This inspection was announced and took place on the 22 and 29 November 2018.

Care Plus Homecare Services Ltd is a domiciliary care agency. It provides personal care to people living in their own houses in the community. For example, older people and people living with dementia, a physical disability, learning disability or autistic spectrum disorder or have a mental health condition.

At the time of our inspection, the service was providing ‘personal care’ to 27 people who were living in their own homes within the Handforth, Wilmslow and Alderley Edge area of Cheshire.

The service is provided by Care Plus Homecare Services Ltd and is coordinated from a business office in the centre of Handforth.

The agency was previously inspected in November 2017. During the inspection we found a breach of the Health and Social Care Act 2006 (Regulated Activities) Regulations 2014. We found that the registered provider had failed to ensure that effective systems were in place to assess, monitor and improve the quality of service. At this inspection, we found that the registered provider had taken action to address the breach and developed a suite of quality assurance checks and records.

The service had a Registered 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that people’s needs had been assessed and planned for. However, we have recommended that care plans and associated records are updated to include more information on people’s specific needs and the level of support required by staff. This will ensure staff have access to more detailed information to help them understand people’s needs when delivering care and support to people.

People were treated with dignity and respect and received care and support that was generally responsive towards their individual needs. People were supported with their medication when necessary and encouraged to maintain good nutritional intake and hydration to safeguard their health and wellbeing.

Sufficient numbers of staff were deployed to provide people’s care and support. Robust recruitment procedures had also been established to ensure the suitability of prospective staff was checked prior to employment. For instance, previous employment references, proof of identity and a criminal conviction check had been obtained.

A programme of staff training and development had been established and tracking systems were in place to monitor progress. Training had been booked to provide staff with any necessary refresher or outstanding training including new courses.

The registered provider had policies and procedures in place relating to the Mental Capacity Act 2005. The registered manager and staff spoken with understood the action that should be taken in the event a person lacked capacity and their duty of care in respect of this protective legislation.

People had been provided with information on the service and a copy of the agency’s complaints procedure. People told us that they knew how to complain if they needed to report a concern or make a complaint.

Quality monitoring systems had been established and were subject to ongoing review and revision to improve oversight of the service. This included obtaining feedback from people using the service or their representatives.

This inspection was announced and took place on the 18 September 2017. A second day of the inspection took place on 6 November 2017 in order to gather additional information.

Care Plus Homecare Services Ltd is a domiciliary care agency provided by Careplus Homecare Services Ltd. The office is based in Handforth, Cheshire and the service operates across Handforth, Wilmslow, Alderley Edge and Congleton. The service was providing the regulated activity 'personal care' to approximately 50 people with a range of needs during our inspection.

The agency was previously inspected in April 2016. During the inspection we found breaches of the Health and Social Care Act 2006 (Regulated Activities) Regulations 2014. We found that the registered provider had failed to ensure that appropriate procedures were in place to assess the needs of people using the service and to plan in detail how to meet them. Furthermore, we found that people were not adequately protected from the risks associated with unsafe medicines management, that staff had not completed all the necessary training for their role and that they lacked knowledge and awareness of the principles of the Mental Capacity Act 2005. We also noted that effective systems were not in place to assess, monitor and improve the quality of the service.

At this inspection, we found that the registered provider had taken action to provide staff with the necessary training for their role and to develop their knowledge and awareness of the principles of the Mental Capacity Act 2005. We also found that the provider had introduced an assessment framework to help identify the needs of prospective service users. Action had also been taken to improve medication recording systems and practice.

At the time of the inspection there was a registered manager at Care Plus Homecare Services Ltd. ‘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 this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that effective systems were not in place to assess, monitor and improve the quality of the service. You can see what action we told the provider to take as the back of the full version of the report.

The managing director and registered manager were present during the two days of our inspection and engaged constructively in the inspection process, together with other members of the office management team and staff.

People spoken with were complimentary of the service provided by Care Plus Homecare Services Ltd and confirmed they were treated with dignity and respect, encouraged to maintain their independence and to exercise choice and control over their lives.

Recruitment was robust with checks in place to ensure that new members of staff were suitable to support people using the service.

Staff understood their duty of care to safeguard the welfare of people using the service and the importance of promoting people's healthcare and good nutritional intake.

This inspection was announced and took place on the 18 April 2016. A second day of the inspection took place on 19 April 2016 in order to gather additional information.

The agency was previously inspected in February 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Careplus Homecare Services is a domiciliary care agency provided by Careplus Homecare Services Ltd. The service operates across Handforth; Wilmslow; Alderley Edge and Congleton. The service was providing the regulated activity ‘personal care’ to approximately 86 people with a broad spectrum of needs during our inspection.

At the time of the inspection there was a registered manager at Careplus Homecare Services Ltd. 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 managing director and registered manager were present during the two days of our inspection and engaged positively in the inspection process, together with other members of the office management team and staff.

People told us that the service they received was generally reliable and that staff were friendly and polite. People also reported that staff respected their preferred routines, preferences and lifestyle and that staff interactions were positive, responsive to need and caring.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take as the back of the full version of the report.

We found that people were not adequately protected from the risks associated with unsafe medicines management and that staff had not completed all the necessary induction, mandatory and other key training relevant to their roles.

Furthermore, we found gaps in the agency’s quality assurance system and that the needs of people using the service had not been comprehensively assessed, planned for or reviewed

Systems had been developed to ensure complaints were listened to and acted upon and to safeguard vulnerable people from abuse. Although incidents of abuse had been referred to the local authority’s safeguarding team, the provider had failed to notify CQC via the statutory notification process. We have written to the provider regarding their failure to notify the CQC.

We have also made recommendations regarding the development of the agency’s policies and procedures (to include a Mental Capacity Act policy).