This inspection took place on 4 and 5 September 2018 and was announced. At our last inspection in March 2018, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to Regulation 12; safe management of medicines, Regulation 11; need for consent, Regulation 9; person centred care, Regulation 17; good governance and Regulation 13; safeguarding service users from abuse and improper treatment. We met with the provider and asked them to complete an action plan to tell us what they would do and by when to improve the service. At this inspection we found sufficient improvements had been made to meet the relevant requirements of the Regulations. This is the third consecutive time the service has been rated Requires Improvement.

Carlton Home Care is a domiciliary care agency. It 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. At the time of our inspection there were 58 people using the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CCQ) 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.

Improvements had been made to the management of medicines and people generally received medicines as prescribed. However, further improvements were required to the administration of time specific medicines and to ensure creams were administered as prescribed.

Staff were being recruited safely and there were enough staff to take care of people. However, some people told us staff did not always arrive on time and stay for the allotted length of time. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs. However, the registered manager recognised spot checks on staff competency needed to be embedded.

People who used the service and their relatives told us staff were helpful, attentive and caring. People told us most staff treated them with respect and compassion.

People told us they felt safe in the company of staff. Systems were in place to record and report concerns about any suspected abuse. Staff had received safeguarding training and knew how to recognise and report signs of abuse. A range of assessments were in place to mitigate any risks to people’s health and welfare. Accidents and incidents were documented with clear actions taken as a result.

Care plans were mostly up to date, person centred and detailed what care and support people wanted and needed.

From our discussions with people, relatives and staff and from reviewing care records, we concluded people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service liaised with a range of healthcare professionals to ensure people’s healthcare needs were met.

Staff knew about people’s dietary needs and preferences and these were documented in people’s care records.

A complaints procedure was in place. Complaints were taken seriously, investigated, and the complainant informed of actions taken as a result.

People, relatives and most staff spoke highly of the registered manager who said they were approachable and supportive. The provider had systems in place to monitor the quality of care provided and where issues were identified they took action to make improvements. However further work was required to embed these improvements and ensure all staff who completed audits did so effectively.

Our inspection of Carlton Home Care took place on 8, 9 and 10 January 2018 and was announced. At our last inspection on 8 November 2016 we asked the provider to make improvements to medicines management and governance processes. At this inspection we found further concerns relating to these areas and the service had not made sufficient improvements to meet the relevant requirements.

This is the third consecutive time the service has been rated Requires Improvement.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. At the time of our inspection the service was supporting 44 people.

A registered manager was in position. 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.

At the last inspection we had concerns about safe medicines management and although we found some improvements at this inspection, we found other continued concerns. The medicines policy was not in line with current legislation, the medicines administration records were not always accurate and there was a lack of information about people's prescribed medicines.

People told us they felt safe and comfortable with the staff that supported them. However we found the provider had not always informed the Care Quality Commission about safeguarding concerns or accidents/incidents when required. Staff were trained to recognise and report signs of abuse.

Care staff told us improvements had been made over the last year in relation to continuity of call visits and most people agreed with this. However, we received mixed feedback about whether staff stayed for the right amount of time or arrived around the agreed visit time.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. However, the policies and systems in the service did not always support this practice. The registered manager acknowledged improvements were required to ensure actions were always taken in people's best interests and following the correct procedures, such as in regard to covert medicines and mental capacity assessments.

The registered manager acknowledged improvements were required to create more personalised plans of care for people and to look at alternative ways to make information available to people who may have difficulty accessing this information. Some care records did not reflect people's current needs. We saw people and/or their relatives had been involved in planning their care.

Although quality assurance systems were in place these were not robust or effective in securing improvements. Some of the concerns we highlighted at inspection had not been picked up at audit and some of these concerns were repeated concerns from the previous inspection in November 2016.

We saw formal complaints were investigated and actions taken and most people told us they had no concerns. Some people expressed concerns that some issues had not been addressed to their satisfaction.

People's health care needs were supported and we saw care staff worked with health care professionals when required.

Staff training was up to date or booked and people told us staff knew how to support them with their care and support needs. People told us staff were kind, caring and respected their privacy and dignity. Staff spoke with affection about the people to whom they provided care and support. It was clear that better consistency of staff had led to good relationships developing between staff and people.

The management team were open and honest at inspection and keen to improve the service provision. From speaking

Our inspection of Carlton Home Care took place between 4 and 8 November 2016. The provider was given 48 hours notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies.

At the previous inspection in November 2015, we found breaches in staffing, medicines management and good governance. At this inspection we saw some improvements had been made to meet requirements. However, we found further improvements to medicines management and quality assurance systems needed to be made.

Carlton Home Care is a domiciliary care agency based in Shipley, West Yorkshire. At the time of our inspection, the service provided care and support to 52 people living in their own homes.

The service was required to have a registered manager in place. 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. However, the previous manager had left the service before completing the registration process with little notice two weeks prior to our inspection. We saw plans were in place to recruit a new manager and the management team were effectively supporting the service during this time.

Safeguarding mechanisms were in place and staff understood how to keep people safe from harm or abuse. Risk assessments had been undertaken to mitigate risks.

Medicines were not always managed safely with systems not in place to record and monitor some people's medicines.

Incidents were documented with outcomes and action to prevent reoccurrence. However, accident reports were not always completed appropriately.

Staffing levels were reasonable although stretched due to a number of staff recently leaving the service without giving any notice. We saw action was being taken to reduce late or missed calls and the service was actively recruiting new staff.

A recruitment process was in place to help ensure people received their support from staff of suitable character and staff had the necessary training to carry out their duties. A system of staff supervisions and appraisals was in place although some supervisions were out of date.

The service was working within the legal framework of the Mental Capacity Act 2005 (MCA). Staff had received MCA training and the group governance lead understood their legal responsibilities under the Act.

People's needs were assessed and person-centred plans of care drawn up which were reviewed regularly. We saw evidence people's independence was supported wherever possible.

Where people were supported with their diet, care plans outlined people’s needs, preferences, likes and dislikes. People were supported with their health care needs.

A complaints procedure was in place although some people thought these had not been addressed effectively by the previous manager.

People told us staff knew them well and supported them in a kind and caring manner.

Some people and staff told us the previous manager had not been approachable and they found it difficult to contact the office. However, they said this situation had recently improved. We found the management team were working hard and willing to look at ways to improve the service.

Although some quality assurance was in place, there was a lack of effective audits of some systems and processes including medicines, incidents/accidents and staff files.

Regular staff meetings were held and quality questionnaires and surveys were sent out to people who used the service, or telephone surveys carried out.

You can see what action we told the provider to take at the back of the full version of the report. We have also asked the provider to send us regular updates to demonstrate action is being taken to address the shortfalls found.

We visited the administrative office of the organisation where we reviewed documentation and spoke with the manager and a senior carer. Later we spoke with staff and people who used the service and their relatives over the telephone.

People we spoke with told us they were satisfied with the service and they felt that their dignity was respected. One person we spoke with said “The service is first class” another said “They are very nice and kind to me”. Staff we spoke with said people were treated with respect and their privacy and dignity was respected at all times.

Carers told us the staffing levels were appropriate and staff were supported through their training. The staff we spoke with were complimentary regarding the training they had been provided with. One member of staff told us “I like it here” another said “I love working with the service users”.

During our inspection we spoke with six people who used the service or their representatives. The people we spoke with were positive about the care and support they received. People told us they had been consulted about the care packages they received and their support plans had been discussed with them.

People told us they had been given written information about the services the provider offered. One person said, “I was visited by the care co-ordinator before the service started and provided with useful and informative information about the agency and the range of services available” Another person said "After having a very unpleasant experience with another agency I was very reluctant to accept further assistance, however, I am extremely pleased with the care and ongoing support I receive from Carlton Home Care."

In addition to the manager we spoke with two senior members of staff and four care staff. The staff told us they enjoyed working for the agency and always respected people's rights to privacy and dignity when providing care and support. They also told us they helped and encouraged people to retain their independence and provided care and support in line with their agreed support plan.

People spoken with told us that they were happy with the care and support provided by staff. They told us that staff were considerate and caring and always provided care and support in line with their wishes.

They also told us that staff have a flexible approach to providing care and support and the manager was generally good at keeping them informed if a different member of staff was going to provide their care and support.

However, one person did feel that communication within the agency was not always good and at times they had failed to inform them if staff were going to be delayed or were not going to turn up.

This inspection took place between 4 and 12 November 2015 and was announced. At the last inspection on 6 January 2014 the service was found to be meeting the requirements we assessed.

Carlton Home Care provides care services to adults throughout the Bradford area. Their main office is based in Shipley. The service provides people with personal care and support to enable them to live in their own homes. Most people who used the service were older people or people living with a learning disability.

A registered manager was in place. However, they were on maternity leave at the time of this inspection so an interim manager was covering the manager’s position. 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.

Accidents and incidents were being monitored and analysed. However, information was not always being translated into care records to ensure care staff had up to date information to ensure appropriate action was taken to mitigate risk.

Our review of records, discussions with staff and people who used the service led us to conclude there were not sufficient care staff available to ensure people received consistent and person centred care.

The records, policies and procedures for managing medicines needed improvement to ensure staff practices and the process for administering medicines was safe.

The provider had appropriate arrangements in place to help reduce the likelihood of abuse going unnoticed and help protect people from the risk of abuse.

Staff received thorough training, on-going support and development to ensure they had the skills and knowledge to provide effective care.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and had a good knowledge of the people they supported and their capacity to make decisions.

Staff supported people to ensure their healthcare needs were met and where support with meals was required helped people to have a healthy balanced diet.

Many people told us they received a good standard of care and provided positive feedback about the staff who supported them. However, people said the quality of carers and standard of care they received was not consistent. Most people said their experience was influenced by staffing issues which led to inconsistencies in the time of their calls and the carers who supported them.

Most people told us staff treated them and their home with respect and dignity. However, as the quality of care staff was variable improvements were needed to ensure consistency in the attitude and approach of care staff.

Care records contained person centred information which demonstrated they had been developed in consultation with people. People told us they felt involved in making decisions about how their care was provided on a day to day basis but were not consistently involved in the formal care planning process.

Records showed and people told us call times were often inconsistent. This meant people did not always receive care and support which was responsive to their needs. People told us this was due to “staff shortages” and the fact the provider did not include travel time on the call run rota, which often caused staff to run late.

Formal complaints were investigated and responded to in line with the provider’s complaints policy. However, where people raised informal concerns it was not always clear what action had been taken to respond to the issues raised. Systems were in place to seek people’s feedback. We saw examples where the provider had taken effective action make improvements based on people’s feedback, however this was not always the case. People told us the management team should be more “visible” and consistently clear about what action they had taken to respond to feedback.

We found the provider’s audit system was not sufficiently robust. We identified concerns with a number of aspects of service delivery including; the management of medicines, staffing, incomplete and ineffective care records. These had not been addressed prior to our visit were not included on the provider’s action plan.

The system for archiving documents was not robust. Some care records contained information which was no longer relevant and other documentation could not be located. Effective systems were not in place to ensure daily notes were checked. This meant important information and changes to people’s needs were not always identified and acted upon.

Staff and people who used the service provided positive feedback about the acting manager. However, due to staffing shortages said they often had to provide hands on care which we saw had a negative impact upon the quality of care records and consistency of management checks.

We identified 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 in relation to this at the back of the full version of the report.