The inspection was carried out on 24 July and 02 August 2018, and was announced.

Ash Tree Homecare Ltd is a domiciliary care agency which provides personal care and support for people living in their own homes. The agency provides care for people in the Rochester area of Medway in Kent. The agency provides support for older people, people with dementia, learning disabilities and physical disabilities. Not everyone using the service receives a regulated activity of 'personal care.' CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and administration of medicines. Where they do, we also take into account any wider social care provided. At the time of the inspection, the service was providing personal care to 28 people.

The service was last inspected on 26 September 2017 and had an overall rating of Requires Improvement. At that time, we found one breach of the Regulations. This was because the registered manager failed to deploy suitably qualified, competent and skilled staff to meet people's needs. We also made three recommendations that the registered manager improved their training records to evidence the training staff had undertaken, training on the awareness of Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We also recommended that the registered manager improved the effectiveness of the audit systems.

We asked the registered manager to send us a plan of action which they returned in the agreed timetable, setting out what they would do to meet legal requirements in relation to the breach. The registered manager told us that the breach of regulation would be met by the 03 January 2018. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection on 24 July and 02 August 2018, we found that improvements had been made in some areas. However, the service required further improvement, therefore had not addressed all of the concerns and remained in breach. This is the second consecutive time the service has been rated Requires improvement.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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.

The registered manager had not ensured that all staff had suitable references and satisfactory DBS checks before staff started working alone in the community. This was contrary to the service’s recruitment policy to make sure staff were safe to work with vulnerable adults.

Staff had not received all necessary training to enable them to carry out their duties. Not all staff had been trained in certain specialised training such as diabetes.

People told us they made their own decisions and choices. However, members of staff did not understand the basic principles of the Mental Capacity Act 2005 and had not made sure their actions upheld people’s rights. Staff had not gained people’s consent when taking their photographs.

The quality audit systems was not always effective. The audit system had not identified the concerns we found during this inspection.

The registered manager did not know their responsibilities in relation to reporting safeguarding concerns.

Some areas of the management of people’s prescribed medicines needed improvement to ensure people received their medicines safely at all times.

Staff had built up good relationships with people. Staff were caring and respectful in their approach and had a good rapport with people. However, staff had not always treated people with dignity.

People were asked about their needs relating to culture, race, religion and sexual orientation in the care plan. This was recorded and acted upo

The inspection was carried out on 26 September 2017, and was an announced inspection. The provider was given 48 hours’ notice of the inspection as we needed to be sure that the office was open and staff would be available to speak with us. This was Ash Tree Homecare Ltd.'s first rated inspection.

Ash Tree Homecare Ltd is a small domiciliary care agency which provides personal care and support for people living in their own homes. At the time we visited the agency’s office in Rochester area of Medway for our inspection, the service was providing personal care to 20 people with many varied needs, such as dementia care, medication administration, learning disabilities, physical disabilities, focuses on supporting people to use their local community, take part in social activities and develop independent living skills.

There was a registered manager at the service. The registered manager was also 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 and associated Regulations about how the service is run.

All staff received induction training at start of their employment. However, not all staff had been trained in key areas related to their roles.

The provider needs to improve their training records to evidence the training staff have undertaken. We have made a recommendation about this.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider understood their responsibilities under the Mental Capacity Act 2005. However, not all staff had been trained on the awareness of Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We have made a recommendation about this.

The agency had processes in place to monitor the delivery of the service. However, the audit system had not been effective in some areas because it was not robust. We have made a recommendation about this.

The agency 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. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

The agency provided sufficient numbers of staff to meet people’s needs and provide a flexible service.

The provider 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 agency and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles.

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

People said that they knew they could contact the provider at any time, and they felt confident about raising any concerns or other issues. The provider carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement. This enabled people to get to know the provider.

People spoke positively about the way the agency was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have to