This inspection took place between 20 and 28 February 2017. The inspection involved visits to the agency’s office and telephone conversations with people, their relatives and staff. The agency was given two working days’ notice of the inspection.

The agency provided 200 people with a domiciliary service, which was for approximately 1,870 hours a week. Most people were older people or people who lived with long-term medical conditions. People received a range of different support in their own homes. Some people received occasional visits, for example weekly support to enable them to have a bath. Other people needed more frequent visits, including daily visits, and visits several times a day, to support them with their personal care. This could include two care workers and the use of aids to support their mobility. Some people needed support with medicines and meal preparation. The agency also provided some people with care workers at night, including for sleeping-in duties and care workers who remained awake for some or all of the night.

Care at Home – Bexhill, supplies a service to people in the Sussex town of Bexhill, and surrounding rural areas. The provider is Care at Home Services (South East) Limited who provide domiciliary care services to people from different offices in the South East of England.

Care at Home – Bexhill had a registered manager in post. 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 at Home - Bexhill was last inspected from 23 November to 21 December 2015. At that inspection, it was rated as requires improvement. The service was in breach of Regulations 12, 17 and 19 of the HSCA Regulations 2014 which relate to safe care, quality of care and recruitment of staff. Following the inspection, the provider sent us an action plan to outline how they would address these areas. At this inspection, we found the provider and registered manager had been successful in making the necessary improvements.

The provider had ensured the safety of people and others by developing its risk assessment and care planning processes. Staff we spoke with were aware of people’s risks and how they were to be reduced. This included, among other areas, supporting people with moving safely and reducing their risk of pressure damage.

People’s safety when taking medicines had also been ensured. Care workers now had clear information on people’s medicines and accurately completed records when they had supported people in taking them.

The provider had audited its recruitment processes and ensured new staff were safely recruited, to reduce risk to people as much as possible.

The provider’s systems for reviewing quality of care had been improved, to include regular audit of a wide range of areas of service provision. The opinions of both people and staff were sought, using a variety of means, and action had been taken when relevant following comments made by people and staff. Any complaints and concerns raised by people were documented and actions taken where needed.

People and staff said there were no issues about missed calls due to staff shortages. The visit rotas showed the provider had successfully reduced the number of very late or very early visits to people during the past year. The provider had also introduced systems to ensure people received improved continuity of care from the same team of care workers.

People said they were fully involved in developing their own care plans. Staff told us people’s care plans gave them the information they needed to meet people’s needs. Where a person’s needs changed, their care plans were up-dated to reflect their current needs.

People said staff respected their wishes and supported their indep

We carried out this inspection to follow up on warning notices issued as a result of concerns identified at the last inspection.

We carried out an inspection at Care at Home, Bexhill on 3 February 2014 and found the provider did not have an effective system to regularly assess and monitor the quality of service that people received. We also found people had not been protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained.

Following our inspection we met with the provider on 13 May 2014 to discuss our concerns. The provider sent us an action plan that informed us they were making changes to ensure these issues had been addressed. We carried out a further inspection on 15 September 2014 and found that the provider had not achieved compliance. We met with the provider on 30 September 2014 and we issued a warning notice, which stated that the Care Quality Commission required the provider to have achieved compliance with the warning notice by 6 November 2014.

From the information gathered during the inspection 21 November 2014 we found the provider had met the requirements of the warning notices, although some of the processes required time to be fully embedded into practice.

We carried out this inspection to follow up on concerns identified at our previous inspection. Evidence gathered at this inspection showed that the provider had not achieved compliance.

We saw that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The provider did not have an effective system to regularly assess and monitor the quality of service that people received. We also found that people had not been protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained.

We spoke to 22 people who used the service. People we spoke with told us that overall they were happy with the care they received. One person said, “The carers are my only point of contact with the world so it’s good that they are friendly and kind. I’m confident in their abilities and they are good at what they do.” One person’s representative told us, “X is always positive about the carers and it was just the usual niggles like people not always being on time but they are happy with the carers.” Somebody else told us, “They are helpful and kind and mostly know what they are doing.”

We looked at people's care files and saw that their consent had been gained when they started to use the service.

We saw that care plans did not always reflect the current needs of people who used the service.

Staff were aware of their responsibilities in relation to safeguarding people.

We looked at medication records and saw that the provider did not have appropriate arrangements in place to manage medicines safely.

We looked at staff files and saw that appropriate checks were undertaken before staff commenced work.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

People that we spoke with told us that the staff were very nice and they were treated with respect. People told us that staff generally visited at the correct time although sometimes delays were inevitable. They told us staff always spent the correct amount of time with them on a visit. One person told us “staff still give you the time, even if they are late”.

People told us that they had regular staff, although there may be changes to cover holiday and days off. People accepted this was unavoidable. One person told us they had a “good rapport with their regular carer”. Another person told us they “knew most of the girls well”.

This inspection took place between 23 November and 21 December 2015. The inspection involved visits to the agency’s office and telephone conversations with people, their relatives and staff, between the beginning and end dates. The agency were given two working days’ notice of the inspection. The agency provided 160 people with a domiciliary service. Most people were older people or people who lived with long-term medical conditions. People received a range of different support in their own homes. Some people received occasional visits, for example weekly support to enable them to have a bath. Other people needed more frequent visits, including daily visits, and visits several times a day, to support them with their personal care. This could include use of aids to support their mobility. Some people needed support with medicines and meal preparation. Some people needed visits from two care workers to support them with their personal care.

Care at Home – Bexhill, supplied a service to people in the Sussex town of Bexhill, and surrounding rural areas around the town. The provider was Care at Home Services (South East) Limited who provided domiciliary care services to people from different offices in the South East of England.

Care at Home – Bexhill had a registered manager in post who was experienced in their role. 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 service was last inspected on 24 November 2014. No issues were identified for action at that inspection.

The provider had not identified a range of areas during their quality audit reviews. These included people and care workers’ concerns about visit times, and high numbers of different care workers sent to people. Complaints and concerns raised by people were not all documented, to enable review of the quality of service provision.

Some people’s care plans were not accurate in all areas and did not ensure all relevant risks to them were identified. Where risks were documented, some people’s care plans did not state actions to reduce risk. Some files did not include relevant information on the safety of equipment used.

The provider’s systems for recruitment of staff did not ensure they had verified care workers had all relevant pre-employment checks performed, to ensure care workers were fit to provide care to them on their own.

The provider did not have full systems to ensure the safety of people when supporting them with taking medicines, including relevant information on medicines prescribed on an ‘as required’ basis and the application of prescribed skin creams. The provider also not have systems to ensure that people who had specific care needs, were supported by care workers who had been trained on how to meet such specific needs.

People said staff were caring, respected them and that they felt safe. People said their individual needs were met. Where they needed support with meals provision, staff were supportive and flexible. Staff spoken with showed a kindly and approachable attitude towards people. Staff were aware of how to ensure people were protected from risk of abuse.

People said staff knew how to support them if they became unwell. Staff were fully aware of how to support people in an emergency or a change in their condition. People said their care plans were regularly reviewed with them. The provider had systems to ensure all people who were supported with medicines had fully completed medicines administration records.

People and staff said there were no issues about missed calls due to staff shortages. Staff said they received regular training in areas such as safe moving and handling of people, the Mental Capacity Act (2005) and food hygiene. They said they were supported in their roles and received regular supervision and spot checks. They also said, due to the provider’s systems, they felt safe working on their own. Staff commented on the friendly and supporting response from each other and the office staff.

During the inspection we found three breaches 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.