This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older people, some of whom may be living with dementia. On the day of our inspection the service had 11 care packages.

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.

We previously carried out an announced inspection of the service on the 25 June and 9 July 2018. During this inspection we found concerns about the safe recruitment of staff. This was due to the lack of references for staff employed by the service. The service was rated as requires improvement with a breach in Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

Following on from our inspection the provider sent us an action plan, which set out what they would do to meet the legal requirements in relation to the breach and to improve the service.

On the 23 and 24 October 2018 we carried out a focussed inspection of the service due to concerns raised by the local authority who had visited at the beginning of October 2018. We also checked to see if the service had implemented their action plan and to establish whether they now met the legal requirements.

During this inspection we inspected against two of the five questions we ask about services, is it safe and is it well led. Although we found some improvements had been made we could not be assured this would be sustained and therefore we have continued the breach of Regulation, 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service remains with a rating of requires improvement in both domains as sufficient improvements had not been made.

Improvements were needed to the recruitment process. The registered manager had obtained appropriate checks for the current care workers but we found they had started work prior to receiving them all. Care worker’s references could not be verified as they were not on headed paper or stamped by the company providing the reference.

People told us they felt safe, and except for the shortfalls identified in the recruitment process, were protected from the risk of harm by the systems, processes and practices in the service. Care workers were trained and felt well supported, and knew how to safeguard people.

The registered manager, who is also the provider, operations manager and the office manager was supporting with the direct delivery of care whilst they continued to recruit more staff but this has meant a reduced capacity to ensure that all aspects of the management and monitoring of the service was being handled as robustly as needed. This had led to a breach of regulation in relation to recruitment of staff.

There were systems in place for managing people’s medicines. Care workers had access to personal protective equipment and were trained in infection control.

The Inspection took place on 25 June 2018 and 9 July 2018 and it was announced at short notice to ensure the registered manager was available.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older people, some of whom may be living with dementia.

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.

Improvements were needed to the recruitment process. The registered manager had obtained some of the appropriate checks for the current care workers but we found they had started work prior to receiving them all. Care worker’s references could not be verified as they were not on headed paper or stamped by the company providing the reference. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe, and except for the shortfalls identified in the recruitment process, were protected from the risk of harm by the systems, processes and practices in the service. Care workers were trained and felt well supported, and knew how to safeguard people.

The registered manager, who is also the provider, and the office manager were supporting with the direct delivery of care whilst they continued to recruit more staff but this has meant a reduced capacity to ensure that all aspects of the management and monitoring of the service was being handled as robustly as needed. This had led to a breach of regulation in relation to recruitment of staff and further concerns regarding the robustness of risk assessments in all instances.

There were systems in place for managing people’s medicines should the service need to do so in the future. Care workers had access to personal protective equipment and were trained in infection control.

People told us that their care workers were very caring, kind, compassionate and genuine. They said the service was very reliable and responsive to their needs. People’s needs had been assessed and catered for and were regularly reviewed and updated.

The service provided people with the support they needed with their meals and drinks. Monitoring charts were in place, where required to ensure that people had sufficient nutrition to meet their needs. People were supported with their healthcare needs when required.

The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible.

People were treated with dignity and respect, and care workers were supportive, whilst encouraging people to regain skills and maintain their independence. People were fully involved in any decisions about their care and support. The registered manager had access to advocacy services should people need them. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People received personalised care that was responsive to their needs. They were confident any concerns and complaints would be listened to, acted upon and resolved to their satisfaction. The registered manager said they would learn from complaints and make changes to ensure that people received an improved service.

People’s confidential information was stored safely in line with data security standards.

Further information is in the detailed findings below.