The inspection took place on the 11 July 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us and that we could meet with people using the service.

Care Your Way is a domiciliary care agency registered to provide personal care and support services to a range of people living with physical disabilities, sensory needs and people living with dementia. It provides care to people living in their own houses and flats.

At the time of our inspection the service was supporting 11 people who were receiving a regulated service. Not everyone using Care Your Way receives a regulated activity; CQC only inspects the service being received by people provided with personal care; help with tasks related to personal hygiene and eating.

At the last inspection on 14 June 2017, the service was rated Requires Improvement. A breach of legal requirements was found. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet the legal requirements in relation to the breach of Regulation 17 of the Health and Social Care Act Regulated Activities Regulation 2014. This was in relation to the governance of care and risk planning, management of medicines and staff training. They provided an action plan on 4 August 2017 detailing what they would do and by when to meet the breach.

We undertook a comprehensive inspection on 11 July 2018 to check whether the required action had been taken, improvements made and the breach met. Many improvements had been made, however we found some new areas for improvement and a further failing of the provider to comply with legal requirements. This report discusses our findings in relation to this.

A registered manager had not been in post since October 2015 and Care Your Way was therefore not meeting a condition of registration to have 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A potential new provider was preparing to take over the service and a manager was appointed in February 2018. Both the potential new provider and the manager had begun the process of registering with the Care Quality Commission (CQC).

The service had made improvements since the last inspection to the management of quality assurance systems, care and risk planning and management of medicines, continence and staff training. People’s care plans and risk assessments had been reviewed and the manager and care co-ordinator carried out regular audits as well as contacting people regularly to discuss and monitor their needs. Changes in needs or concerns shared by people, their relatives or staff were addressed in a timely way and clear guidance for staff to ensure they could meet people’s needs. Staff training was updated and planned for, where required staff had received competence training in relation to manual handling and medicines administration including the use of PEG tube, to support administration of medicines. However, we have identified other issues relating to the governance of medicines that suggest the improvements made, require more time to be embedded fully.

Quality assurance systems and processes were still being embedded. Staff had a good understanding of the needs of people. However, in relation to the recording of one person’s care planning and medicines guidance the quality assurance systems had not ensured that staff practice was fully informed when administering the person’s ‘as required’ medicine.

The management arrangements of the service were still being established. However, there were known lines of responsibility and accountabil

This inspection took place on the 14 and 15 June 2017. This was an announced inspection. This means the provider was given notice due to it being a domiciliary care provider and we needed to ensure someone was available. The inspection involved a visit to the agency’s office and conversations with people and their relatives. This was the service’s first inspection since being registered with the CQC.

Care Your Way is a domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people and people living with dementia and learning disabilities. At the time of our inspection 16 people were receiving a service. The service operates from a small office in Bexhill on Sea, East Sussex. This service became part of Berkeley Home Health Limited in November 2016. However the service is still trading at this time as Care Your Way.

There has been no registered manager in post for two years since registration with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Management cover is provided by the regional director and the registered manager of a sister service in Burgess Hill.

Care and support records for people lacked detail and were not all person centred. Risks had been identified with information about how to minimise additional risk. However, some risk assessments had not calculated levels of risk appropriately. Despite the service having a quality assurance system, this had failed to recognise concerns we raised at the time of the inspection.

We looked at how the service managed people's medicines and found that the management of 'as required' medicines were not recorded clearly. The arrangements for administering medicines through a stomach tube (PEG) were not recorded and did not include vital steps to ensure the safe administration of medicines. We looked at the Medicines Administration Records (MAR) for people these had all been completed correctly and were up to date.

People told us they felt that staff had the right skills and training to do their job. However there was a lack of competency assessments to underpin the training. Some staff had not always received supervision and appraisal from the management team. New staff were given induction training at the start of their employment which identified the principles and values of the service.

There was an appropriate up to date accident and incident record in place. There were robust recruitment procedures and required checks were undertaken before staff began to work for the service.

Staff had access to a copy of the organisation's policies and procedures which were available electronically or in paper format and staff knowledge of these policies and procedures was tested at supervision meetings and as part of the process of induction.

Before any care and support was given, consent was obtained from the person or their representative. People and their relatives told us that staff were kind and treated them with dignity and respect.

People told us they knew how to complain. Complaints had been recorded and responded to in line with the provider's policy.

We found a breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.