The inspection took place over the period of 16 October to 22 October 2018, with the provider being given short notice of the visit to the office on 16 October in line with our current methodology for inspecting domiciliary care agencies. The service was last inspected in February 2018, and was given an overall rating of “inadequate.” Six breaches of regulations were identified at that inspection, relating to; how the service was managed and the governance arrangements; how medicines were managed; how consent was obtained and acted upon; how complaints were managed; and how people were safeguarded from the risk of abuse. In response to this we took enforcement action against the provider.

We also placed the service into 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.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults in the Rotherham and Sheffield areas. At the time of the inspection they were providing support to approximately 80 people.

The provider was registered as an individual, meaning that there was no requirement for a registered manager.

People’s care files showed that their care needs had been thoroughly assessed, and they received care in accordance with their assessed needs.

People told us that they experienced a good standard of care and that they found staff to be warm, friendly and caring. Staff told us that providing a caring service was the most important aspect of their role.

Staff were provided with a comprehensive training programme which they told us they found useful. This helped them meet the needs of the people they supported.

Records demonstrated people’s capacity to make decisions had been considered as part of their care assessment, and where people lacked the capacity to make decisions about their care and welfare the provider ensured decisions were made lawfully.

People’s care was reviewed to ensure it met their needs, and care was tailored towards each person’s individual preferences and care needs.

There was a system in place to tell people how to make a complaint and how it would be managed. People told us they felt confident to make a complaint and were assured it would be dealt with appropriately.

There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to individual people. Risk assessments were up to date and detailed.

We found recruitment processes were thorough, which helped the employer make safer recruitment decisions when employing new staff.

The way that medicines were managed by the service required improvement, as adequate records of the administration of some medicines were not kept.

The registered provider had a clear oversight of the service, and of the people who had used or were using it, and the standard and quality of care visits was regularly monitored. Other audits had been introduced, although they were not particularly comprehensive.

A supervision and appraisal programme had been introduced, but had still to be embedded into day to day practice within the service.

The inspection took place over the period of 14 February 2018 to 26 February 2018, with the registered provider being given short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. The service was last inspected in July 2017, and was given an overall rating of “requires improvement.” Five breaches of regulations were identified at that inspection, relating to; how the service was managed and the governance arrangements; how medicines were managed; how consent was obtained and acted upon; a failure to notify the Care Quality Commission (CQC) of specific incidents where required; and a failure to display their CQC rating.

At our inspection of 14 February 2018 to 26 February 2018 we found the registered provider had failed to act on the findings of the previous inspection and address all the breaches of regulation identified at that inspection.

Care Assistance is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults. At the time of the inspection the registered provider could not tell us precisely how many people they were providing personal care to, but told us they thought it was “about 80.”

The provider was registered as an individual, meaning that there was no requirement for a registered manager.

People using the service told us they found staff to be caring, telling us they had a good relationship with the staff who provided care for them. However, they told us that at times care calls could be late. A small number of people told us there had been missed care calls in the past.

People’s medicines were not appropriately managed, with staff at times administering medicines that were not supported by records. Risk assessments lacked detail and did not give sufficient information about how staff should act in order to manage and minimise risks.

The registered provider did not have appropriate arrangements to ensure they complied with the Mental Capacity Act 2005 (MCA.) People’s consent was not always lawfully obtained, and where people lacked the mental capacity to give consent to their care, the correct steps were not followed.

The registered provider had a complaints policy in place, but did not follow this policy when addressing complaints.We saw incidents of complaints not being appropriately investigated or responded to.

The registered provider was failing to carry out sufficiently robust audits to ensure that shortfalls or concerns were identified and addressed. The registered provider did not have a system in place to monitor the quality of service provided, and could not evidence that it was complying with the law in this area.

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 begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve

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 pr

The inspection took place on 28 July 2017 with the provider being given short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. The service was last inspected in July 2016, and was given an overall rating of “requires improvement.” Three breaches of regulations were identified at that inspection, relating to; how the service was managed and the governance arrangements; how medicines were managed; and the service’s recruitment arrangements.

Care Assistance provides personal care to people living in their own homes in the Rotherham and Sheffield areas. At the time of the inspection the provider was providing care services to 67 people.

The provider was registered as an individual, meaning that there was no requirement for a registered manager.

People we spoke with told us the service, and the care staff, were extremely caring. One person said: “They really are lovely, I couldn’t be without them.” Another said: “I’m very satisfied, they are all great girls.” The provider had received various compliments and thank you notes from the relatives of people using the service, with one saying: “If all care companies were like yours then the care in this country would be first class.”

People’s care and progress was monitored by means of regular reviews, so that the provider could respond to any changes, altering care packages as required to ensure people’s needs were met. However, we saw that records were not always updated to reflect this.

We identified improvements to the way that recruitment was managed within the organisation, meaning that recruitment decisions were safe.

There was a safeguarding policy and clear procedures for staff to follow if they suspected abuse. All staff had received training in relation to this. However, we found that the provider had not followed correct procedures when dealing with an allegation of abuse.

Medication records had improved since the last inspection, but there were still improvements to be made.

The provider had not followed the correct, legally required, procedures when obtaining people’s consent to their care and treatment. Where people lacked the capacity to give consent, the provider was unaware of the steps they were required to take.

Staff told us they felt well trained to do their jobs, although we noted there were some key areas of training that staff had not received.

The provider was failing to carry out sufficiently robust audits to ensure that shortfalls or concerns were identified and addressed. The provider did not have a system in place to monitor the quality of service provided, and could not evidence that it was complying with the law in this area.

You can see what action we told the provider to take at the back of the full version of the report. We are taking enforcement action against the provider, and will report on this at a later date.

The inspection took place on 26 July and 2 August 2016 with the provider being given short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. The service was re-registered with the Commission in December 2015 due to a change in the address of the location, so this was the first inspection under the new registration.

The agency provides personal care to people living in their own homes in the Rotherham area. Care and support was co-ordinated from the services office which is based near the centre of Rotherham. At the time of our inspection the service was supporting people whose main needs were those associated with older people, including dementia, but other services were available.

The service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

At the time of our inspection there were approximately 30 people receiving support with their personal care. We spoke with two people who used the service and six relatives. People we spoke with told us they were happy with the service provided and raised no concerns or complaints.

The provider had a policy in place to protect people from abuse, which told staff about the types of abuse, and how to recognise and report potential abuse. However, the system for recording any incidents lacked organisation. Staff we spoke with confirmed they had received training about protecting people from abuse, however training records did not demonstrate that all staff had received this training.

Care records identified people’s needs, as well as any risks associated with their care and their preferences. People told us they had been involved in planning care, but this was not evidenced in the care files we checked. People said staff were meeting their individual needs and delivering care as they preferred. We found people were mainly supported by the same team of staff who were knowledgeable about their needs and preferences.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. However, this had not always been consistently followed. For example, we found five staff members did not have a second reference on file. This was a breach 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.

We saw new staff had received an induction at the beginning of their employment, but documentation was not always up to date. Staff said they felt they had received enough training and support to enable them to carry out their job. However, training records did not demonstrate that all essential training had been provided in a timely manner. Staff had received an appraisal of their work performance, but regular one to one support sessions had not taken place consistently.

Where people needed assistance taking their medication appropriate support was provided, but this was not always accurately documented. For example, care plans did not always fully detail the support needed from staff, and medication administration records were not always in use where staff were assisting people to take their medicines. This was a breach 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.

The provider had a quality assurance policy which detailed how they intended to gain people’s options about the service they had received, but we found it had not been followed. The people we spoke with told us the