This inspection took place on 22 March 2017 and was announced. Carmel Domiciliary Care is a domiciliary care service which provides support and care to people with mental health needs in their own homes.

A registered manager was in place as required by their conditions of registration. 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 and associated Regulations about how the service is run.

At our previous inspection, the systems to assess, monitor, action, evaluate and mitigate any risks relating to the welfare of people, staff development and the quality of the service were not effective. Since this inspection, a new provider had acquired the service.

At this inspection we met with the new provider and registered manager and found they were acting on our concerns and implementing systems to monitor the quality of the service and improve the records relating to people’s care.

A system was now in place to monitor staff recruitment, training and support. The new provider was planning to implement a new support plan format to capture people’s care and support needs. People’s risks and medicines were now recorded in detail to provide staff with guidance on how people should be supported. The new provider had established quality monitoring systems to monitor the service and identify any shortfalls. The registered manager also regularly worked alongside people and staff which gave them an insight into the running of the service and people’s needs.

We found that the service had met the legal requirements. However we could not improve the ratings for well-led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This inspection took place on 28 September and 5 October 2016 and was announced. Carmel Domiciliary Care is a domiciliary care service which provides support and care to people with mental health needs in their own homes.

A registered manager was in place as required by their conditions of registration. 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 and associated Regulations about how the service is run. The registered manager was only available on the first day of our inspection; however a team leader assisted us on the second day of our inspection.

The registered manager regularly worked alongside people and staff which gave them an insight into the running of the service and people’s needs. However, the systems in place to assess, monitor, action, evaluate and mitigate any risks relating to the welfare of people, staff development and the quality of the service was not effective.

People were protected from harm and abuse. People were supported to take risks such as accessing the community alone but the management of their risks was not always recorded. People were protected from financial abuse as new systems were in place to store and record people’s income and expenses.

People received their medicines as prescribed. The service was working with a new pharmacist to ensure there were safe systems in place to manage their medicines. Protocols were needed for people who required medicines ‘as required’ such as if they became agitated.

There were adequate numbers of staff to meet people’s needs. The registered manager was reconsidering the management structure to ensure people and staff had clear direct line of support. A safe recruitment system was in place though any discrepancies in staff employment histories were not always recorded. Staff told us they felt trained and supported, although clear recorded systems were not in place for monitoring their training and development requirements.

There was caring and friendly interaction between staff and people. Relatives were positive about the care people received. They complimented the nature of staff. People had access to a range of activities of their choosing. Some people preferred their time at home while others enjoyed community based activities. People were encouraged to maintain a healthy and well balanced diet. Together they planned the weekly menus with staff to ensure their preferences were catered for.

People had been involved in the planning of their care. Staff always sought people’s permission before they supported them with care. Staff described people and the support they required positively. They showed a good understanding of the triggers for a person’s anxiety and how they supported them. Care plans were tailored to the person. Where a person’s mental or physical health presentation had changed it was evident staff worked with other professionals including the community mental health team. Staff had also supported people to attend routine health care appointments.

We found a breach 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 this report.

We carried out an announced comprehensive inspection of this service on 29 January 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) managing people’s medicines.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carmel Domiciliary Care Limited on our website at www.cqc.org.uk.

Carmel Domiciliary Care is a domiciliary care service which provides support and care to people with mental health needs in their own homes. We visited five people who are supported with their personal care and share a house in the community. The registered manager was not available during our inspection so we spoke with the deputy manager who was in charge of the service and assisted us with the inspection.

At our previous inspection in January 2015, the provider did not meet all the legal requirements in relation to managing people’s medicines. Following this inspection, the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We found that on the whole improvements had been made and people’s medicines were now generally being managed well.

People were supported by staff who were knowledgeable in the support they required to order, store and administer their medicines. Records were in place to show when people had received their medicines. These records were regularly checked and reviewed. However people’s care plans did not always provide staff with adequate guidance on how they should be supported with their medicines especially for medicines which should only be used ‘as required’.

Staff told us they had received up to date training and a new medicine’s policy had been implemented to give staff guidance.

This inspection took place on 29 and 30 January 2015 and was announced. Carmel Domiciliary Care is a domiciliary care service which provides support and care to people with mental health needs in their own homes. We visited five people who are supported with their personal care and share a house in the community.

A registered manager was in place as required by their conditions of registration. 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 and associated Regulations about how the service is run. The registered manager was not available during our inspection so we spoke with the deputy manager who was in charge of the service and assisted us with the inspection.

At our previous inspection on 14 May 2014, the provider did not meet all the legal requirements in relation to safeguarding people from financial abuse; monitoring the quality of the service as well as recruitment processes and supporting and training staff. Following this inspection, the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We found that improvements had been made in systems to ensure people’s money was stored and managed effectively and they were protected from financial abuse. Systems were also in place to ensure the quality of service was effective and met the needs of people using the service.

People were supported by staff who were suitably trained and recruited to carry out their role. Staff were now regularly supported however some staff had not received all their relevant training. There were sufficient numbers of skilled staff to meet the personal care needs of the people they supported.

People’s medicines were ordered, stored and administered in a safe way. However the provider’s medicines policy did not reflect the practices of the management of people’s medicines. There was no clear guidance for which over the counter medicines people could take if they had a minor illness. Records of when people had taken medicines when they became upset or anxious were not accurate. You can see what action we told the provider to take at the back of the full version of the report.

Staff and the registered manager understood their role and responsibilities to protect people from harm and abuse. People’s personal support needs and risks had been assessed and discussed with them. Staff were aware of how to best support people when they were upset or at risk of harm however there were no records to guide staff on the triggers or reasons for why people may become upset.

People’s health, emotional and social needs were assessed and reviewed. Their care was focused around their needs and wishes. People told us they enjoyed the food and meals served to them. They were supported to eat and drink sufficient amounts and maintain a balanced diet. Their dietary needs and preferences were considered when planning the weekly menu. Alternative food was available if people did not like the meal options.

People spoke highly of the staff and the registered manager. People told us that staff were caring and gave them the support they needed. Complaints were managed effectively and actions were put in place to prevent the concern reoccurring.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.