The inspection was announced and took place on the 19, 20 and 21 March 2018.

Brooks Care and Nursing Services Limited is a domiciliary care agency registered to provide personal care for adults living in their own homes. At the time of our inspection care was being provided to 111 people. The service does not provide nursing care. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing].

At our previous inspection in June 2017 we found the service was in breach of Regulations 12, 16, 17.18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we rated the service inadequate and placed them into special measures. Following the last inspection, we met with the provider to ask the provider to complete an action plan to show what they would do and by when to improve the key questions; Safe, Effective, Caring, Responsive and Well Led to at least Good. At this inspection we found improvements had been made and the service was no longer in breach of the regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall in any of the key questions. Therefore, this service is now out of Special Measures.

Two registered managers were in post who were also the owners of the business. 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. People were supported to take their medication by staff trained to support them.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005. 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 support this practice.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals.

Staff were well trained and attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

The service was responsive to people’s needs. People knew how to make a complaint should they need to. When needed people were provided with the appropriate care and support at the end of their life.

The registered managers had a number of ways of gathering people’s views, staff held regular meetings with people and their relatives and used questionnaires to gain feedback. The registered managers carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

Brooks Care and Nursing Services Limited is a domiciliary care agency registered to provide personal care for adults living in their own homes. At the time of our inspection care was being provided to 131 people. The service does not provide nursing care.

At our last inspection in January 2017 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Regulation 9 Person Centred Care, Regulation 11 Need for Consent, Regulation 12 Safe Care and Treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation16 Receiving and acting on complaints, Regulation17 Good Governance and Regulation 18 Staffing. We also issued the registered provider with a warning notice in relation to Regulation 17. Following the inspection the provider wrote to us to tell us the action they would be taking to ensure they met all the relevant Regulations.

We undertook this announced inspection on the 1, 7 and 12 June 2017 to check that the registered provider had followed their action plan to meet the breaches of regulations. We found that the registered provider had addressed some of the concerns that we had identified at our previous inspection however, there were still areas which required further improvement which the registered provider was working towards.

Two registered managers were in post who were also the owners of the business. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to being the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of this registration.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or t varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. The Care Quality Commission is no considering the appropriate regulatory response to resolve the problems we found during our inspection.

We found that the registered provider had made improvements in their auditing processes since our last inspection. However these had not highlighted the areas we identified during our inspection. There was not always sufficient numbers of care workers deployed to meet people’s needs in line with their preferences and/or commissioned care packages. Some people also experienced late or missed calls. Recruitment procedures were not thorough to ensure people were suitable to work with vu

The inspection was completed on the 10, 11, 16, 18, 19 and 24 January 2017.

Brooks Care and Nursing Services Limited is a domiciliary care agency registered to provide personal care for adults living in their own homes. At the time of our inspection care was being provided to 158 people. The service does not provide nursing care.

Two registered managers were in post who were also the owners of the business. 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.

During our inspection we identified a number of concerns about the care, safety and welfare of people who used the service. The quality assurance processes in place at the service were not robust enough to assess, monitor and mitigate the risks relating to the health and welfare of people using the service and to drive service improvement. We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of this report.

The service did not always have sufficient numbers of care workers who were effectively deployed to meet people’s needs. Care workers were not allocated travel time between call visits and told us they often had to pick up additional call visits. The service had no systems in place to robustly monitor late and missed call visits.

Care workers understood the risks and signs of potential abuse and the relevant safeguarding processes to follow, however the service did not keep succinct records of safeguarding allegations, accidents and incidents and had no structured procedure in place to analyse these. Also, the service had not submitted notifications relating to allegations of abuse to the Care Quality Commission in line with Regulations. Improvements were required to safely assist people with the management of their medicines and ensure people received their medication as prescribed.

Improvements were required to ensure care workers received regular structured supervision and training to enable them to keep their skills up to date to meet people's needs effectively. Most of the care workers we spoke with had limited knowledge of the Mental Capacity Act 2005 (MCA) and the service had not adhered to the principles of the MCA. People’s nutritional needs were not always met as, although feedback from people was generally positive, we found care plans contained limited information on people’s dietary and nutritional needs and associated risks. Where required people were supported to access healthcare professionals.

Although most people told us that care workers were kind and caring and that they were treated with dignity and respect, some people and their relatives said that care workers did not always know their needs and preferences for how their care and support should be delivered. Improvements were required to ensure care plans contained sufficient information and guidance to ensure that care was provided appropriately by care workers in line with people’s individual needs and that risks relating to people’s health, safety and welfare were mitigated.

There were processes in place to seek the views of people who used the service and those acting on their behalf but it was unclear how this feedback was used effectively to improve the quality of the service. Improvements were required to ensure people’s concerns and complaints were acted upon.