The inspection took place on 9 May 2018. The inspection was announced.

This service is a domiciliary care agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. Not everyone using Agincare UK Medway 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 inspection, although the service supported approximately 250 people in total, only approximately 60 people were receiving personal care in their own homes.

A registered manager was employed at the service by the provider. 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.

At our last inspection on 23 February 2016, the service was rated as ‘Good’. At this inspection, we found that there were now areas that required improvement. This is the first time the service has been rated 'Requires Improvement'.

Individual risks were not always identified in order to ensure measures were in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were highlighted to keep people, staff and others safe from hazards.

Accidents and incidents were recorded by staff but not always followed up by the registered manager to identify themes and ensure appropriate action had been taken and to learn lessons.

Some areas of the management of people’s prescribed medicines needed improvement to ensure people received their medicines in a safe way at all times. Gaps were evident in medicines administration records (MAR). Creams were not always applied as per prescription or with the advice of a healthcare professional. It was not always clear whether staff were expected to sign their name when prompting people with their prescribed medicines.

A safeguarding procedure for staff to follow should they have concerns about people was available to staff. People told us they felt safe and knew who they would talk to if they did not.

The provider and registered manager followed safe recruitment practices to make sure only suitable staff were employed. Enough staff were available to be able to run an effective service and be responsive to people’s needs. Most people told us that staff were on time when visiting and always stayed to support them for the whole time they were allocated. Staff had suitable training at induction when they were new as well as continuing regular updates.

Most staff training was up to date, however, staff did not have their competency checked when administering peoples’ prescribed medicines to ensure they continued to carry out this task safely.

People told us they made their own decisions and choices. The registered manager understood the basic principles of the Mental Capacity Act 2005 and made sure their processes upheld people’s rights.

People were supported with their nutrition and hydration needs where necessary, although many people did not require this assistance. People and their relatives told us they were happy with the support given by staff.

Many people did not require the assistance of staff to take care of their health care needs as they either managed this themselves or had a relative or friend to help. Where assistance was required, people told us staff were observant and willing to help to refer or make appointments with healthcare professionals.

The caring approach of staff was evidenced by people and their relatives making positive comments about the staff who supported them. People told us they had regular staff providing their care and support who had got t

We inspected the service on 23 February 2016. This inspection was announced. We gave short notice of the inspection because the registered manager was often out of the office supporting staff and some of the people using the service were often out at their daily activities. We needed to be sure that they would be available to speak with us. We made telephone calls to people that used the service and staff on the 26 February and 3 March 2016.

Agincare UK Medway is a domiciliary care agency which provides personal care to older people, including people with dementia and physical disabilities. Agincare UK Medway also provides a Medway Carers Respite Service. This is a four hour service, usually once a week that enables the relative of the person needing support to have a period of time for themselves. The agency provides care for people in the Medway area and the office is situated in Chatham. There were over 200 people receiving support to meet their personal care needs on the day we inspected.

The service had a registered manager. 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.

People’s views about the service they received were positive. People told us staff were kind, caring and communicated well with them. Communication between staff within the service was good.

The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the registered manager, or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.

The registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interests if they lacked capacity to make certain decisions about their care.

People were able to express their opinions and views. The field care supervisors involved people in planning their care by assessing their needs on their first visit to the person, and then by asking people if they were happy with the care they received. There was a strong emphasis on person centred care. People were supported to plan their support and they received a service that was based on their personal needs and wishes. The service was flexible and responded positively to changes in people’s needs.

The field care supervisors carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the service and the individual person concerned. People were supported by their family members to discuss their care needs, if this was their choice to do so.

People were supported with meal planning, preparation and eating and drinking. Staff supported people, by contacting the office to alert senior staff of any identified health needs so that their doctor or nurse could be informed.

People were supported and helped to maintain their health and to access health services when they needed them.

There were suitable numbers of staff available to meet people’s needs, and people were informed if their planned care had been allocated to another member of staff.

The service had robust recruitment practices in place. Applicants for post were assessed as suitable for their job roles. All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding people a