This inspection took place on 12 and 20 July 2018 and was announced.

Our last inspection took place on 9 and 16 October 2017 and at that time we found the service was not meeting five of the regulations we looked at. These related to safe care and treatment, need for consent, staffing and good governance. The service was rated ‘Inadequate’ and was placed 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. This inspection was therefore carried out to see if improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures.’

During this inspection the provider demonstrated significant improvements had been made and the service is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of ‘Special Measures.’ However, while we concluded improvements had been made they needed to be fully embedded and sustained to make sure people consistently received safe, effective and responsive care and support. This is reflected in the overall rating for the service which is now ‘Requires Improvement.'

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.

On the first day of inspection the registered manager was on annual leave and therefore information was provided by two directors of the company. However, the registered manager was present on the second day of inspection.

People told us they felt safe having their care and support provided by 06 Care Limited. We found staff had received training in safeguarding vulnerable people and were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy and told us they were certain any concerns they raised would be taken seriously by the registered manager.

We found support plans were person centred and contained detailed information that guided staff on the level of support people needed to meet their health and social care needs. Care records were reviewed regularly to ensure they reflected people’s changing needs and detailed risk assessments were in place. People told us they had been consulted about their care records and felt involved in how their care was provided.

People’s nutritional needs were met and people were encouraged to eat a varied and balanced diet if this formed part of their care package. People told us staff treated them with kindness and respect and promoted their independence and right to privacy.

There were enough staff employed for operational purposes and the staff recruitment process ensured only people suitable to work in the caring profession were employed. Staff received the training, support and supervision they needed to carry out their roles effectively.

The service had an infection control policy which gave staff guidance on preventing, detecting and controlling the spread of infection. Staff had received training on infection prevention and control.

The registered manager demonstrated a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and staff demonstrated good knowledge of the people they supported and their capacity to make decisions. The registered manager and staff were aware of the process to follow should a person lack the capacity to consent to their care.

We found that the registered manager and all the staff we spoke with could tell us about the people who used the service. They knew their likes and dislikes and things that were important to them

The inspection of 06 Care Limited took place over two days on 9 and 16 October 2017 at the agency office. Prior to the office visit, we made telephone calls to people using the service and staff between 28 September 2017 and 1 October 2017. The site visits were announced. The service had previously been inspected in April 2016 and was rated requires improvement. There were two breaches of the Health and Social Care Act 2008 and associated Regulations, for safe care and treatment and good governance. We looked at this inspection to see if improvements had been made.

06 Care Limited provides personal care support to 61 people, adults and children, living in their own homes in Bradford and its environs. This support includes day calls and night check visits (for eight people), and the agency also provides a night-sitting service for three people with complex health needs.

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.

Most people told us they felt safe but one person raised concerns about the different staff visiting. We found 06 Care provided staffing through ‘runs’ which meant staff were told a start time and were given a list of people to visit. This information was not consistently shared with people using the service and staff had unrealistic schedules to follow. Call times were frequently cut short and people were subject to a wide variance in call times.

Medication was not properly managed or safely administered as the provider did not demonstrate an awareness of the NICE Guidelines for domiciliary care agencies which provide clear direction. 06’s source of information for most topics was the local authority but this meant they were not always following the relevant legislation.

Staff were trained but this was not always followed up with timely competency checks and more experienced staff had not received regular supervision or appraisal. Staff were also not supported through regular meetings.

Risks in regards to moving and handling, or more complex care packages were managed in a person-centred manner with detailed guidance provided for staff. Staff demonstrated a sound awareness of infection control procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We spoke to the registered manager about ensuring the person signed their own record unless physically unable to do so.

People were supported with their nutritional needs and had access to external health and social care support as required.

Staff were spoken of highly by people who told us they were caring, kind and compassionate. We saw some compliments which endorsed this view. People felt they participated in planning their care.

Care records contained sufficient detail so staff knew what support to offer people. Daily notes tended to be task-focused.

The service had not logged any specific complaints as they dealt with issues when they arose. We saw these ‘occurrences’ were dealt with promptly and investigated well.

The service had detailed quality assurance processes which considered certain aspects of care delivery. However, the more general service delivery was not audited sufficiently well as can be seen by the issues we found with staffing and medication.

This inspection found breaches of the Health and Social Care Act 2008 associated regulations relating to the need for consent, safe care and treatment, good governance and staffing.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.

Services in special measures will

The inspection tool place on the 19, 20 and 22 April 2016. We announced the inspection 48 hours prior to our arrival in order to ensure someone would be in the office.

During our last inspection which took place between 25 August and 1 September 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to safe care and treatment, person centred care and good governance. We issued warning notices in relation to the breach of safe care and treatment which had a compliance date of 13 November 2015. The issues identified were around how medicines and potential risks to people’s health and safety were being managed. We also issued requirement notices for the breaches relating to person centred care and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

06 Care Ltd provides support to people living in their own homes in Bradford, Keighley, North Yorkshire and the surrounding areas. Referrals are made from continuing health care, direct payments and private customers. 06 Care Ltd support people with personal care and support to enable them to live in their own homes. At the time of this visit there were approximately 61 people using the service.

The service had 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.

Improvements had been made to how medicines were managed. For example, more robust arrangements were in place for recording the administration of medicines. However, further improvements were required to the documentation and audit processes to ensure people were fully protected from the risks associated with medicines.

Care records needed to be improved to ensure they were accurate, complete and up to date so that care staff had the information they needed to provide effective and consistent care. Care records did not always contain person centred information particularly in areas such as people’s preferred visit times, dietary needs and social histories.

We saw evidence staff provided appropriate support to ensure people consumed an appropriate diet and maintained good health. We also saw some good practices in relation to how risks had been assessed. However, further improvements were required to ensure risk assessments were person centred and that staff consistency recorded how they mitigated potential risks to people’s health and wellbeing.

People told us they felt safe when staff visited them and we saw staff took effective action to help protect people from the risk of abuse. However full details of the decision making and actions taken to reduce risk were not always recorded.

Where people provided feedback about the service they told us they felt listened to and staff were responsive in addressing any issues or concerns. People provided positive feedback about care staff and told us staff treated them with dignity and respect.

People told us staff asked their consent before providing support and the staff we spoke with demonstrated they had a good knowledge of the people they supported and their capacity to make decisions.

Staff were recruited in a safe way and there were sufficient numbers of staff to ensure people received the support they needed. Staff had the required skills, knowledge and experience to deliver effective care.

The provider had introduced a system to ensure daily notes were returned to the main office to be checked each month. This enabled the office staff to identify any concerns or issues and ensure people had received the support they needed. Ho

We spoke with three people or their relatives who used this agency. They all spoke highly of the care they or their relatives received and told us they would recommend it.

One person commented, "they are very polite and do a good job, they always respect my dignity and know my needs," another person said "they tick all the boxes," and another person said "very pleased with them, they go over and above what you expect every person deserves the care that 06 give."

The care records we reviewed showed people who used the service were involved in making care decisions and consented to their care. The care records also showed care plans were up to date and people had their health and welfare needs met.

We spoke with four care staff who were very complimentary about the agency and the support they received. One care worker told us, "the managers are very professional they have a good attitude towards me and the clients.They always ask me how I am, I enjoy going to work." Another member of the care staff said "06 is run with consistency and continuity," and another said "the managers are very good, no complaints at all I love it here."

06 Care Ltd was a local winner of the Local Business Accelerators competition and they will go forward to the national final later this year which is to be held in London.

We spoke with three people who used the service or their relative. They all told us they had been involved in planning the care package and had consented to that care. We also spoke with three member of staff. They all told us the care packages were well organised and clearly documented in the persons care record book.

We spoke with three people who were using the service. They all gave very positive feedback about the care they received from 06 Care. One person told us "The care has been really good so far and the staff are fantastic" they also told us the service had accommodated changes to the plan at short notice and this had been extremely helpful. Other comments included;

"The staff always have happy faces no matter what time of the day they come and they are never rushed, they take time to include all the family."

"The staff are wonderful, I am very happy with the care I receive."

"They are always kind and gentle when they help me."

"They come in and get an with the job, we look forward to them coming as they are always so nice."

All three of the people we spoke with told us they felt safe being supported by 06 Care.

The inspection took place on 25 and 26 August 2015. We announced the inspection 24 hours prior to our arrival in order to ensure someone would be in the office. We also telephoned people who used the service and their relatives on 25, 26 August and 1 September 2015.

06 Care Ltd provides support to people living in their own homes in Bradford, Keighley, North Yorkshire and the surrounding areas. Referrals are made from continuing health care, direct payments and private customers. 06 Care Ltd support people with personal care and support to enable them to live in their own homes. At the time of this visit there were approximately 80 people using the service.

The service had 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.

We were not always able to evidence that the service had consistently ensured potential risks to people’s health and wellbeing were managed, monitored and mitigated. The provider had recognised they needed to improve the way medicines were managed. However, we found  the new systems they had introduced did not ensure medicines were managed in a safe and proper way.

People told us they felt safe when care staff visited them and they were treated with kindness, respect and dignity. Overall feedback about the standard of care provided was good. However, most people’s experience of the standard of care they received was influenced by the variance in call times. People told us this sometimes meant they didn’t get help and support at the times they really needed it. Some people also commented that they did not receive a consistently good experience because some staff were more caring than others. The provider explained they were working hard to employ the right people who were committed to delivering the high standard of care that they wanted to deliver.

Procedures were in place regarding safeguarding and whistleblowing, however these needed updating to ensure they reflected current legislation. Staff had a good awareness of safeguarding, how to report concerns about people’s wellbeing and what they had to do to keep people safe.

A number of staff had unexpectedly left the service which had impacted upon the consistency of people’s call times. The provider had worked hard to recruit additional staff and ensured the people recruited were of good character and fit to perform the role. We found sufficient numbers of staff were employed to ensure each call run was covered.

We found the quality of information within care records was inconsistent. The information contained within care records did not always reflect people’s changing needs. Further improvements were needed to ensure all care records contained accurate and complete information to ensure staff could deliver effective care. Staff had a good understanding of how to assist people with their meals and we saw evidence they provided appropriate support to ensure people ate and drank appropriately. However, the gaps in care records risked that this support was not consistent. Daily notes were not being regularly reviewed which risked that changes and issues were not always identified and acted upon.

People told us staff were well trained and provided them with effective support. We saw evidence care staff had been provided with appropriate training and support to enable them to fulfil their role. Care staff demonstrated a competent understanding of key subjects and the people they supported which demonstrated the training was effective. However, further improvements were required to ensure the training programme reflected the provider’s policy commitments and that staff received timely refresher training.

People told us they felt involved in the care planning process and we saw a formal process was in place to ensure people could express their views about the care and support they received. We saw that where possible the service responded to people’s requests. Care records also reflected that people and their relatives had been consulted and involved in making decisions about their care. A positive feature of the service was that staff were clear that it was the views of the person using the service that were the most important in shaping how care was provided. However, further improvements were needed to ensure the issues people raised were consistently responded to.

Most people told us they had experienced inconsistent call times. The provider had identified this was an issue and had started to put processes in place to address it. We saw this was an improving picture, however, further improvements were required to ensure the issue was fully addressed and person centred care was consistently delivered.

We found the governance systems and processes needed further refinement to ensure they consistently ensured the delivery of high quality care.

People and staff provided positive feedback about the new management team and the changes they were making. The roles and responsibilities of the new management team needed to be more clearly defined. However, it was clear the provider had invested in a pro-active management team who were committed to making the required improvements to ensure people received good quality care.

We identified 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 in relation to this at the back of the full version of the report.