This inspection took place on 12 and 20 July 2018. The inspection was announced as the service is a domiciliary care agency and we needed to make sure that the manager was available to meet with us.

At the last inspection on 18 October 2017, we asked the provider to take action to make improvements in relation to making sure that risks to the health and safety of people were well managed and to begin to operate effective systems to monitor and improve the quality of the service. The provider sent us an action plan to tell us how they were going to do this. At this inspection we found that while some improvements had been made, they were not sufficient to meet the law. The provider remains in breach of the law in relation to these areas.

This service provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults.

Not everyone using Care Avenues Birmingham receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of our inspection, Care Avenues Birmingham offered support to 85 people living in the community who received personal care. The service is required to have a registered manager who was in post when we inspected, but has since left the service. 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.

People who used the service spoke positively about the care that was provided to them. Staff members also spoke positively about the people who they supported. The service had developed personalised assessments of risks to people. However, these were not consistently done well and were not robust. We found that the assessments did not include sufficient guidance for care staff about how to manage identified risks and minimise the likelihood of harm. Staff members demonstrated that they understood how to safeguard the people who they supported. Safeguarding training and information was provided to staff. People were protected from the risk of abuse.

Staff members had received training in safe administration of medicines. However, we could not be assured that arrangements were in place to ensure that people's medicines were given safely. Staff recruitment processes were in place to ensure that workers employed by the service were suitable for the work they were undertaking. The provider had checked staff references and criminal records prior to their appointment. Staffing rotas met the current support needs of people, although there were some concerns about how the rotas were managed and may not have given staff time to travel. There was a system for ensuring that care calls were managed and monitored. Staff and people who used the service had access to management support outside of office hours.

Staff members received training to ensure that they had the skills and knowledge they required to undertake their duties, Staff members received supervision sessions with a manager. The service was meeting some of the requirements of the Mental Capacity Act. Information about people's capacity to make decisions was included in their care plans, although the registered manager was not aware of the best interest decision making process. People were asked for their consent to any care or support that was provided. Staff members spoke positively and respectfully about their approaches to care and the people that they provided care to. People told us that staff were caring and respectful. People who used the service and staff members spoke positively about its management. T

We carried out an announced comprehensive inspection of this service on 13 December 2016 and rated it ‘Good’ in all domains. On the 10 October 2017 we received information of concern from a person who worked at the service. They included concerns about the skills and knowledge of some staff who worked at the service, people’s call times and how the leadership team responded to information of concern.

As a result of this information we undertook an unannounced focused inspection on 18 October 2017 to identify if the service kept people safe and was well-led. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection in December 2016, by selecting the 'all reports' link for Care Avenues Limited on our website at www.cqc.org.uk. We also alerted other agencies to some of the concerns we received. As a result this inspection did not examine the circumstances of these other concerns.

Care Avenues Limited provides personal care to 130 people in their own homes. At the time of the inspection the service had a registered manager although they were absent during our visit. We were accompanied during our inspection by the nominated individual for the service and the area manager. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not operate effective systems and processes to assess, monitor and improve the quality of the service. Staff were unable to confirm if all the people who used the service had received calls in line with their care needs. Audits had not identified that people’s care records lacked detailed or contained contradictory guidance for staff. Systems to store and retrieve information and records was not effective. This meant during our inspection visit staff were unable to tell us about any incidences which had occurred and any action to prevent similar incidences from reoccurring. The provider’s systems had not ensured that their latest inspection ratings were displayed on their website or that we received a formal notification when the registered manager left the service. The provider did not always fulfil their legal responsibilities to the commission.

Although people who required support to receive their medicines safely said they were happy with how they were supported we saw that people were at risk of not receiving their medicines as prescribed. Some people’s medication records were incomplete or contained contradictory guidance for staff.

People spoke affectionately about the staff who regularly supported them and said they attended their calls in line with their wishes. However several people said they were occasionally supported by staff who were not familiar with their care needs. We could not be assured that the provider’s systems for ensuring there were enough staff on duty to meet people’s care needs was robust.

Staff we spoke with did not consistently demonstrate they were aware of the action to take should they suspect that someone was being abused. Members of the management team had notified the local authority when they were concerned that people might be at risk of or experiencing abuse.

People said staff would respond promptly if they became unwell or their condition deteriorated. Staff could describe people’s specific conditions and how they managed any potential risks they presented. Records sampled did not always contain sufficient details for staff about how they could reduce the risk of harm for people.

There was clear leadership at the service. Staff told us members of the leadership team were accessible and would listen to their concerns. There were staff meetings and supervisions but it was unclear how frequently it