Atlas Care Services Ltd Lincolnshire is a domiciliary care agency registered to provide personal care to people living independently in their own homes. This includes people living in extra care housing. Extra care housing is purpose built or adapted single household accommodation in a shared site or building. The accommodation is rented and is the occupants own home. People’s care and housing are provided under separate contractual agreements. Care Quality Commission (CQC) does not regulate premises used for extra care housing. This inspection looked at people’s personal care and support.

Atlas Care Services Ltd Lincolnshire currently provides personal care to older people, people living with dementia and people with a physical disability. Not everyone using Atlas Care Services Ltd Lincolnshire receives 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.

We carried out a focused inspection of the service in June 2017. At this inspection we found the registered provider had not addressed areas of non-compliance identified at a previous inspection and continued to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). This was because the registered provider had taken insufficient action to improve the organisation of staffing resources and the scheduling of people’s care calls. Shortfalls in organisational governance meant the registered provider was also still failing to effectively monitor the quality of service delivery and to fully assess and mitigate risks to people’s safety. We rated the service as requires improvement and issued two warning notices requiring the registered provider to address the breaches of the regulations.

We inspected Atlas Care Services Ltd Lincolnshire between 10 December 2018 and 4 January 2019. The inspection was announced. On the first day of our inspection 240 people were receiving a personal care service from the registered provider.

At this inspection we found the registered provider had taken sufficient action to meet the requirements of the Warning Notices and were no longer in breach of regulations. This was because they had made improvements to the scheduling of care visits, the organisation of staffing resources and monitoring the quality and effectiveness of service delivery. However, further work was required to fully embed new processes and ensure sustainability. The registered provider acknowledged this and confirmed to us that they would continue to work closely with partner agencies such as service commissioners to achieve this.

A system to manage complaints and concerns was in place and people who used the service were generally satisfied with the way in which their concerns were handled. However, there were on-going concerns regarding the responses from office based staff. The registered provider had identified this and taken action to address the issue.

People had care plans in place which clearly set out their needs and preferences. However, not everyone who had recently transferred from another care provider had their care plans fully reviewed and updated. This meant that staff may not always have up to date information available to provide people’s support. The registered provider had a development plan in place to address this issue.

At the time of this inspection there was a new manager in post. We were aware that they had commenced their application to register with us. People who used the service and staff were positive in their feedback about how the new manager had quickly established themselves into the role. 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 require

Atlas Care Services Ltd Lincolnshire is registered to provide personal care to people living in their own home. Most of the people using the service are over the age of 65 and live in the Holbeach, Spalding and Long Sutton areas of Lincolnshire.

We carried out an announced comprehensive inspection of the service on 12 and 13 September 2016. At this inspection we found four breaches of legal requirements. This was because there were significant shortfalls in the organisation of staffing resources; the monitoring of service quality and the assessment and mitigation of risks to people's safety; the notification of significant incidents and the response to people's concerns and complaints.

Following this inspection, the registered provider (‘the provider’) wrote to us to tell us what they would do to address these breaches. We undertook this focused, follow-up inspection on 1 and 2 June 2017 to check that they had followed their plan and to ascertain that legal requirements were now being met. We also took the opportunity to review medicines management in the service in the light of two recent incidents involving people’s medicines which had been investigated under the local authority’s safeguarding procedures. At the time of our inspection approximately 350 people were receiving a personal care service from the provider

This report only covers our findings in relation to these issues. You can read the report from our previous comprehensive inspection by entering ‘Atlas Care Services Ltd Lincolnshire’ into the search engine on our website at www.cqc.org.uk.

On this inspection we found that the provider had not addressed two of the four breaches of legal requirements we identified in September 2016.

There was a continuing failure to organise staffing resources consistently and effectively to meet people’s needs and expectations. There was also a continuing failure to effectively monitor the quality of service delivery and to fully assess and mitigate risks to people's safety.

We have taken action against the registered provider to ensure that they make the necessary improvements to become compliant with legal requirements. You can see what action we have taken at the end of the full version of this report.

We found that the provider had made changes to the way any concerns and complaints were handled and legal requirements in this area were now met.

We also found that the provider had introduced a new system to ensure CQC was notified of any significant incidents relating to the service and that, as a result, legal requirements in this area were now met.

There were systems in place to ensure people received any medicines they required.

Atlas Care Services Ltd Lincolnshire is registered to provide personal care to people living in their own home. Most of the people using the service are over the age of 65 and live in the Holbeach, Spalding and Long Sutton areas of Lincolnshire. The registered provider set up the service in 2015 to take on a major new contract awarded by Lincolnshire County Council following a reorganisation of homecare services in the county. Under this contract, a large number of people who had previously received care from other agencies started to receive their care from Atlas Care Services Ltd Lincolnshire.

We inspected the service on 12 and 13 September 2016. The inspection was announced. At the time of our inspection approximately 380 people were receiving a personal care service from the provider.

The service did not have a registered manager. The service was being managed by the managing director of the registered provider (“the managing director”) and a recently appointed assistant manager. Shortly before our inspection visit the managing director had applied to CQC to become the registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers (‘the provider’), 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.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff had received training in this area and demonstrated their understanding of how to support people who lacked the capacity to make some decisions for themselves.

During our inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the deployment of staffing, the handling of complaints and concerns and the monitoring of service delivery. We also found a breach of the Care Quality Commission (Registration) Regulations 2009. This was because the provider had failed to notify us of significant incidents relating to the service.

You can see what action we told the registered person to take in respect of these four issues at the end of the full version of this report.

We also identified the need for improvements in staff training to ensure people who used the service, and staff from other agencies, had full confidence in the ability of staff to support people safely and effectively.

In other areas, the provider was meeting people’s needs.

Staff had warm relationships with people they supported and cared for them in a kind and person-centred way. Staff knew people as individuals and supported them to have as much choice and control over their lives as possible. People were treated with dignity and respect.

People’s care plans were very detailed and were understood and followed by staff. The provider had systems in place to ensure people’s plans were reviewed and updated on a regular basis.

People were supported to eat and drink whenever this was required. Staff also assisted people to access local health and social care services if they needed specialist advice or treatment. Staff supported people to take their medicines in accordance with the guidance set out in their care plan.

Staff worked together in a friendly and supportive way and were provided with regular supervision, including direct observation of their care practice. Senior staff demonstrated a supportive and non-hierarchical style of leadership which was appreciated by staff at all levels in the service.