This inspection took place on 23 and 24 August 2018 and was announced.

Altogether Care LLP Live in Service – Care at Home is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection they were providing personal care and support to 77 older adults living in the general geographical area of Wareham.

The service supported people who received care from live in carers. Live in carers, lived in people’s home for periods up to nine months at a time. At the time of the inspection there were 20 people receiving this service.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Individual risks to people were not always identified to ensure measures were in place to help keep people safe and prevent harm. There were inconsistencies in how staff reported accidents and incidents. This meant there was a risk that appropriate action would not be taken by the service to, identify themes, learn lessons and prevent future occurrences taking place.

People told us they received their medicines safely. However, management of people's prescribed medicines required improvement to ensure people received their medicines in a safe way. Care plans, Medicines Administration Records (MAR) and daily records showed conflicting information about people's medicines. Systems around auditing records in regards medicines were not being thoroughly undertaken, to ensure any errors or shortfalls were addressed.

People told us they felt consulted in regards choice and decision making. The registered manager told us information had been gathered in regards consent for people who lacked capacity to consent. However, we found these decisions were not documented in peoples’ care records.

There were policies and procedures in place to help keep people safe from abuse. A safeguarding procedure with the information staff would need to follow if they had concerns about people was available, and staff told us they would be confident to raise concerns. People told us they felt safe and knew who they would talk to if they did not.

People told us they had regular staff to support them who were on time, and received a rota in advance which informed them who would be visiting them. They told us staff stayed their allocated time and treated them with dignity and respect.

Care plan records did not always provide the person centred information necessary for staff who did not know a person well to continue to provide the same good quality care as regular staff.

Staff were recruited safely with appropriate pre-employment checks and received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

People were supported by staff who respected their individuality and protected their privacy. Staff understood how to advocate and support people to ensure that their views were heard and told us that they would ensure that people’s religious or other beliefs were supported and protected.

Staff had undertaken training in equality and diversity and understood how to use this learning in practice.

The provider had systems and procedures in place designed to enable them to seek and document people's consent to care. However, although the provider told us best interest decisions had taken place there were no records in place to identify the discussions or outcomes.

People were protected from the spread of infection by staff who understood their role in infection control and used appropriate Personal Protective Equipment (PPE).

Environmental risks inside and outside people's homes were documented to keep pe