Signet Healthcare Limited provides a range of services to people in their own home including personal care. People using the service had a range of needs such as learning and/or physical disabilities and dementia. At the time of our inspection 30 people were receiving personal care in their homes.

The service had 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.

When we last visited the service on 7 and 12 September 2016 the service was rated as ‘Requires Improvement’, and we identified four breaches related to staffing, safe care and treatment, recruitment and good governance respectively.

Therefore, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions 'Safe', ‘Effective’ and 'Well-Led' to at least good. At this inspection we found action had been taken to make improvements.

The service had made improvements to ensure people were safe. There were systems and processes in place to support care workers to understand their role and responsibilities to protect people from avoidable harm. Where safeguarding concerns had been identified there were records to confirm the service had taken appropriate action.

Risks to people were minimised because there were effective systems and processes in place. The risk assessment contained detailed information for supporting care workers on how to protect people.

Staffing had improved since the last inspection. The service had filled many of the staff vacancies and there was an ongoing recruitment drive. Pre-employment checks had been carried out to make sure new care workers were of good character. As a result, there were sufficient numbers of suitable care workers to support people to stay safe.

There was a process in place to monitor any accidents and incidents. Guidelines were in place for care workers on how to report accidents and incidents. Learning derived from incidents was documented and discussed with staff.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

There were systems in place to ensure proper and safe use of medicines. Care workers had been trained and assessed as competent to support people to take their medicines.

Care workers understood the Mental Capacity Act 2005 (MCA) and we found that people's consent was sought before the service provided care to them. Care workers were aware of the need to assess people's capacity to make specific decisions.

People’s health needs were met. They had their needs assessed across a wide range of areas. Care plans included details about how needs in these areas were met.

There was a comprehensive training system in place. Care workers received an induction before they could provide care to people. They also underwent a 12-month probationary period, which was followed by regular training and support.

Care workers had regular supervisions with their line managers. They also received spot checks to monitor their performance when caring for people. Those who had been at the service for longer than 12 months had also received an appraisal.

People were supported to have sufficient amounts to eat and drink. Their care plans contained detailed information about food and drink. Care workers monitored people's weight and sought professional guidance when required.

Care workers respected people’s privacy. There were arrangements for gaining access to people’s homes, whilst maintaining privacy and ensuring people’s safety.

Care workers had built good relationships with people. The service matched care workers to meet people's preference

We undertook an announced inspection of Signet Healthcare Limited on 7 and 12 September 2016. We gave the provider two working days’ notice because the service is a domiciliary care agency and we wanted to make sure someone would be available.

During our last inspection on 2 July 2015 the provider was not meeting the legal requirements in relation to ensuring people safely received their medicines, following the Mental Capacity Act, making sure that people’s nutritional needs were being met and having an effective quality assurance system in place.

At this inspection we found some improvements had been made but improvements still needed to be made to the quality assurance systems in place to ensure areas requiring attention were identified and addressed.

Signet Healthcare Limited provides a range of services to people in their own home including personal care. People using the service had a range of needs such as learning and/or physical disabilities and dementia. At the time of our inspection 47 people were receiving personal care in their home. The care had either been funded by their local authority, the Clinical Commissioning Group (CCG) or people were paying for their own care.

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.

Although care workers confirmed they received an induction and training, the records did not always evidence that this had taken place.

Most risks to people's safety had been assessed and the provider had taken action to minimise the risks of harm. However, some areas of risk had not been identified and assessed and this placed people at risk because they did not follow good practice guidance and did not always ensure people were being cared for in a safe way.

The recruitment checks carried out on care workers did not always ensure that they were suitable to work with people using the service.

Not all records were accurately maintained or complete.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns. However, records needed to show how some complaints had been investigated.

There was some mixed feedback about the care workers and missed calls occasionally occurring but overall people and their relatives were complimentary about the service.

There were appropriate procedures to safeguard people and the staff were aware of reporting any concerns to the registered manager.

There were systems and training in place for care workers so that people safely received their medicines.

Assessments of the person’s needs were carried out before the person started to receive care in their own home. Each person had a care plan in place which described their support needs.

People had consented to their care and treatment and were involved in decisions about their care.

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

The inspection took place on 2 July 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.

We last inspected the service on 17 September 2013. At the last inspection there were no breaches of the Regulations.

Signet Healthcare Limited is a domiciliary care agency providing personal care and support to people living in their own homes. At the time of the inspection 26 people were receiving a service. The majority of these people had their care funded and organised by the local authority or the Clinical Commissioning Group (CCG).

The registered provider had until two days before the inspection been the registered manager. They had cancelled their registration as the manager and a deputy manager was now in day to day charge of the service. They were in the process of applying to be the new 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.

Information about people’s medicines needs was not clearly recorded. For example, some information was inconsistent and contradictory. Where the local authority had requested specific support for a person with their medicines, it was not clear if people were safely receiving their prescribed medicines.

Where the service was required to support people to eat there were no systems in place to record and monitor what people were eating. Therefore if there were any problems the service did not have an accurate record of where the person had refused to eat or what they had eaten for that day.

There were some procedures in place to consider if a person could give consent to the care and support they were receiving. However, staff had not received training in the Mental Capacity Act 2005 and there were no procedures in place to ensure people were assessed if they could not make daily decisions about their lives.

Systems were in place to monitor the quality of the service. However, these had not been fully effective in highlighting the shortfalls identified during this inspection.

Feedback from people using the service and relatives was mixed. Some commented on care workers occasionally being late for a visit and not always knowing which care worker would be coming to visit them. However, many spoke positively about the care workers and said they felt able to contact the staff based in the office when they had concerns. One person confirmed the care workers were “kind” and “patient”.

There were procedures for safeguarding adults and the care workers were aware of these. The risks to people’s wellbeing and safety had been assessed.

The service employed enough staff to meet people’s needs safely. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.

Care workers received the training and support they needed to care for people.

People’s needs were assessed prior to receiving a service and care plans were developed from the assessment. These informed care workers about how to support the person safely and in a dignified way.

There was a complaints procedure which the provider followed. People and relatives felt confident they could raise a complaint if they had one and that their concerns would be listened to and dealt with.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the proper and safe management of medicines, assessing people’s ability to give consent to their care, supporting people safely if they needed help to meet their nutritional needs and shortfalls in assessing and monitoring different aspects of the service.

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

We have made a recommendation that the provider reviews their arrangements for supporting care workers.

At the last inspection which took place on 10th June 2013 we found that the service was not meeting essential standards of quality and safety. For example, we found that the service had not carried out full recruitment checks on the staff who worked for the service to ensure that they were suitable to work with vulnerable people. We also found that staff were not appropriately monitored and did not receive sufficient supervision or an annual appraisal to support their development and check they were able to meet people’s needs effectively. Following the inspection the provider submitted an action plan informing us that the service would address these issues and be compliant by 28th August 2013.

During this inspection we saw that where possible the manager had made attempts to obtain recruitment information that was missing at the last visit. We viewed seven staff employment files and saw that relevant information was held on file, such as completed application forms and identification of the staff member. Criminal record checks were completed for staff before they worked with people in their own homes and the manager said staff would only start working once all the recruitment information had been received and checked.

We also saw evidence that since the last inspection visit the manager and deputy manager had carried out monitoring spot checks on the care staff. These checks involved observing staff carrying out their tasks in people’s homes. It also provided the person using the service an opportunity to give their views about the support and care they received. We saw that staff had also received one to one supervision and had an annual appraisal. This provided them with the chance to discuss their performance and for the manager to raise any concerns or issues that had been identified.

We spoke with the deputy manager, two people who use the service, two care workers and three relatives. People’s comments included, “I am happy with the service” and “the care workers go over and above what is needed when they visit”. Relatives said “staff listen to me” and confirmed the care workers were careful and considerate when supporting their family member.

We viewed the care records of three people using the service and found that the majority of their care needs were assessed and recorded in their care plans. However, we found that information about their needs in relation to medicines was unclear and did not always reflect what staff were doing. The deputy manager said she would review this to ensure that care plans accurately reflected people’s needs.

Risk assessments had been completed to make sure that people were cared for safely. People's needs were reviewed and relatives confirmed they had seen a member of staff from the office who had asked them for their views.

Recruitment procedures did not fully protect people using the service. There was a lack of systems in place to check that all the necessary information about a new member of staff was in place before they started working for the service.

Staff were provided with training relevant to their roles and responsibilities; however they did not receive regular one to one supervision or an annual appraisal.

The manager of the service had not implemented any formal quality assurance processes. However she had developed an annual audit of the service and we saw the report relating to this. It included looking at where the service had made improvements and adjustments to how it operated.

The service had a complaints policy in place and the relatives we spoke with told us they would feel confident to raise any concerns with the manager. We saw from the records that complaints were listened to and acted on.

We spoke with two people who use the service, two relatives and four care staff (who will be referred to as carers) who work for Signet healthcare agency.

Both relatives we spoke with confirmed the manager had assessed people’s needs before offering the person a service. This ensured people’s needs were identified and could be met by the carers.

One person who used the service told us the carers carried out the tasks appropriately and were respectful and caring. Another person told us that carers took account of their views and a relative confirmed carers and the manager listened to their opinions. A person commented positively stating they had a “good carer” and they trusted them.

People we spoke with and the two relatives said they felt able to talk with the manager who was “approachable”. One relative gave an example where the manager had responded swiftly when they had raised a concern. Another relative told us the manager had been flexible in assisting them when there was a potential emergency. This had reassured them that they could turn to the agency if they needed help.