Cambridge Care Company Haverhill is a domiciliary care agency. It provides personal care to people living in their own homes. In addition, it supplies staff to two supported living services for people with a learning disability. It provides a service to adults. At the time of this inspection of 11 June 2018 the agency supported approximately 60 people. The inspection was unannounced.

The last comprehensive inspection was between 7 March 2017 and 28 April 2017 and the service was rated requires improvement. At our last responsive inspection of 2 October 2017, the service was rated Requires Improvement overall. We rated ‘Safe’ Inadequate and there were breaches of regulations in staffing, protecting people from abuse and improper treatment and safe care and treatment. After the inspection the provider wrote to us to tell us what actions they would take to meet the breaches in regulations. At this inspection we have found improvements, but still found them rated as Requires Improvement.

A registered manager was not in post, despite the registered provider giving an undertaking to register a manger when we met with them in December 2017. We had met to discuss our findings and agree a way forward. 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.

We were aware that since our inspection visit and the publication of this report a number of staff have resigned. Concerns have come to light about the ongoing consistency of care and support to people in their own homes. We are assured that the local authority has taken steps to make sure people are safe. The local authority had suspended their contract with this agency. We will continue to monitor developments and inspect further when needed.

At the time of our visit we had found a manager that had made improvements and changes to progress this agency. The manager was keen to listen to feedback and take action on points we raised. For example, risk assessments relating to people at risk when smoking.

Medicine management had improved. People had sufficient medicines ordered to meet their needs and stock was monitored. Some people’s records were not consistent and some antibiotics where not consistently and timely administered.

People told us that they were satisfied with the care and support they receive from staff and found them caring. People told us that staff arrived usually when expected and were rarely let down. If this did happen they were informed by telephone. People told us that they had no need to complain, but felt the manager would listen and resolve if they need to raise issues.

Peoples views were sought and care plans were kept under review. People were supported to access healthcare and were supported, if needed, to eat a balanced diet. Staff told us they were well supported and given the training they needed. Unannounced spot checks wee carried out to ensure care was of good standard and as agreed.

Recent developments at the agency included making links with the local community including a local care home where the agency led a sing-a-long. Another new initiative was on line care plans that staff accessed from their telephone. This was still very new and needed time to imbed to assess the effectiveness of replacing paper records.

Further information is in the detailed findings below.

We carried out an announced comprehensive inspection of this service between 7 March 2017 and 28 April 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 18 on staffing and Regulation 12 medicines.

We undertook this unannounced focused inspection on 2 October 2017 to check that they had followed their plan and to confirm that they now met legal requirements. We also telephoned people over the next three days and awaited further information from the provider that arrived on 18 October 2017. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cambridge Care Haverhill on our website at www.cqc.org.uk.

We had been contacted by people’s representatives who used the service and staff who worked for Cambridge Care who shared concerns about care delivery. The team inspected the service against one of the five questions we ask about services: is the service safe.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and supported living for adults with a learning disability. This inspection focused upon Haverhill and we were told that they provide approximately 1300 hours per week to 100 people. As well as staffing two bungalows 24 hours for adults with a learning disability.

The service had an appointed manager in post that was in the process of applying to become registered with the CQC as the registered manager of the Haverhill location. 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.

At the previous inspection there was a breach in staffing because there was not always enough staff deployed in a timely manner. This remained the same at this inspection. People told us they were generally happy with the service, but people could not rely upon Cambridge Care to meet their needs when they needed them met. People experienced an inconsistent service delivery with staff changes made that led people to experience a service that was well meaning but erratic for some people. Therefore we have found an on going breach of regulation because the service did not have sufficient staff to keep people safe and meet their needs.

At the previous inspection we found a failure to manage people's medicines safely and the inadequate risk management placed people at risk of harm. At this inspection some people fed back they were generally satisfied others were deeply unsatisfied and said people were at risk when they did not receive their medicines. We found that medicines were not safely managed. Staff had not consistently followed policy and procedure when a prescriber of medicines verbally communicated a change in amounts of medicines to be administered. Nor had they been given written instruction when medicines needed specific administration methods. Audits were not consistent an thorough. But of concern was that some important medicines had gone missing. We did not see that an investigation and report into the matter had been conducted to learn from the events to ensure all concerned learnt from the incident. Therefore we have fo

The inspection took place over several dates. On the 7 March 2017 we visited the office. On the 8 and 9 March 2017 we visited people in their own homes and on 19, 20 & 28 April 2017 we telephoned people who used the service to get their feedback about their experience of the service.

Cambridge Care Company is located in Haverhill and provides personal care and support to people living in their own homes and supported living accommodation. There were 92 people using the service at the time of our inspection.

Cambridge Care Company Limited has three separately registered locations with main offices in Newmarket, Bury St Edmunds and Haverhill, all in Suffolk. They provide support across the three locations to just over three hundred people. Since the last inspection in December 2013 the agency were awarded the Support to Live at Home contract by Suffolk County Council. They have been working closely with the Council to implement the contract. The contract supports a move away from task focused care to more holistic care which can be measured in terms of outcomes for people using the service.

The service had a newly appointed manager in post who was in the process of applying to become registered with the CQC as the registered manager of the Haverhill location.

People told us they were generally happy with the service, although the times of the calls varied and did not always reflect people’s preferred choices for when their care was provided. Some people reported poor communication from the office with regard to concerns about the times of their calls.

The provider recognised that during recent months the service was not always responsive due to several care staff leaving the service. We were told that existing staff had been required to work additional hours to cover these vacancies. This meant that people did not always receive consistent care from people that they knew. However the service had recruited several new care staff in recent months and continues to advertise for additional care staff, in order to reach their full complement of staff.

Staff we spoke with were knowledgeable about people`s needs and the risks involved in people`s daily living. Although staff were trained in safe administration of medicines they were not always following best practice guidance when administering or recording people`s medicines. We also found that medicines were not managed effectively or safely and the monitoring system in place had failed to resolve a serious medicine error discovered during this inspection.

People were asked to provide consent before staff supported them and this had been recorded in their care plans. Staff had some understanding of MCA requirements and the provider told us that MCA/DOLs training was being arranged for all staff.

Staff felt that the support from the management team had not always been consistent during recent months due to some internal changes within the management structure of the service. However they told us things had slightly improved recently and that staffing was better; however last minute sickness or absence still caused stress and put pressure on them to cover for these instances.

There were some systems in place to monitor the quality of the service and additional systems were being developed to help ensure the support provided was consistent. However the current system for monitoring call times was not efficient or effective in alerting or identifying calls that were late or missed. The provider told us that they were in the process of purchasing and implementing an electronic monitoring system to help improve the recording of calls times and alerting office staff about late or missed visits.

People told us they felt safe and trusted the staff who offered them care and support. Staff were knowledgeable about safeguarding procedures and how to report their concerns. Staff knew people well and treated them with dignity and respect.

People told us that they were supported to