The inspection took place on 17 January 2019 and was announced. The service had previously been inspected in 2016 and had not met the regulation on good governance or supporting staff to develop. 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 effective and well-led to at least good. We checked for improvements at this inspection.

Advanced Community Healthcare provides a domiciliary care service in the Kirklees area of West Yorkshire for people over the age of 18. It provides personal care to people living in their own houses and flats in the community. Not everyone using Advanced Community Healthcare Ltd 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. At the time of this inspection they supported 45 people.

There were two registered managers’ in post who had owned the company until December 2018. The business had been sold and the two registered managers had applied to deregister. The new owners were in the process of recruiting a new manager who would apply to register with CQC. 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 in place in relation to the environment and for people using the service and the registered managers sought advice when required to ensure people were safe. Staff ensured the risk of harm was minimised and people were supported to stay safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; Staff were able to describe how they would support people to make decisions if they lacked capacity and how they would act in their best interests when providing care. Decision specific capacity assessments and records of best interest decision records was an area the new provider highlighted to improve.

Supervision, training and appraisals had not all been completed in line with recommended evidenced-based best practice guidance.

People who used the service and their relatives were positive about the staff providing care and told us they were caring and compassionate. They said staff were respectful always and ensured their privacy was maintained and their independence promoted.

Care plans were recorded in a person-centred way to enable an understanding of the person’s personal history, individual preferences, interests and aspirations. They detailed information about the person’s strengths, their levels of independence and what they could do maintain this.

There was a lack of systems and processes including regular audits which meant the registered managers had been unable to identify where quality needed to improve. Up to date nationally recognised guidance had not been implemented in the service.

The new provider had undertaken their own audits and had identified where improvements were needed. They had an action plan which detailed what improvements they intended to make over the next few months and had identified the issues we also found on inspection.

The culture of the organisation was positive, and staff told us they wanted to provide the best service possible. Staff told us how much they enjoyed their role and how supportive their colleagues were. They were positive about proposed changes and were keen to engage with the new provider.

This is the second consecutive time the service has been rated Requires Improvement. We found a continuing breach of the Health and Social Care Act 2008 (Regulated Activities)

The inspection took place on 30 September 2016 and was announced. The service had previously been inspected on 30 October 2013 and met the requirements in place at that time.

Advanced Community Healthcare provides a domiciliary care service in the Kirklees area of West Yorkshire for anyone requiring care from birth upwards. At the time of this inspection Advanced

Community Healthcare provided care to 50 people. The provider is registered to provide the regulated activities of personal care, diagnostic and screening and treatment of disease and disorder. On the day of our inspection, people using the service were supported with the regulated activity of personal care and no care requiring registered nursing was provided.

It is a condition of registration with the Care Quality Commission that the service has a registered manager in place and there were two registered managers 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.

All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents. They were confident their concerns would be acted upon by the registered managers.

The service practised safe recruitment to ensure people were cared for by staff who had undergone the necessary checks and had the right values and behaviours to care for people in their own homes

Environmental risks had been assessed to ensure a safe working environment for staff. The service had assessed the risks to people they supported and put in measures to reduce risks to keep people safe.

The service was not meeting its responsibilities under the Mental Capacity Act 2005. No capacity assessments or best interest decisions had been recorded and not all staff understood the principles of the Act although they could describe how they supported people to make decisions.

Staff were not receiving formal ongoing or periodic supervision or regular appraisal of their performance to identify training, learning and development needs and to enable the registered provider to plan training and support the person to develop. Spot checks were regularly undertaken by the team leaders to check staff were competent to provide care to people.

People were cared for by staff who were caring and compassionate and who respected their dignity and privacy.

Care records were person centred and recorded people’s preferences, views and how they wanted their care to be delivered. Daily records contained information on how staff had supported people at each visit.

The service had a complaints policy in place and complaints were handled appropriately to ensure a satisfactory outcome for people using the service. A record was kept of all compliments received and these were shared amongst staff by group text.

Staff spoke highly of the registered managers and the organisation and told us they were supported in their role. They enjoyed their caring role and showed great pride in their work and the feedback they received from the people they cared for.

The registered managers had a clear vision in place for their service. However, they were not meeting their regulatory requirements in regard to the supervision and appraisal of staff, team meetings, and measuring their service against the fundamental standards of care to ensure they were meeting their regulatory requirements.

We found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 17 Good Governance and Regulation 18 Staffing

You can see what action we told the provider to take at the back of the full version of the rep

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 as 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 joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We spoke on the telephone with six people (or their relative) who received a service from this agency, to gain their views about the service.

People we spoke with on the telephone told us they were very happy with the quality of care they received and were treated with dignity and respect. Everyone we spoke with said they had been involved in making decisions about their care and felt able to express their views. People thought they received a service which was personalised and met their individual needs.

We visited four people, in their own homes, who received a service from this agency. They told us they were happy with the service. Comments included, “They show an interest” and “They have never failed me yet.”

As part of our inspection we spoke with one person who used the service, four relatives, four staff members and the two registered managers. These are some of the things people told us:

"I find them fantastic really good."

"Staff are wonderful and are always in a good mood."

"I find working here everything I hoped it would be."

"I love working here the managers are really approachable."

We found care and treatment was planned and delivered in a way that ensured people’s safety and welfare. We saw care plans were person centred and people's wishes were recorded in the care plan.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Appropriate recruitment checks were in place prior to the employment of staff. We found people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People had their comments and complaints listened to and where appropriate action had been taken.