This inspection took place on the 11, 16, 18 and 20 April 2018 and was announced. We gave the registered provider 48 hours’ notice to make sure someone was available in the office to meet with us.

This was our first inspection of the service since it was registered with the Care Quality Commission in May 2017. 268 Ashingdon Road is a domiciliary care agency that provides personal care and support to people living in their own homes. Most people using the service were older people with palliative care needs. There were seven people receiving a service at the time of our inspection.

At the time of inspection there was no registered manager in post. The registered provider had been the registered manager but had resigned from the position but was still actively involved in running the service. A new manager had been recruited who was going through the registration process. 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.

Risks to people had been assessed with guidance in place for staff on how to manage them. However, risks to people's home environments had not been adequately considered.

We made a recommendation about assessing risks in people’s homes.

People’s needs had been holistically assessed, however we found there was insufficient written guidance recorded in people's care records for staff to follow.

We have made a recommendation about the quality of information held in people’s care records.

Staff training needs had not always been identified or training provided to ensure staff had the necessary skills and knowledge to meet people’s needs. However, plans had been put in place to address this issue.

Staff had not received formal supervisions, annual appraisals or observations of their practice which help services to monitor staff performance and identify any learning needs. However, staff felt well supported and had access to informal and ad hoc support and advice as needed.

Where people had specific communication needs these had not always been assessed and recorded.

We have made a recommendation about inclusive communication practices.

Care plans were task-focussed and did not always contain sufficient information to support staff to provide individualised care.

We have made a recommendation about the provision of person-centred care.

Most people who used the service received palliative care and the service ensured they had access to treatment and support from health professionals to keep them comfortable and pain free. However, people’s care records had not captured their wishes and preferences for their end of life care.

We have made a recommendation about end of life care planning.

The provider had not ensured that the quality and safety of the service was monitored robustly. Oversight of the service and staff team was not always sufficient to identify areas that required improvement.

We have made a recommendation about quality monitoring and oversight of the organisation and staff team.

There were sufficient numbers of staff who had been safely recruited to meet people’s needs. Staff had been trained in how to safeguard adults from abuse and understood how to report concerns to keep people safe.

Medicines were safely managed as staff had received training from the provider who had checked to ensure staff were competent to administer people’s medicines.

People were supported to have enough to eat and drink and maintain their health and wellbeing. People's consent to care had been sought and staff understood how to help people living with dementia make their own decisions.

Staff were kind and caring. People were supported to be as independent as possible by regular staff that knew them well and had formed pos