The inspection took place on 6 November 2018. We told the provider two working days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

The last inspection of the service was 12 February 2018 when we rated the service inadequate for the key questions of 'is the service safe?' and 'is the service well-led?' The key questions of, 'is the service effective?', 'is the service caring?' and 'is the service responsive?' were rated as requires improvement. The overall rating of the service was inadequate. We identified breaches of six of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person centred care, need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed. The service was placed in special measures.

Vista Business Centre is the only location for the provider UK Star Care Ltd. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and some younger adults who have disabilities. Since the last inspection, the provider moved from a different office location to the Vista Business Centre. At the time of the inspection, 17 people were using the service. They lived in the county of Surrey and their care was commissioned by the local authority.

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.

At this inspection, we found improvements had been made in all areas and we have rated the service requires improvement.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

However, we identified some areas where further improvements were needed.

The provider did not always manage medicines in a safe way, although improvements had been made, further improvements were required to make sure risks associated with medicines administration were mitigated.

Some of the care visits did not take place on time. The provider had spoken with the staff about this issue in team meetings, and some people were happy with the timing of the calls. However further improvements were needed to make sure everyone received visits at the right time.

Most people felt their needs were being met, but a small number of people felt that the staff did not always care for them to the level they expected. In particular, the relatives of one person felt that the staff did not have the information or knowledge to meet the specific care needs of their relative.

The provider's audits had not always been effective at identifying where improvements were needed. Although, there had been improvements in this area. The provider had increased their auditing, and in most cases, this had been effective at ensuring the service improved

People using the service were happy with their care workers. The care workers were kind and considerate. They were involved in the development and review of their care plans and were able to feed back their opinions of the service.

The staff were happy and felt supported. They had access to a range of training and regular support from the registered manager and other senior staff.

There was a positive and open culture at the service

We undertook an announced inspection of Sceptre House on 12 and 13 February 2018. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Sceptre House is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to both older and younger adults. At the time of the inspection it provided personal care to around 26 people in their own homes in Surrey. The majority of people’s care was funded by Surrey County Council.

We previously inspected Sceptre House on 24 and 25 July 2017 and rated it Requires Improvement. We identified breaches of regulations in relation to safe care and treatment (Regulation 12), safeguarding people from this risk of abuse (Regulation 13), good governance (Regulation 17), staffing (Regulation 18) and fit and proper person employed (Regulation 19). We issued warning notices in relation to Regulation 12 and Regulation 17 and asked the provider to meet the regulations by 22 November 2017.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions of ‘Is the service Safe, Effective, Responsive and Well-led?’ to at least good.

At the time of the inspection a registered manager was in post. The registered manager was not available to attend the inspection but knew it was going ahead in their absence. 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 in relation to prescribed medicines that should be administered was not accurate and did not provide appropriate guidance for care workers which meant there were risks that people might not receive their medicines as prescribed.

Risk management plans for risks identified during people’s needs assessment were not in place to provide care workers guidance on how to reduce these risks and ensure people’s safety.

The provider had a procedure for the recruitment of care workers but this was still not being followed, as the provider did not ensure that appropriate references were in place before assessing applicants’ suitability for the role.

Staff were not deployed appropriately as the provider did not always ensure that care workers arrived at the time agreed with the person and stayed the full length of the visits.

New care workers completed induction training but the records of shadowing sessions did not demonstrate the competency of the new care worker had been assessed to ensure they had appropriate knowledge for their role.

The provider had a policy and procedure in place in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act to ensure people could consent to their care or that decisions were made in their best interests.

Care plans identified the person’s wishes as to how their care should be provided but the records were not updated when a change to the person’s support needs occurred to provide up to date information for care workers.

The provider had audits in place but these did not identify areas where improvement was required. There was no robust system in place to ensure care workers visited people at the planned time and stayed for the agreed length of time.

Most of the people we spoke with told us they felt safe when they received care. The provider had systems for the recording and investigation of incidents and accidents, complaints and safeguarding concerns to identify any trends or required actions.

An assessment of the person’s support needs was completed to ensure the service

We undertook an announced inspection of Sceptre House on 24 and 25 July 2017. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people and we wanted to be sure someone would be available to assist with the inspection.

Sceptre House is a domiciliary care agency that provides personal care for people in their own homes. At the time of the inspection eight people had their care funded by a local authority with four people funding their own care.

This was the first inspection of the service since it registered with the Care Quality Commission in August 2016.

At the time of the inspection a registered manager was 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.

Risk assessments were not developed to ensure specific risks related to each person were identified and guidance was not provided as to how to reduce any possible associated risks.

The provider had an administration of medicines policy but care workers were not always provided with information on the MAR charts or in the care plans to ensure medicines were being applied in an appropriate and safe way.

The provider had a recruitment process but this was not always followed therefore not providing appropriate information regarding applicants to ensure they were suitable for the role.

The provider had a policy in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act. Records did not clearly indicate if the person using the service had the capacity to make informed decisions in relation to their care.

The competency of new care workers to complete care tasks was not assessed appropriately during the induction period. Some care workers had completed their induction training a number of months before starting work. This meant the provider could not ensure the new care workers had the appropriate knowledge and skills required to meet people’s care needs safely.

Records relating to care and people using the service did not provide an accurate and complete picture of their support needs.

Regular audits had not been carried out to identify aspects of the service requiring improvement and action had not always been taken to address issues.

People told us they felt safe when they received care in their own home. The provider had processes to respond to any reported safeguarding concerns as well as incident and accidents.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care.

An assessment of people’s support needs was carried out before home care started and care plans identified how people wanted their care provided.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns.

The person and relative we spoke with felt the service was well-led.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to the safe care and treatment of people using the service (Regulation 12), safeguarding service users from abuse and improper treatment (Regulation 13), good governance of the service (Regulation 17), staffing (Regulation 18) and fit and proper persons employed (Regulation 19). Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.