The inspection visit took place on 28 November 2016 and was announced. We gave the provider 48 hours’ notice because the service is a small home care agency and the registered manager is often out of the office supporting staff or providing care. We needed to be sure they would be in.

At our last inspection on 16 March 2015, we asked the provider to take action to make improvements to their procedures for monitoring and improving the service. This action has been completed.

BM Care Management Solutions is a home care agency based in Earl Shilton in Leicestershire. It supports people who live in their own homes. At the time of our inspection six people used the service.

The service had a registered manager. 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.

People who used the service were safe. They told us they felt comfortable with and trusted the care workers who supported them. Staff were recruited under procedures that ensured only people suited to work at the service were employed. Staff understood and applied their responsibilities for protecting people from abuse and avoidable harm. They advised people about how to keep safe in their homes.

People’s care plans included risk assessments of activities associated with their personal care routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting their independence.

Enough suitably skilled and knowledgeable care workers were deployed to meet the needs of the people using the service. Care workers regularly supported the same people and therefore understood their needs.

People were supported to take their medicines at the right times by staff that were trained in medicines management.

Care workers were supported through supervision and training. People who used the service told us told us they felt staff were well trained and competent.

The registered manager understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff had awareness of the MCA and understood they could provide care and support only if a person consented to it and if the proper safeguards were put in place to protect their rights.

Staff supported people to have meals. They also supported people to access health services when they needed them.

People were involved in decisions about their care and support. They received the information they needed about the service and about how the service could support them.

People told us they were treated with dignity and respect. The registered manager actively promoted values of compassion and kindness in the service and care workers shared those values.

People contributed to the assessment of their needs and to reviews of their care plans. Their care plans were centred on their individual needs. People knew how to raise concerns if they felt they had to and they were confident they would be taken seriously by the provider. When people expressed preferences about their care and support these were acted upon by the service.

The provider had effective arrangements for monitoring the quality of the service. These arrangements included asking for people’s feedback about the service and a range of checks and audits. The quality assurance procedures were used to identify and implement improvements to people’s experience of the service.

The inspection took place on 16 March 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

The service provides care and support to people with needs associated with age, dementia, learning disabilities, physical disabilities or mental health living in the own homes in the community. At the time of our inspection the service was providing care and support to 38 people.

The service had a registered manager. 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.

People felt safe when they were being supported by care staff and staff had a good understanding of the various types of abuse and their roles and responsibilities in reporting any safeguarding concerns.

When people first started using the service a member of the management team visited them and discussed their requirements and needs. This information was then developed into a plan of care and other documentation such as risk assessments were completed. However, there were inconsistencies in the documentation that people and staff had access to relating to their care and they had not always been updated to reflect any changes that had occurred.

Staff had been through a recruitment and selection process before they started work but they had not always received adequate training to enable them to carry out their roles.

There was not an effective system in place of allocating and amending staff rotas and care calls and staff’s planned visits were frequently changed. People did not always receive their care calls at the times that had been agreed with them and they did not have regular staff to provide their care.

People that used the service and staff both told us that the registered manager was very approachable. However, they did not feel assured that any concerns they raised would always be acted on or if they were acted on they could not be sure of the amount of time for which they would then be sustained.

There was no system in place to identify if people had received their care calls. There was a risk that people were being left without sufficient care to meet their needs. There was not an effective system in place to assess, monitor and improve the quality of the service.

The provider could not be assured that people had all received their medicines as prescribed by their doctor. There were a number of gaps in Medication Administration Record (MAR) charts that they could not account for. There was a risk that people may not be receiving their medicines as they required as there was no system in place to identify any errors and put them right.

People’s needs were not always consistently recorded which meant there was a risk that people may not have been receiving the care they required. There was no system in place that identified the inconsistencies in the records and addressed the concerns.

The registered manager had failed to act effectively on concerns raised by people and respond to their requests to have consistent staff.

During this inspection we identified a breach of Regulation 10 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which following the legislative changes of 1st April 2015 corresponds to regulation 17 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 the report.