We undertook an announced inspection of Tamar Care UK Limited on 28 August 2018.

Tamar Care UK Limited is a domiciliary care agency registered to provide personal care to people in their own homes. The Care Quality Commission only inspect the service 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 inspection, the service provided ‘personal care’ to 11 people.

There was a registered manager in post. 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.

The previous inspection on 20 July 2017 found three breaches of regulation and made two recommendations. We rated the service as "requires improvement". During this inspection on 28 August 2018, we found that the service had made improvements in respect of care documentation, staff employment checks, staff training, supervision, quality checks and audits. However, during this inspection we identified that risk assessments and medicines management could be improved.

People who used the service and relatives told us that they were satisfied with the care provided. People told us they were treated with respect and dignity and felt safe when cared for by care workers. They spoke positively about care workers and management at the service.

Our previous inspection found a breach of regulation in respect of recruitment checks. We found that appropriate recruitment checks were not carried out prior to staff commencing work. Our inspection in August 2018 found that the service had made improvements. We found that the service had a recruitment procedure in place and carried out necessary checks to ensure that care workers recruited were suitable and had the appropriate checks prior to being employed.

Risk assessments were in place which detailed potential risks to people. However, we found that these did not consistently include sufficient information to support care workers on how to effectively and safely mitigate identified risks. We raised this with management and they confirmed that they would ensure that risk assessments consistently included this information.

Systems and processes were in place to help protect people from the risk of harm. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

At the time of our previous inspection in July 2017, the service did not support people with their medicines. During this inspection in August 2018, the registered manager confirmed that the service supported two people with their medicines. We saw that Medicine Administration Records (MARs) were completed by care workers when administering medicines. These included details of the prescribed medicine and dosage. We discussed with management the importance of ensuring that copies of completed MARs were kept at the office and they confirmed that this information would be kept at the office. However, there was no documented evidence that MARs were consistently audited by management and we raised this with management.

The majority of people and relatives we spoke with told us that there were no issues with regards to care worker’s punctuality and attendance. They told us that care workers were usually on time and if they were running late, the office called to inform them of the delay. At the time of the inspection, the service was in the process of implementing an electronic system for monitoring care worker’s timekeeping and duration of their visit and advised that this would be running by November 2018.

Our previous inspection found a breach of regulation as we did not see sufficient evidence t

LW Health Care Limited provides personal care and support to people in their own homes.

The inspection visit was carried out on 20 July 2017. At the time of the inspection there were 10 people who used the service.

A registered manager was in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

This was the first comprehensive inspection of this service since it was registered by CQC in September 2016.

LW Health Care Limited is a new service, which started trading in March 2017. The registered manager was abroad at the time of the inspection so we were assisted by the care manager. It was not clear to us that the registered manager had notified us as required about their absence from the service. Registered persons are required to notify CQC where they will be absent from the service for 28 days or more. We are looking further into this.

In order to carry out the inspection fully we asked for details of the contact details of people using the service and care workers. However, this was not provided to us and we were not able to speak with people using the service and care staff. We could therefore not confirm with people receiving care if they received safe, effective, caring, and responsive care from a well-led service. We could also not check the knowledge of care workers in relevant areas of their work. We have reported on the evidence we have at this stage and will carry out another inspection in the near future which will involve feedback from people receiving care, care workers and other stakeholders.

The service was not well-led. The provider did not have adequate systems in place to monitor and maintain an overview of the service. Proper recruitment checks had not been completed on all care workers before they commenced working at the service. There were no effective arrangements in place to ensure that staff received suitable training opportunities, formal supervision and an annual appraisal of their overall performance. Risk assessments were not detailed. Risk assessments had not been fully developed for all areas of identified risk.

People’s care plans did not contain relevant and current information to guide staff on the most appropriate care people required to meet their needs taking into account of their privacy and dignity. We could not be sure that people were treated with compassion, kindness, dignity and respect because we were not able to speak with them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We also made two recommendations regarding involving people in decisions about their care and person centred care.