About the service: At Home-Specialists in Care Ltd is a domiciliary care service that was providing personal care to 72 people; mainly older people, but also to younger adults, people with a learning disability or autistic spectrum disorder, people with physical disabilities, mental health, sensory impairment and people living with dementia.

People's experience of using this service: People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

People received safe care and support because systems and processes in place ensured any risks were safely managed by staff, and their needs met with minimal restrictions in place.

Staff understood the importance of providing person-centred care and had developed positive relationships with people.

Staff were recruited into their role with appropriate checks in place before they commenced independent duties with people in their own homes.

Staff had received training and clear guidance was followed to help people to understand how to remain safe from avoidable harm and abuse.

People received help with their medicines as assessed. Records confirmed people had received their medicines as prescribed.

People were involved in their care planning. Records were person-centred and regularly reviewed.

Staff received appropriate induction, training, and support and applied learning effectively in line with best practice. This led to good outcomes for people and supported a good quality of life.

Staff were friendly and polite. Staff took time to get to know people. They had a clear understanding of, and how to support, people's individual and diverse needs.

People and their relatives told us they were confident if they had any complaints the registered manager would address them appropriately.

Everybody spoke positively about the staff and management of the organisation. The manager was responsive to any concerns we raised; implementing immediate corrective actions. They were clearly passionate about providing people with care and support that improved their lives and helped them to remain in their own homes.

The provider had good relationships with people, other organisations and used feedback to help drive improvements.

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Rating at last inspection: Requires improvement. (The last report was published on 10 May 2018.)

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At Home–Specialists in Care Ltd are a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older people, younger adults, people with a learning disability or autistic spectrum disorder, people with physical disabilities and people living with dementia. Our inspection took place on 16 and 19 March 2018 and was announced. At the time of our visit the service provided care to 38 people.

At the time of our inspection there was a registered manager at the service. A registered manager is a person who is registered with the Care Quality Commission 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 2008 and associated regulations about how the service is run.

At the last inspection on 12 November 2015 and 15 January 2016 we found that care and treatment was not provided in a safe way. This related to training for staff on medication administration. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities). We also found that checks were not in place to ensure fit and proper persons were being employed. This related to staff starting work unsupervised before all checks were in place. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities).

During this inspection we reviewed actions the provider told us they had taken to become compliant with the breaches identified at the last inspection. We looked to see if improvements had been made in respect of the breaches. We found the breach of Regulation 12 had been fully met but the breach of Regulation 19 had not. We also found a breach of Regulation 17 in relation to good governance.

This is the second consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

Recruitment checks needed to be more robust to ensure the safe recruitment of staff before they worked independently in people’s homes.

The registered manager had not informed CQC and the local safeguarding authority of all significant events as required by regulation. We have written to the provider about this.

Care records for people had not been accurately maintained and some were incomplete. We have made a recommendation about care plan reviews.

There was a positive culture within the service; people were treated with dignity and respect. People received person centred care.

People were supported to make their own decisions; this was encouraged and reflected in their care plans. Care plans demonstrated that the principles of the Mental Capacity Act (MCA) 2005 had been applied.

Staff had access to an induction period and on-going training. The management carried out competency checks and spot checks to ensure staff were competent in the role they were carrying out.

Staff understood what action to take to safeguard people from abuse.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. The management completed investigations into incidents and accidents. However the registered manager recognised the need for a more robust system of recognising and recording of accidents, incidents and complaints.

People were protected from the risks of infection through the provision of personal protective equipment.

People’s nutritional and hydration needs were catered for. Staff supported people with their choice of meals.

We found the management and administration of people's medicines were safe. Recent improvements had been made to help reduce the risk of any medication errors.

There were quality audits in place completed by the care coordinator and the registered manager. However, checks in relation to care planning and recruitment needed to be more

The first day of the inspection took place on 12 November 2015 and was announced; we carried out a second day of inspection which was unannounced on 15 January 2016 after receiving information of concern in relation to medicines and recruitment. This was the first inspection since the location had been registered as a domiciliary care provider in February 2015.

At Home Specialists in Care is registered to provide personal care for people in their own homes. The agency also provides other support such as administering medicines, meal preparation, overnight calls and social support. On the first day of the inspection 27 people were receiving a service from the agency. The main agency office is located in the market town of Pocklington in the East Riding of Yorkshire. Staff provide a service to people that live in Pocklington and the surrounding areas of Driffield and Market Weighton, also in the East Riding of Yorkshire.

The registered provider is required to have a registered manager in post and during the inspection there was a 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they received the support they required from staff and they expressed satisfaction with the assistance they received with meal preparation and the administration of medicines. However, we found that not all staff were appropriately trained in medicine administration before they began supporting people who used the agency with medicines. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

We found that all current staff had been appropriately checked and employed following the agency’s recruitment and selection procedures. However, we found that a single individual (who no longer worked for the agency) had supported people in their own homes without having first had all appropriate checks in place. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Fit and proper persons employed.

The registered manager of the agency was able to show they had an understanding the Mental Capacity Act (2005) and care plans and consent were in place which showed us that people who used the agency were offered choice and decisions about their care.

People told us that they felt safe whilst they were receiving a service from staff working for At Home Specialists in Care. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns.

Staff confirmed that they received induction training and regular supervision and we saw records to support this. They were happy with the training and support provided for them. Some staff had also achieved a National Vocational Qualification (NVQ) in health and social care.

We found that people were cared for and supported by kind and caring staff who respected people’s privacy and dignity. Person-centred care plans were in place to instruct staff on how best to support people and meet their needs. These were clearly written.

People told us they were confident that if they expressed concerns or complaints they would be dealt with appropriately by the agency.

There were opportunities for people who used the service and staff to express their views about the service that was provided by the agency.

You can see what action we told the provider to take at the back of the full version of the report.