The inspection took place on 15 and 20 March 2018 and was announced. The previous inspection took place on 31 October and 2 November 2016 and we had rated the service as requires improvement. At this inspection we found a good quality service that had delivered on assurances made to improve the safety and well led sections in the last report.

Ann Mason Care is a domiciliary care agency, which provides personal care and support to people in their homes. People receive a range of different support in their own homes, from daily visits, to live-in care. At the time of inspection there were 51 people receiving a service. The locations covered for daily visits included south Suffolk and North Essex. Including but not limited to Maningtree, Colchester central, Stoke by Nayland, Dedham and East Bergholt. The live in care was provided to people mainly in Suffolk and Essex, but also other nearby counties including Wiltshire.

There was a clear management structure in place. As a registered person, the provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were systems in place to monitor the quality of the service and a computer system was able to monitor and run reports to ensure that systems ran smoothly. People’s views were sought and acted upon. Staff felt supported and the provider promoted an open culture which welcomed constructive criticism. Feedback about this service from people and staff was highly positive. Both parties felt supported by an organisation that promoted good values of care.

People were supported by staff to stay safe in their homes. Recruitment was robust and safe. Staff assisted people to take their medicines as prescribed. Checks helped ensure people were receiving the medicines they needed. Risk assessments ensured staff were aware of how to support people to remain safe in their homes. There were sufficient staff to meet people’s needs and to manage risk safely.

Staff were well supported and spoke highly of the service and the manager. Training ensured staff developed the necessary skills meet people’s specific needs. People were given choices about the care they received. Where people did not have capacity there was understanding of how to make decisions which were in their best interest. People were supported to consume food and drink of their choice. Staff worked well with health care professionals to help people to maintain good health.

Staff knew people well and developed positive relationships with them and their families. Staff treated people with respect and dignity. Care plans were in place which outlined people’s needs and there were systems to ensure people’s needs were reviewed as required. People received a detailed response when they made a complaint and their concerns were dealt with effectively.

The inspection took place on 31 October and 2 November 2016 and was announced.

Ann Mason Care is a domiciliary care agency, which provides personal care and support to people in their homes. People receive a range of different support in their own homes, from daily visits, to live-in care. At the time of inspection there were 36 people receiving visits in their home and 8 people had a live-in carer. The service does not provide nursing care.

The provider had appointed a general manager to manager the service on a day-to-day-basis. As a registered person, the provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

When we inspected in 13 and 14 June 2016 we had a number of concerns relating the lack of oversight by the manager which meant people were not assured of a consistently good service. Following our visit, the manager had worked enthusiastically to drive through improvements and they were able to demonstrate they had a better understanding of the support people received.

There were new systems in place to monitor the quality of the service and a new computer system had been purchased which was intended to address many of the concerns we had raised. A significant number of changes had been introduced over a relatively short period of time. As a result, additional time was needed for these to become fully embedded and for the manager to be able to demonstrate that improvements were sustainable.

People were supported by staff to stay safe in their homes. Improvements had been made to the checks carried out on new staff to ensure recruitment was robust and safe. Staff assisted people to take their medicines as prescribed. Improved checks helped ensure people were receiving the medicines they needed. The manager had revised risk assessments to ensure they were aware of how to support people to remain safe in their homes. There were sufficient staff to meet people’s needs and to manage risk safely.

Staff were well supported and spoke highly of the manager. Training had been improved to ensure staff developed the necessary skills meet people’s specific needs. The manager had worked with staff to increase their knowledge of the Mental Capacity Act. People were given choices about the care they received. Where people did not have capacity there was an improved understanding of how to make decisions which were in their best interest. People were supported to consume food and drink of their choice. Staff worked well with health care professionals to help people to maintain good health.

Staff knew people well and developed positive relationships with them and their families. Staff treated people with respect and dignity. Care plans were in place which outlined people’s needs and there was in improved system to ensure people’s needs were reviewed as required. People received a detailed response when they made a complaint and their concerns were dealt with effectively. The manager had introduced measures to monitor the complaints they received.

Ann Mason Care is a domiciliary care agency, which provides personal care and support to people in their homes. People received a range of different support in their own homes, from daily visits, to a 24-hour live in care service. At the time of inspection there were 46 people using the service.

There is a Registered Manager at this location. 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.

During the inspection, we identified a number of concerns about the care, safety, and welfare of people who received care from the provider. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ Services in special measures will be kept under review. If we have not taken immediate action to propose to cancel the provider’s registration of the service, they will be inspected again within six months. You can see what action we told the provider to take at the back of the full version of the report. The expectation is that providers found to be providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the inspection, we found, the provider did not have a robust selection and recruitment process and had employed care staff without obtaining all of the relevant information to make sure they were suitable to provide care and support to vulnerable people.

Some staff reported that training offered to new care workers was not effective. There were ineffective systems in place to ensure that staff were provided with training. Some staff had identified they needed additional support. Staff were not supported and did not have access to regular supervision or an appraisal.

We found the provider had not ensured people were safe because they had not always provided care and support in accordance with people’s individual care plans. We found that the provider had not ensured that people had been protected from the risks of unsafe care because people’s needs had not been appropriately assessed and reviewed. Care plans did not contain enough detail to enable staff to meet the individual needs and preferences of people. The provider had not identified that some people’s care plans were not accurate in all areas and did not ensure all relevant risks were identified. Where risks were documented, some people’s care plan