This inspection took place on 14 March 2017 and was announced.

Axis Recruitment Limited is registered to provide personal care and support to people living in their own homes. At the time of our inspection one person was using the service.

There was a registered manager in post. A manager is required to register with us by law. 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 (Regulated Activity) Regulations 2014 about how the service is run.

During our last inspection on 19 and 25 May 2016, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; how risks were assessed and managed, the management of people’s medicines, the appropriate application of the Mental Capacity Act 2005, adult safeguarding procedures and staff training, how people’s preferences were assessed and recorded and the systems and processes in place to check on the quality and safety of the service. After the inspection the provider sent us an action plan to tell us what action they would take to meet these breaches in regulation.

During this inspection we checked to see whether improvements had been made. We found these breaches in regulation had been met. Some further improvements were required in some areas and the provider was taking action to address these areas.

Staff had received adult safeguarding training and had detailed information of the action required if they needed to report a safeguarding concern. New documentation had been completed that showed risks associated to people’s needs had been assessed and reviewed.

Sufficient staff were available to provide care and support as required. Safe staff recruitment checks were completed before staff commenced work. Improvements had been made to the management of medicines. However, further improvements were required. This was in reference to staff medicine competency assessments. The process of checking medicines received required two staff signatures but this was not happening.

Staff had received training before they commenced employment; the provider monitored when their refresher training was due and ensured this was completed as required.

New documentation had been complemented that showed consent had been sought about how care and support was provided. A policy and procedure for the Mental Capacity Act 2005 (MCA) had been implemented. Staff were clear about offering choices and respecting people’s wishes. Staff required MCA training, action was being taken to address this.

People were supported by staff to eat and drink, needs and preferences had been assessed and support plans introduced. New documentation had also been introduced that showed health needs had been assessed, planned for and monitored.

Action had been taken by the provider to introduce new support plan documentation that had been completed and reviewed with the involvement of the person using the service and their relative. This provided staff with detailed information of support needs, routines and preferences. A service user guide was available that provided information about what the service provided.

Feedback was received of how staff were kind, caring and respectful. Staff had good knowledge and awareness of individual needs, routines and preferences. Independent advocacy service information was not available but action was being taken to address this.

The provider’s complaint procedure was shared with people. Improvements had been made to the systems in place that monitored quality and safety. Positive feedback about the service was received and staff felt well supported. The provider had met their regulatory requirements.

This inspection took place on 19 May 2016 and was announced.

Axis Recruitment Limited is registered to provide care to people in their own homes. Two people were using this service at the time of our visit.

There was a registered manager in post. A manager is required to register with us by law. 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 (Regulated Activity) Regulations 2014 about how the service is run.

Risks to people using the service were not being identified or managed appropriately. The provider did not have suitable arrangements in place to identify, manage and report incidents of potential abuse. Staff had some level of understanding about safeguarding and their responsibility to ensure people were protected from harm.

Sufficient staff were available to provide care to the people using the service. However, procedures were not followed to ensure staff were recruited safely. Where the service was responsible for people’s medicines, the provider had not carried out competency checks to ensure staff were administering medicines safely. There were no systems in place to review people’s medicine charts. This placed people’s health at risk because there were no checks in place to ensure they were receiving their medicine as prescribed, by their GP.

Staff had received training, but this was in their previous employment. The provider had not completed competency checks to ensure staff had the required knowledge and skills to perform their role. Suitable arrangements were not in place to ensure staff were recruited and supported appropriately. Staff were recruited and received supervision over the telephone. This placed people using the service at risk of receiving poor care, as the fitness and competence of staff had not been thoroughly checked.

People had not given their consent or been involved in making decisions about their care. The provider was not adhering to or following the principles of the Mental Capacity Act 2005. No processes and procedures were in place to ensure people’s consent to care was relevant and appropriately been given.

People were supported by staff to eat and drink, however support plans did not detail how this should be managed by staff. People’s likes, dislikes, preferences, and allergies were not recorded. People were not supported to maintain good health. Information in their support plan was limited or fit for the purpose to ensure they received appropriate support to maintain their health needs.

People’s support plans were not always in place or reflective of their care needs. Although people’s care and support was reviewed people were not involved in decisions or review of their care needs. Information provided to people who use the service was not relevant or suitable for people receiving care and support. People were not always treated with dignity and respect. Care plans did not include people life history, likes and dislikes or preferences. Inappropriate terminology was used in care and support plans.

People did not always receive personalised care. No assessments of care had been completed. We could not identify if people’s views were sort. The processes in place were not sufficient or effective to ensure people needs were responded to. The complaint procedure was shared with people.

There was a lack of robust quality monitoring processes in place to ensure people received high quality care.

Overall, we found significant shortfalls in the care and service provided to people. We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.