About the service: Accommodating Care is a domiciliary care agency providing personal care to 21 people at the time of inspection. Not everyone using Accommodating Care receives regulated activity; CQC only inspects the service being 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.

People’s experience of using this service: People were not always protected from harm and abuse. Internal and external systems were not followed to protect people and ensure their safety.

Potential risks to people were not always identified. Where risks were identified the information for staff was brief and did not detail how to mitigate risks to people and keep them safe.

Staff recruitment was not robust. Pre- employment checks were insufficient and employment gaps were not explored to ensure potential staff were of good character and suitable to work with vulnerable people.

People had assessments and care plans regarding their care and support needs. However, the care plans lacked important information and were not always kept up to date.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; However, the policies and systems in the service did not support this practice.

Complaints were not managed in line with company policy.

The service was not well-led and there was a lack of effective governance and oversight. Quality assurance processes were not completed and records for the running of the service were not always accurate or up to date.

Rating at last inspection and update; At the last inspection the service was rated requires improvement (published 4 April 2018). This service has been rated requires improvement for the last two consecutive inspections.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve.

At this inspection improvements were still needed and the provider continues to be in breach of regulations. This has resulted in the service being rated Inadequate overall and being placed in special measures. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

Why we inspected: This was a planned inspection based on the rating at last inspection.

Enforcement: We have identified breaches in relation to Regulations 19,12,16 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This provider did not ensure fit and proper people were employed at the service, did not ensure safe care and treatment of people using the service, did not manage complaints adequately and demonstrated a lack of robust quality assurance meant people were at risk of receiving poor quality care.

Following this inspection, we wrote to the provider to request an action plan and to gain further assurances for people’s safety.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

This was an announced inspection which took place on the 4th and 18th January 2018, and 15 February 2018. The inspection was announced to ensure that the registered manager would be available to assist with the inspection visit. At the last inspection, the service was rated good. At this inspection we found the service to be requires improvement in safe, effective, responsive and well-led.

Accommodating Care (Driffield) is a domiciliary care provider which supports people with personal care who live in their own homes in areas of the East Riding of Yorkshire. They support people with a range of needs, including people living with dementia. At the time of our inspection there were 48 people using the service.

Not everyone using Accommodating Care (Driffield) was receiving the regulated activity; the Care Quality Commission (CQC) only inspects the service being 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.

There was a registered manager in post at the time of our inspection that had been running the service since August 2017. Following the inspection the local authority advised us that the registered manager had served their notice and was due to leave the provider within a couple of weeks. A registered manager is a person who has registered with 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.

Staff were knowledgeable about maintaining people's safety and how to report any abuse or allegations of abuse should they need to. However, we did find that safeguarding information had not been recorded centrally and the provider lacked oversight in this area.

Staff training schedules were not in place to identify training that had been completed and highlight when refreshers were due. Some staff records showed very little training and the provider did not have this information. We could not be sure that staff had received the training necessary to carry out their roles effectively. This was an area the registered manager was reviewing in order to ensure all training was current for all staff.

Disciplinary procedures were in place and the provider had utilised these when necessary. However, when errors had been identified and the disciplinary process opened, staff had not been offered additional training to support them and observations to check competency had not been considered.

Accidents and incidents were recorded in people’s individual care files. However, these were not always fully completed and lacked details of actions taken and referrals made to other health professionals. There had been no overall analysis or review so that lessons could be learnt.

Recruitment processes were not robust. The registered manager had obtained only one reference for some employees, identification documents were not always present and some application forms contained conflicting information that differed from the curriculum vitae provided. We could not evidence that the registered manager had questioned these discrepancies at the interview stage.

Risk assessments did not always contain sufficient detail to guide staff in how to mitigate risks and some had not been reviewed since 2015.

The provider had failed to implement regular checks to identify medicine errors despite their being recent issues with medicines administration. Since our inspection the local authority were supporting the registered manager to improve in this area.

People told us they received consistent carers that attended within thirty minutes either side of the allocated timeframes. People told us that staff offered choices to them and supported their independence. People felt that staff respected their privacy and dignity at all times

The inspection of Accommodating Care (Driffield) domiciliary care agency took place on 1 December 2015 and was announced. We gave the service several hours’ notice so that the registered manager could meet with us. At the last scheduled inspection on 12 December 2013 the service was not meeting the requirements for quality monitoring systems in place under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At the follow-up visit on 25 March 2014 the service had met these requirements. On 1 April 2015 the 2010 regulations were superseded by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Accommodating Care (Driffield) is a domiciliary care agency that provides care and support to approximately 23 older people in their own homes, some of whom may be living with dementia. The service operates from an office in the premises of The White House Residential Care Home located on a main road in Driffield, East Yorkshire.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a registered manager employed at the service. 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 found people that used the service were protected from the risks of harm or abuse, because there were systems in place to ensure that all suspected or actual incidents of abuse were appropriately handled and managed. The provider had ensured staff were appropriately trained in safeguarding adults from abuse and there were systems in place to ensure safeguarding referrals were made to the appropriate local authority safeguarding department.

People were safe because the risks that were presented to them in their homes were reduced by implementing an environmental risk assessment and other risk assessments, for example, on falls, using mobility equipment and eating healthily. They were supported by staff in sufficient numbers to meet people’s needs and staff recruitment practices followed safe policies and procedures. There were medication management systems in place to ensure those people without capacity were safe from the risk of receiving the wrong medication.

We found that people were supported by trained and skilled staff who in turn received support and supervision from their registered manager. Communication was important in the service and systems had been improved following an incident, which meant that staff were more vigilant about checking people and sharing information to ensure people’s safety.

People were protected by the use of legal systems, where necessary, in cases where they had reduced capacity to make decisions. They received regular and consistent support with their nutrition and maintaining their health and wellbeing.

We found that people were supported by caring and kind staff who knew about people’s needs. The staff team explained what they were doing at each stage of providing support to people. Staff respected people’s privacy, dignity and independence when carrying out tasks so that their personal wellbeing was assured.

People were cared for according to their assessed needs and personal preferences as written in their support plans. People were encouraged to maintain interests that they may have had in the past or new ones that they had discovered in later years. They were also encouraged by staff to maintain relationships that were important to them and staff were responsive to people’s needs for contact.

We found that while our questionnaires to people indicated that some people were unsure of who to complain, people we spoke with told us they knew how to make complaints if needed to. We saw that complaints and compliments were appropriately managed and recorded.

We saw that people benefitted from receiving a service that was led by a conscientious manager who steadily improved the service each day. We saw that staff were guided and supported by the registered manager who ‘led by example’.

People were able to make contributions to changes in their individual care by engaging in care reviews.  They were able to affect changes in the overall service delivery by engaging in the quality assurance and monitoring systems operated in the service.  There were several means of seeking people’s views: surveys, visits and phone calls from the registered manager and periodic spot checks carried out on staff performance, at which people were asked to comment on the staff member’s ability, skill and caring nature.  We saw that the service completed regular audits on many areas of service delivery to identify shortfalls and that all of the information gathered was used to devise action plans for improvement.

When we visited the service in December 2013 we made a compliance action in respect of outcome 16; Assessing and monitoring the quality of service provision. We were concerned that there had been little opportunity for people who received a service and staff to comment on the quality of the service provided. We also found that the lack of quality audits had led to medication errors. We received a satisfactory action plan from the provider that informed us of the action they intended to take to achieve compliance.

We did not speak with people who used the service during this inspection. We visited the agency office to speak with the manager about how they monitored the quality of the service and to review associated documents.

We found that the service had achieved compliance with this outcome. Satisfaction surveys had been distributed to people who used the service and spot checks had been undertaken in people's own homes that included an opportunity for them to express their views about the service they had received.

Staff meetings had taken place, staff had been having supervision meetings with the manager and training courses had been arranged. Staff had undertaken training on the administration of medication and medication audit forms had been introduced.

New monitoring systems had also been introduced to audit the number of missed calls and we saw that, as a result, these had reduced.

At the time of our visit Accommodating Care (Driffield) was providing support to 16 people in their own homes. The service is separate to, but based at The White House Residential Care Home, also in Driffield.

People’s consent was obtained before care and support was provided. Where people did not have capacity to consent to care or treatment best interest decisions were made that involved the relevant people involved in the person’s care.

Care records provided clear guidance to support staff to ensure people’s needs were safely met. People we spoke with confirmed they were satisfied with their support. One person told us “They are all nice girls”.

People who were supported with their medicines told us they received their medicines regularly. We visited one person who agreed we could audit their medicines. We found that a lack of checks and audits increased the risks of medication errors.

Appropriate recruitment policies were in place to check that people working at the service did not present a risk to people who lived at the service. However, we found there were gaps in the records for some staff. We raised this during our visit and asked the manager to address this. The manager contacted us following our visit to explain all recruitment records had been received and were available for future checks.

The provider did not have effective systems in place to check on the quality and safety of the service people received. On the day of our visit we wrote to the provider asking them to submit a report the following day explaining the actions they had taken to ensure improvements were made to the quality checks required to minimise the risks associated with supporting people with their medicines. We found the lack of a quality assurance policy impacted on the quality of care people received.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency. This inspection was part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector.

We visited people at home and used telephone interviews to speak to people's main carers (a relative or friend) and people who worked for the agency to gain views about the service.

The people that we spoke with told us that they were satisfied with the support they received from care workers. They said, “They do things with me, not for me” and “The care workers are very good to me – I like them all.”

Relatives/friends were very positive about the service provided by the agency. One person said, “The agency has noticed her changing needs and adapted the care they provide accordingly” and “…….. would not cope with too many different care workers and the agency has made sure that only familiar people support her.”

The people we visited and people's relatives/friends rated the care provided by the agency as ‘Excellent’. One person said, “The care workers are respectful but they provide support with good humour; this makes it informal and more positive for …..”

The people that we spoke with told us that they felt safe when care workers were in their home. They were able to name people that they could speak to if they had any concerns. They said, “They are lovely people. I feel comfortable when I am with them and I trust them.”

People's relatives/friends said that they would not hesitate to speak to the manager if they had any concerns and they were confident that they would be dealt with. One relative/friend said, “I would speak to the manager if I had any concerns. She is a good listener and would respect me for sharing my views.”