitor the quality of the service and staff had not received appropriate necessary training and professional development to enable them to carry out their role effectively. Mental capacity assessments had not been undertaken and the service was not operating in accordance with the Mental Capacity Act 2005.

At this inspection we identified on-going breaches of the regulations in relation to need for consent, staffing and good governance. We found a further four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, safe care and treatment, and fit and proper persons employed.

There was a registered manager in post, who was also the nominated individual. 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.

Prior to the inspection we were informed the registered manager was due to retire and the provider was actively looking to recruit a new manager. At the time of our inspection the registered manager had been asked by the director to assist with the inspection process, which she did. We were informed by the registered manager she had officially left Sedgeborough House on 14 July 2017, but assisted with the inspection process to help the director.

During the inspection the director informed us that she had taken responsibility for managing Sedgeborough House for the last two months, working alongside the registered manager until she left on 14 July 2017. However, during the inspection we noted the director did not have experience working in adult social care and had not undertaken any key training to ensure she was competent in her role. Shortly after the inspection we were informed by the director the registered manager had returned to her role as manager, until the provider recruits a new experienced manager.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports aft

We carried out an inspection of Sedgeborough House on 22 and 23 March 2016. The first day of inspection was unannounced.

Sedgeborough House is a domiciliary care service providing personal care and support to people living in their own homes. The service also works closely with healthcare commissioning teams in supporting people who have complex healthcare needs. The hours of support vary depending on the assessed needs of people. Calls range from 30 minutes or more and the service also provides 24 hour live in carers.

At the time of the inspection the service was supporting eight people within the local community. We last inspected the service on 1 October 2013 when we found the provider was compliant in all six standards inspected at that time.

There was a registered manager in post. 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 received safe care, which was reliable and consistent. The service had sufficient staff to meet people’s needs, and people were given the time they needed to ensure their care needs were met.

We saw that people were protected from avoidable harm. During the inspection we checked to see how the service protected vulnerable people against abuse and if staff knew what to do if they suspected abuse. There was an up to date safeguarding vulnerable adult’s policy in place. Risks to people were assessed and risk management plans were in place. We found that the staff we spoke with had a good knowledge of the principles of safeguarding although electronic training records we saw did not always reflect that everyone had attended formal safeguarding training.

Staff were trained to administer medication. We were told that observation of staff competencies were undertaken by the trainer and the registered maanger but these weren’t documented.

The service was not working to the principles of the Mental Capacity Act, 2005 and staff did not receive any formal training on MCA or the Deprivation of Liberty Safeguards (DoLS). The service was not assessing and documenting, where necessary, people’s ability to consent to care which meant that care staff were not always clear about supporting people to make their own choices about their care.

The service had robust recruitment processes which included the completion of pre-employment checks prior to a new member of staff working at the service. This helped to ensure that staff members employed to support people were suitable and fit to do so. People who used the service could be confident that they were protected from staff that were known to be unsuitable to work with vulnerable people. Staff knew their roles and responsibilities and were knowledgeable about the risks of abuse and reporting procedures.

We saw evidence of the induction process, and there was some training provided for caring roles and responsibilities. Not everyone had received training in mandatory elements such as safeguarding and moving and handling.

People were supported with a range of services which enabled them to continue to live in their own homes safely. People we spoke with who used the service and their relatives told us they had been involved in the assessment and planning of the care and support provided and that the service responded to changes in people’s needs.

The care records contained information about the support people required. We saw documented evidence of people’s likes, dislikes and preferences and records we saw were complete and up to date. Reviews of support packages were undertaken after the initial m onth of support and then on a three monthly basis, or more regularly if changes in need were identified. The service was not able to offer gender-sp

We were unable to speak with any of the people who used the service because they were unable to communicate with us because of their illness. In light of this, we spoke with three people’s relative’s in order to obtain their views of the service provided.

The relatives we spoke with said they were happy with the service provided. They described the staff as ‘kind and respectful and ’fantastic’. One person told us, “The staff are very good, they are all lovely. My relative is very settled with the staff who visit, we like the fact that we get the same carers. They are all very kind and respectful. Another relative said, “The staff are fantastic, they are all very good and always aim to make my relative as comfortable as possible. The manager gives me a staff rota each week so I know who will be coming the following week so I know what’s going on. The staff just do what’s necessary. If things take a bit longer, it’s never a problem.”

Staff were trained on how to safeguard people from abuse and harm when they were first employed, and this was part of the on-going training programme.

Thorough recruitment and selection processes were in place which meant suitable staff were employed.

People who used the service and their relatives were given a copy of the agency’s complaint procedure so they knew what to do if they were unhappy with the standard of care they received.