This inspection took place on 13 February 2019 and was announced. We gave the provider 48 hours’ notice of the inspection as we needed to be sure the registered manager would be available at the registered office.

About the service:

Alma Care (UK) is a domiciliary care agency that provides personal care and support to people living in their own homes. Not everyone using Alma Care (UK) receives the 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 our inspection visit there were 11 people using the service. The service had a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Rating at last inspection:

At our previous inspection in June 2018, the overall rating for this service was 'Requires improvement'. However, we placed the service in 'special measures' because the service had been rated as 'Inadequate' in a key question over two consecutive comprehensive inspections. We found several issues which indicated a continued lack of good governance including a lack of effective systems to assess and monitor the quality of care people received.

Following that inspection we met with the provider to discuss our concerns. The provider sent us regular action plans stating how they were making the required improvements and the date by which these actions would be completed.

Why we inspected:

We scheduled this inspection based on the previous rating; as well as to check the provider had completed the actions set out in their action plans and made the required improvements. During this inspection we found the provider was meeting the regulations. The overall rating for the service is now “Good”.

People’s experience of using this service:

People felt safe receiving support from Alma Care staff because they were usually supported by the same staff who arrived for planned visits when expected and knew what to do once they arrived. Staff were caring and treated people with respect. They supported people in a way which maintained their independence.

People received their medicines safely and as prescribed. People were protected from the risk of infection because staff followed the provider’s infection control policies and procedures.

Appropriate checks were carried out on staff before they began to work alone with people. Staff received relevant training, supervision and performance reviews which helped them to provide safe and effective care.

The provider conducted risk assessments to help make sure care was provided safely to people; and to protect people from abuse and foreseeable harm. Staff understood the importance of reporting accidents and incidents. The provider learned from accidents and incidents; and used this learning to improve the service. Staff knew how to recognise abuse and report any concerns about people’s safety.

The provider gave people regular opportunities to provide feedback on the quality of care they received. The feedback received by us and the provider was that people were satisfied with the quality of care they received.

Following our previous inspection, the provider took prompt action to improve the systems to assess and monitor the quality of the service. During this inspection we found that these systems were consistently used by the provider and were operating effectively.

Follow up:

We will continue to monitor this service and plan to inspect in line with our re-inspection for services rated "Good".

This inspection took place 6 June 2018 and was announced. We gave the registered manager 48 hours’ notice of the inspection visit because the service is small and we needed to be sure the registered manager would be available.

At our last announced comprehensive inspection of this service in October 2017 we rated the service ‘Requires Improvement’ overall because we found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to safe care and treatment, safeguarding, consent, person-centred care, good governance and submitting notifications to the Care Quality Commission (CQC). The provider sent us an action plan setting out when the required improvements would be made. Some of these actions have been completed.

We found breaches of the regulations relating to safe care and treatment, fit and proper person’s being employed, the provider's failure to submit statutory notifications and good governance. The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Alma Care (UK) is a domiciliary care agency that provides personal care and support to people living in their own homes, many of whom were older people. Not everyone using Alma Care (UK) receives the 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. Most people using the service lived in Surrey.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The registered manager told us there were nine people receiving the regulated activity (personal care) from Alma Care (UK) at the time of our inspection. After speaking to Alma Care (UK) staff and representatives of Surrey County Council, it appeared that Alma Care (UK) were providing the regulated activity to at least 13 people. As there was a discrepancy in the number of people the registered manager told us was using the service, on five occasions after the inspection we asked the registered manager to confirm the number of people using the service. These requests were responded to promptly but on each occasion the information supplied was incorrect. We have sent the provider a requirement letter. This means the provider is required under Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 provide us with information we have requested relating to the safety of people using the service.

At our previous inspection we found the provider did not always assess risks to people to ensure robust management plans were in place to reduce the risks. At this inspection, the provider had improved the assessment process so that people had personalised risk assessments and risk management plans in place. This included risks relating to people’s health needs.

The provider did not always manage people’s medicines safely. The provider did not know the number of people that staff were supporting with their medicines. In addition, the systems in place in relation to medicine administration were not sufficiently robust to help ensure people received their medicines safely.

Staff had received training in how to recognise and report abuse. They knew how to report any concerns and were confident that any allegations made w

This inspection took place on 16 October 2017 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

At our last announced comprehensive inspection of this service on 31 July 2015 we rated the service ‘Good’ overall and found the service was meeting the fundamental standards.

Alma Care (UK) is a domiciliary care agency that provides personal care and support to people living in their own homes, many of whom were older people. There were six people receiving services from Alma Care (UK) at the time of our inspection. Most people using the service lived in Surrey.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider did not always assess risks to people to ensure robust management plans were in place to reduce the risks. This included risks relating to people’s health needs.

The provider did not always manage people’s medicines safely. The provider did not provide us with all records relating to medicines management we requested. In addition, medicines records the provider shared with us for one person indicated staff recorded medicines administration poorly which meant people were at risk due to poor medicines practices.

The provider did not always provide care in line with the Mental Capacity Act (MCA) 2005. This was because the provider did not investigate whether family members had legal capacity to consent on behalf of people. In addition the provider did not carry out mental capacity assessments when necessary and did not follow procedures to make decisions in people’s best interests when people were found to lack capacity. The provider did provide training to staff to help them understand their responsibilities in relation to the MCA.

The provider did not always involve people in developing and reviewing their care. In addition, the provider did not ensure people’s care plans were detailed and contained information about the person’s background, people who were important to them, how they would like to receive their care and what mattered to them in relation to their care.

People were not always safeguarded from abuse and neglect because the provider had not made the necessary improvements to protect people after two safeguarding allegations relating to missed calls and lateness were upheld against the provider. The provider did not always deploy sufficient staff to support people safely.

The provider did not have effective systems in place to monitor, assess and improve the service. This was because the provider had not identified the issues we found during our inspection and there were no systems in place to monitor medicines management. In addition, the provider did not always seek feedback, or record people’s feedback as a way of improving the service.

The provider had not notified CQC of allegations of abuse made in relation to people using the service.

The provider continued to support staff with suitable induction, supervision and appraisal. The training offered to staff was suitable except for the lack of MCA training.

People received the support they needed in relation to eating and drinking and the provider supported people in relation to their healthcare needs.

One person was not satisfied with the way staff cared for them in relation to maintaining their dignity, although other people and relatives were satisfied in respect of this. The provider did not always treat people with respect by informing them when staff would arrive late to care for them. Otherwise the service was car

This was an announced inspection that took place on 31 July 2015.

The agency provides short term domiciliary re-enablement care, longer term, crisis intervention and live in care. Re-enablement is the process whereby people are supported to regain the skills to live independently.

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 and associated Regulations about how the service is run.

At the last inspection in May 2013, our inspection found that the service met the regulations we inspected against. At this inspection the home met the regulations.

People told us they were very happy with the service provided. The designated tasks were carried out to their satisfaction, they felt safe and the staff team and organisation really cared. They thought the service provided was safe, effective, caring, responsive and well led.

The records were kept up to date and covered all aspects of the care and support people received, their choices and identified and met their needs. They contained clearly recorded, fully completed, and regularly reviewed information that enabled staff to perform their duties well.

The staff we spoke with where knowledgeable about the people they supported, the way they liked to be supported and worked well as a team. They had appropriate skills and provided care and support in a professional, friendly and supportive way that was focussed on the individual. They were well trained, knowledgeable, professional and accessible to people using the service and their relatives. Staff said the organisation was a good one to work for and they enjoyed their work. They had access to good training, support and there were opportunities for career advancement.

People and their relatives were encouraged to discuss health and other needs with staff and had agreed information passed on to GP’s and other community based health professionals, as required. People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. People were positive about the choice and quality of the service provided. They also said the management team and organisation were approachable, responsive, encouraged feedback from them and consistently monitored and assessed the quality of the service provided.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to three relatives of people using the service. One relative said “The care feels very personal and staff are always available and accommodating” and “As a family we are very happy and have no complaints.” Another relative spoke positively about staff. They said staff were “happy, friendly and very kind”. We spoke with a commissioner from a local authority who told us they had not received any complaints about the service.

We also gathered evidence of people’s experiences of the service by reviewing completed satisfaction surveys. We saw the majority of people that responded were positive about the care received by the service.

We looked at the plans in place to provide care and support to people using the service. There were instructions and guidance for staff about how to meet people’s care and support needs. Staff were also given guidance about what they should do to protect people who may be at risk of abuse, harm or neglect.

There were effective procedures in place to recruit and appoint staff and appropriate checks were made about staff’s suitability to work for the service. People's views and suggestions were used to make changes and improvements that people wanted.