This announced inspection took place on 08 and 10 November 2016.

St. Gregory’s Homecare Ltd is a domiciliary care agency based in Carnforth offering a range of services in people's homes, including people living with dementia, learning and physical disabilities and people with palliative care needs. Services provided includes, domestic support, waking and sleep in night services, 24 hour care and respite care. The service covers an extensive area of the South Lakes with a large rural area and parts of North Lancashire. At the time of inspection the registered provider was supporting 150 people and employed approximately 100 staff.

The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure someone would be in at the office.

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.

A comprehensive inspection of St Gregory’s Homecare Ltd took place between the period of May and June 2015. At the inspection breaches of Regulations were identified in relation to health and safety of people, management of medicines, and delivery of person centred care. Following the inspection visit, the registered manager submitted an action plan to show what improvements they were going to make to ensure they met the fundamental standards.

A focussed inspection was carried out in February 2016 to check that improvements had been made. At this inspection visit it was noted improvements had been made to ensure medicines were suitably managed and person centred care was delivered, however there was a continuing breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014 as risk was not sufficiently managed to ensure people were kept safe. We took enforcement action against the provider following this visit.

We used this inspection carried out in November 2016 to ensure action had been taken to ensure all fundamental standards were now being met. We also carried out a comprehensive inspection to review the rating of the service.

At this inspection visit, carried out in November 2016, we found the required improvements had been made. Following the previous inspection visit a working group had been developed to look at care planning systems and ways to improve the quality of the care plans and risk assessments. During the inspection visit it was noted the service was in the process of changing the care planning documentation to make them easier to follow. Systems had been implemented to manage and monitor risk to promote safety.

We noted care plans and risk assessments were reviewed and updated when people’s health care needs changed or when new risks were identified. People who used the service told us their nutritional and health needs were met.

People told us when they required assistance with their medicines, staff were reliable and knowledgeable. Although we received positive comments about the management of medicines we found arrangements for managing and administering medicines were not consistently applied. We have made a recommendation about this.

People spoke positively about the quality of service provided. People consistently told us improvements had been made within the service in the past year. They said staff were reliable and turned up when expected. At the time of the inspection visit the service was in the process of implementing a call monitoring system to track and record staff attendance at visits. The registered manager had introduced the system following concerns being raised about missed visits.

People spoke highly about the staff. They told us staff retention was good and said they had formed positive re

We carried out this announced focussed inspection on 13 January and 2nd February 2016. Documentation relevant to the inspection was also collected on 18th January 2016. We last inspected this service in July 2015 during which we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

St. Gregory’s Homecare Ltd is a domiciliary care agency based in the town of Carnforth. It offers a range of services in people's homes, including care and support for people living with dementia, learning and physical disabilities and people with palliative care needs. Services also provided includes, domestic support, waking and sleep in night services, 24 hour care and respite care. The service covers rural and urban areas of South Cumbria, Lancashire and North Yorkshire.

There was a registered manager employed at the service. 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 the last inspection in July 2015 we asked the provider to take action to make improvements to the following (Regulated Activities) Regulations 2014, safe care and treatment including the proper and safe management of medications and person centred care. This inspection focussed on whether those actions had been met.

During this inspection we found that there was a continuing breach of Regulation 12 Safe care and treatment of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the assessing of risk to health and safety of people using the service and doing all that is reasonably practicable to mitigate any risks.

Although people told us that they felt safe receiving care and support from this service we found the provider was not identifying all of the risks associated with providing safe care and treatment. Where risks had been identified they had not always been recorded.

The quality and accuracy of care plans and risk assessments recorded were not consistent and some information about some people’s current care needs had not always been recorded. Where care plans had been reviewed previous risks identified had not always been included in the reviewed care plans.

Where risks were evident staff had not always relayed them to the senior staff who manage the care plans or identified them in people’s care records themselves.

Most people received support from a regular team of staff who they knew and who understood the care and support they required. We saw that people were treated with kindness and respect and people made positive comments about the staff who visited their homes.

During this inspection we found improvements had been made to the management of medications. The provider was still working on systems and processes to continue to improve the safe management of medications.

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

Our inspection team was made up of two Inspectors. During this inspection we also checked if requirements from the last inspection we carried out in April 2014 had been completed. During the inspection we gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found:

Is the service safe?

During our visit we found concerning information in relation to the safeguarding of a person using the service.Whilst the senior on call considered they had acted appropriately based on the information they had been given at the time. We informed the operations manager to report it to the appropriate authority. This meant that information being received, that indicated people may be at risk of harm, was not appropriately recognised or managed by the service.

We last visited this service in April 2014. We did not see evidence at this visit that the quality monitoring systems in use had been effective in reducing the number of concerns and complaints being raised by people using the service. Nor did we see that where concerns relating to the safety and well being of people had been appropriately recognised or recorded on all occasions. This meant that people who used the service could not be sure that the safety and quality of the service was being effectively monitored and managed by the provider. Nor did we see that comments and complaints had always been taken into account to improve the service.

Is the service effective?

We spoke with the senior administrator who does not have any responsibility for the planning of care. She told us that her role, since our last visit, had been focused on meeting the regulation requirements for the recruitment of staff. We were told they were aware that the appropriate assessments and plans of care had not been completed due to the lack of sufficient staff to manage the workload.

We saw that new checking systems since our last visit were effective in ensuring the required information was in place before people commenced working in people's homes .

Is the service caring?

We visited, with permission, four people receiving care and treatment from St Gregory’s Homecare Ltd in their own homes. We also spoke with two relatives.People we spoke with told us they were ‘more than happy’ with the carers that they received care from. One person told us,"The carers that come are marvellous’’ and another said ‘’They are all lovely’’.

People who used the service who we spoke with during our visit told us they had also experienced missed or late visits. This meant that the delivery of care was not planned in an appropriate way in order to meet the needs of the people using the service.

During our visit we looked at the most recent completed satisfaction survey questions asked of some people using the service. This had been completed in May / June 2014 by 17 people. We saw that 15 out of 17 strongly agreed that they felt comfortable and safe with their carers. The same amount of people said their carers treated them with respect and dignity.

Is the service well-led?

People we spoke with during our visit told us they were unhappy with the organisation of the rotas. We were told that on a regular basis people receiving services did not know who or if a carer would be visiting.

Staff we spoke with told us that they did not receive regular supervision or appraisal. One person told us they had not had any supervision since November 2012. Staff also told us of the low morale and pressures of working extra hours. We noted from the action plan audited on 10th June 2014 that the identified required outcome for supporting workers recorded that staff were regularly supervised and had an annual appraisal. This meant that staff had not been appropriately supported in their responsibilities to enable them to deliver care and treatment to services users safely and to an appropriate standard.

Is the service responsive?

We looked at a sample of the reports for calls made to the office during opening times from 16/06/2014 to 22/06/2014. These records highlighted that a number of people using the service were unhappy with the provision. During the period of the week one relative contacted the service three times to report missed visits. Ten calls were made reporting people had been unhappy with the service received. We saw that only one of these had been recognised as a complaint by the service.

We saw that new checking systems since our last visit were effective in ensuring the required information was in place before people commenced working. A comprehensive audit on the records of staff recruitment had been completed in May 2014 and we saw that this had been repeated in June 2014.

We looked at minutes of a manager's meeting held on 9th June 2014. The meeting was recorded as being called to discuss the events that occurred during the last weekend as the on call person had reported having to go out to cover visits due to staffing problems. The meeting was also to discuss how they were to manage the shortfall of 300 hours gaps on the rotas. It was recorded in the meeting minutes that two office staff were to change their working hours to accommodate supporting the gaps on the rota at the weekends.

We carried out this announced inspection between 5 May and 13 July 2015. We last inspected this service in November 2014 during which we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These Regulations have now been replaced with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

St. Gregory’s Homecare Ltd is a domiciliary care agency based in the town of Carnforth. It offers a range of services in people's homes, including care and support for people living with dementia, learning and physical disabilities and people with palliative care needs. Services also provided includes, domestic support, waking and sleep in night services, 24 hour care and respite care. The service covers an extensive rural area of the South Lakes and parts of North Lancashire.

There was a registered manager employed at the service. 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 the last inspection in November 2014 we asked the provider to take action to make improvements to the following (Regulated Activities) Regulations 2010,care and welfare of people who use services, safeguarding people who use services from abuse and the assessing and monitoring the quality of service provision. These actions have now been completed, with the exception of the safe management of medicines.

During this inspection, July 2015, we found one continuing breach of Regulation 12 Safe care and treatment of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the safe management of medications.

We also found two new breaches that related to assessing the risks to the health and safety of people using the service Regulation 12 and to how people’s care needs were assessed and recorded Regulation 9 of the Health and Social Care Act (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.

Although people told us that they felt safe receiving care and support from this service we found that they could not be confident that they would always get their medicines as their doctor had prescribed. We found some care plans and records relating to the administration of medications were not always accurate.

The provider was not identifying the risks associated with providing safe care and where these were identified these were not always recorded.

The quality of care plans and risk assessments recorded were not consistent and information about some people’s care needs was not always recorded. Newly implemented quality monitoring systems were not seen to be fully effective.

Most people received support from a regular team of staff who they knew and who understood the care and support people required. We saw that people were treated with kindness and respect and they made positive comments about the staff who visited their homes.

There were enough staff to provide the care people required. The staff had completed training to ensure they had the skills to provide the care and support individuals needed.

Staff knew how to identify and report concerns about a person’s safety. The recruitment process for new staff included all the required checks to ensure that they were suitable to work in people’s homes. This helped to protect people from the risk of abuse.

People had been included in agreeing to the support they received and were asked for their views about the service. The registered manager was knowledgeable about the Mental Capacity Act 2005 and about their responsibility to protect the rights of people who could not make important decisions about their own lives.

We recommended that the service considered the consistency of the quality auditing of their care planning to ensure that accurate information is recorded about the needs of people who used the service.