We carried out this announced inspection between the 12 March 2018 and the 9 April 2018. The provider was given short notice of our intention to inspect the service. This is in accordance with the Care Quality Commission’s [CQC} current procedures for inspecting domiciliary care services.

Bronte Care Services is a community based domiciliary care service which provides personal care and support to adults and children living in their own homes. The service is operated from offices in Bingley, West Yorkshire and supports people in Bingley, Keighley and surrounding areas. At the time of the inspection 85 people were using the service.

Our last inspection took place on 11 and 12 July 2017 and at that time we found the service was not meeting three of the regulations we looked at. These related to person centred care, safe care and treatment and good governance.

On this inspection we found the registered provider had carried out a full audit of the policies, procedures and systems and improvements had been made in some areas of service delivery. However, we found improvements were required to ensure people who used the service received safe, effective and responsive care and support.

For example, we found the audit system had not identified that at times staff were not always arriving on time or staying the correct length when visiting people or that travelling time was not routinely being taken in to account when completing staff rotas.

In addition, whilst most people who used the service were complementary about the care staff providing their care and support, some were critical of the management of the service and thought there was a lack of communication and accountability.

There were sufficient number of staff employed for operational purposes although people had mixed views about the way they were deployed. There was a staff recruitment process in place to ensure only people suitable to work in the caring profession were employed. However, the registered provider did not always ensure references were taken from the applicant’s last employer.

Training records showed staff received training in a range of topics relevant to their roles. However, they did not distinguish between whether staff had attended practical and theoretical moving and handling training. This meant we could not be sure all staff had been trained to use equipment such as hoists and slide sheets correctly.

Staff were able to describe how individual people preferred their care and support delivered and the importance of treating people and their property with respect.

Records showed, if required, people were assisted to access other healthcare professionals and their medicines were administered as prescribed.

Where risks to people’s health, safety and welfare had been identified appropriate risk assessments were in place which showed what action had been taken to mitigate the risk. If people required staff to assist or support them to prepare food and drink information was present within their support plan and staff told us they encouraged people to eat a healthy diet.

The support plans we looked at provided sufficient information to enable staff to provide the care and support people required and were reviewed on a regular basis to make sure they provided accurate and up to date information. The staff we spoke with told us they used the support plans as working documents and they provided sufficient information to enable them to carry out their role effectively and in people's best interest. However, some people who used the service told us they had not been involved in reviewing their support plan.

The registered provider demonstrated a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and staff demonstrated good knowledge of the people they supported and their capacity to make decisions.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or s

Our inspection took place on 11 and 12 July 2017 and was announced. This meant we gave the service a short amount of notice of our visit to ensure a manager would be present in the office. This was the first inspection of the service since they became a newly registered service due to a change of registration in June 2016.

Bronte Care Service provides personal care to people in their own homes in Bingley and the surrounding areas. At the time of the inspection there were 95 people using the service.

The registered provider is a single provider and therefore manages the service on a daily basis. 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.

Medicines were not managed safely. We found a number of discrepancies where we could not confirm whether people had received their medicines as prescribed. Where medicines had been left out for people to take later, this had not been recorded in a clear way.

We saw a high number of missed calls. This indicated people who used the service had been put at risk of harm from these missed calls. People told us they were not happy with the service due to the lack of continuity with their care workers; in that care workers were often changed and the service did not let them know about these changes. Staff told us they did not have travel time so they were always running late. People told us and we saw a record of a number of late or short calls which meant people’s individual needs were not met.

People told us they felt safe receiving care and support from the service; however, we found risk factors were not well documented. Risks associated with people’s care and support were not always consistently documented and was not used to produce meaningful guidance to staff to help minimise those risks.

People told us staff were generally kind to them and treated them with dignity and respect. They said staff were well trained to carry out their role. People were supported by staff who had received induction training which included shadowing more experienced staff. We looked at the provider’s training matrix. This is a document which lists training staff have received and the dates completed. This showed staff received training in a number of subjects.

We saw recruitment was safely managed to ensure staff were suitable to work with vulnerable adults. However, we found staff did not always receive regular supervision and annual appraisals.

The provider told us there were sufficient staff employed to enable the service to provide care and support to people. However, we found rota’s had no travel time and calls were unreliable. Staff were not always deployed in the right places at the right time.

Staff told us the provider conducted regular unannounced spot checks to make sure they were doing things correctly. They said they came unannounced and checked their working practices such as how they speak to people, how they completed care plans and whether they moved people safely. However, we found some staff members had not had a spot check for several months.

Staff told us that care plans were usually kept up to date but said if there was a change to people’s needs it would sometimes take weeks for the care plan to be updated. One staff member told us, “Office staff should improve communication, such as letting carers know about changes more promptly.”

People told us they were happy with the support they received to have a healthy diet. Staff were able to recognise and report when people’s healthcare needs changed.

The service had systems in place to deal with concerns and complaints. However, some people told us complaints had not been appropriately managed and complaints had not been consistently recorded.

We did not find adequately robust governance systems in place. Audits were not comprehensive or meaningful and the service did not always respond to concerns raise