This announced inspection took place on the 18 and 24 May and 8 and 13 June 2018.

Step Ahead Home Care Services is a small care at home service. The office is based close to the centre of Leeds and supports people in and around the Leeds area.

Our last inspection of the service was carried out in May 2017. At that inspection we rated the service as requires improvement and found them in breach of Regulation 9 Person-centred care and Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good. At this inspection we found that further improvements were required and this is the third consecutive time the service has been rated as requires improvement.

This service is a Domiciliary Care Agency. It provides personal care to people living in their own houses. It provides a service to older people. At the time of our inspection 33 people were receiving a personal care service.

There was a registered manager in place at the time of our 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.

There was not an effective quality assurance system in place. We found areas of the service had no checks and others did not have a robust check. This meant the service had not identified the concerns we raised during the inspection.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided. However, we identified areas of risk the service had not assessed against. Accidents and incidents were reported and reviewed to reduce the risk of an incident occurring again.

People's care plans were not always detailed, personalised and did not always provided staff with sufficient information to enable them to meet people's care needs. The care plans included objectives for the planned care that had been agreed between the service and the individual. All the care plans we reviewed were up to date but did not always reflect each person's individual needs and wishes. We found care records were not always accurate and complete.

Medicine procedures were not always safe. The service supported most people with their medicines by prompting them. Daily notes recorded when people had been prompted with medicines. However, we found some people were fully supported with their medicines and this had not been appropriately documented. We have made a recommendation about the management of medicines.

Staff were not always recruited in a safe way. We found some had not completed their application form, while other staff had not received verifiable references. No interview records were stored to show an interview had taken place. We have made a recommendation about the recruitment process.

Staff were available in sufficient numbers to meet people's needs. Staff were supported by a system of induction, training, one-to-one supervision and appraisals to ensure they were effective in their role. However, some staff had not completed their mandatory training courses while others had not always received their supervision in line with the providers policy. We have made a recommendation about the supervision process.

People were satisfied with the quality of the service they received and the caring approach from staff. People told us; "They are great" and "They really help me."

People told us they had not experienced a missed care visit. The service had effective procedures in place to ensure that all planned

This inspection took place on 16 and 22 May 2017 and was announced. The provider was given 48 hours' notice of the inspection because they provide domiciliary care and we needed to be sure someone would be in the office to facilitate the inspection.

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.

The service had systems and procedures in place which sought to protect people who used the service from abuse. The service had a safeguarding and whistleblowing policy in place and this told staff what action to take if they had any concerns.

We found the care and support records of people who used the service lacked detail and were not person centred. Care documentation was poorly organised and it was difficult to understand all the paperwork. We saw risks had been identified with information about how to minimise additional risk. However, some risk assessments had not calculated levels of risk appropriately. Despite the service having a quality assurance system, this had failed to recognise concerns we raised at the time of the inspection.

We looked at how the service managed people's medicines and found that suitable arrangements were in place to ensure that people who used the service were safe. We looked at the Medicines Administration Records (MAR) for people when we visited them in their own homes and found that these had all been completed correctly and were up to date. There was an appropriate up to date accident and incident record in place.

We found there were robust recruitment procedures in place and required checks were undertaken before staff began to work for the service. People who used the service told us they felt that staff had the right skills and training to do their job. New staff were given induction training at the start of their employment which identified the principles and values of the service.

Staff had access to a copy of the organisation's policies and procedures which were available electronically or in paper format and staff knowledge of these policies and procedures was tested at supervision meetings and as part of the process of induction.

Staff told us they felt they had received sufficient training to undertake their role competently. Records showed staff had completed training in a range of areas, including dementia, safeguarding, first aid, medicines, the Mental Capacity Act 2005, food hygiene and health and safety. Some staff had not always received supervision and appraisal from the registered manager. Records were maintained of staff supervisions that had taken place.

Before any care and support was given, consent was obtained from the person who used the service or their representative. People who used the service and their relatives told us that staff were kind and treated them with dignity and respect. People told us they knew how to complain. Complaints had been recorded and responded to in line with the provider’s policy.

We found two breaches of regulation. 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 18 April 2016 and was announced. This was the provider’s first inspection.

Step Ahead Care Home Services provides care and support to people in Leeds and surrounding areas. The agency's office is situated in Leeds. They offer a range of services to individuals who live in their own homes and need support or 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 and associated Regulations about how the service is run.

People we spoke with told us they were happy with the care they received from the service.

People who used the service told us they felt safe with the staff and the care they were provided with. We found there were systems in place to protect people from risk of harm and appropriate recruitment procedures were in place. There were policies and procedures in place in relation to the Mental Capacity Act 2005 and staff showed they understood how to ensure their practice was in line with the MCA.

We found people were cared for, or supported by, appropriately trained staff. Staff received support to help them understand how to deliver good care. People who used the service said their visit times suited their needs and staff always stayed the agreed length of time. Some people told us calls were sometimes late, but they were always notified of this by a call from the office or care worker.

We looked at four staff personnel files in detail and saw the recruitment process in place ensured that staff were suitable and safe to work in the agency. Staff we spoke with told us they received supervisions and were due annual appraisals in April and May 2016. We saw minutes from staff meetings which showed they had taken place on a regular basis and were well attended by staff.

The care and support plans we looked at were person centred and were reviewed regularly by the registered manager. However in five of the six care/support plans were not signed by the people or their relatives. We spoke to the registered manager about this.

People told us they got the support they needed with meals and healthcare. We saw arrangements for medication were safe.

Systems were not always in place to monitor the quality of the service provision. We found there were appropriate systems in place for the management of complaints. However some people we spoke with said they did not always know who to contact if they had a complaint.