This inspection took place on 23 May and 1 June 2018 and was announced.

This service 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. Not everyone using Cathedral Gate Domiciliary Care Services receives regulated activity. CQC only inspects the service being received by people provided with ‘personal care’, and help with tasks related to personal hygiene and eating. For people who receive a regulated activity, we also take into account any wider social care provided.

The last inspection took place on 16 December 2016 and 12 and 13 January 2017. We identified two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks were not always identified and sufficiently addressed, medication profiles were not in place and records of topical ointments and creams were not maintained. In addition, auditing of the service was not fully effective, and findings were not used to improve the service. We also made a recommendation to develop a more person centred approach to care planning.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions of whether the service was safe, effective, responsive and well led to at least good. At this inspection, improvements had been made to all areas, although further work was needed in relation to the well led domain.

There was a registered manager in post. 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 registered manager was not available on the first day of the inspection, but was present on the second day.

Following the last inspection, the registered manager had researched quality auditing systems and the formats available. However, further work was needed to implement these and to ensure an overview of different areas of the service.

Improvements had been made to people’s care plans. The information reflected people’s needs, the support they required and their interests. The content of the plans was easy to read, detailed and person centred.

A new format had been introduced for staff to document the administration of people’s medicines. The information gave clear instructions which minimised the risk of error.

People were happy with the service they received. They said they were supported by a consistent team of staff who knew them well. People told us staff generally arrived on time and there were no concerns about staff not arriving to support them. They told us staff asked for their consent and always did what was asked on them.

People were complimentary about the staff. Staff were well supported and received a range of training to help them to undertake their role more effectively. Safe recruitment practice was followed and new staff received a thorough induction before working with people on their own. There were enough staff to support people.

There was a strong culture that was built on kindness and compassion. Core values, such as dignity and respect, were an integral part of service provision.

People told us they felt safe. Staff were aware of their responsibilities to identify and report a suspicion or allegation of abuse.

People were supported with meal preparation and encouraged to drink sufficient amounts. They were supported with their health care needs as required. The agency had built good relationships with local services.

People knew how to make a complaint and were encouraged to give their views of the service. Any requests or suggestions were addressed although there was not an overview, whi

This inspection took place on the 16 December and the 12 and 13 of January 2017. It was the first inspection since moving locations and changes of registration.

Cathedral Gate Domiciliary Care Services provide personal care and support to people in their own home.

A registered manager was in post. 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.’

Quality assurance systems were in place but systems and process were not always effective. Systems for assessing standards were not used to identify shortfalls and to develop action plans on improvements. Audits undertaken were not consistent with the findings of this inspection. For example, recruitment procedures were not stringent for one member of staff.

While members of staff knew the actions needed to minimise the risks to people, the records and action plans were not always developed on how staff were to manage the identified risks. Where people had refused to use equipment the risk assessment was not reviewed to ensure people were protected from potential harm.

Medication records were not in place for topical ointments and creams. Where staff had recorded medicines administered as “per the blister pack” on the medication administration records corresponding information on these medicines were not in place. This meant staff were not provided with guidance on the purpose of the medicines and their side effects.

Records were not clear on people’s capacity to make specific decisions. While staff knew they had to gain consent before undertaking personal care tasks it was not possible to determine from the records if the person had capacity to make decisions about their care and treatment.

Care plans lacked a person centred approach. Care plans lacked guidance to staff on people’s preferences and how their care was to be delivered. Where people had medical conditions there was little guidance on how this impacted on their care needs. People told us their care plans were not reviewed.

Members of staff had opportunities to discuss their personal development, their performance and training needs. Team meetings were held regularly which meant staff received feedback and were kept informed about policy changes.

People we spoke with described the staff as “dedicated, pleasant, professional” and always willing to assist with additional jobs. They told us the staff arrived on time, stayed for the allocated time and made time for a chat and the filling in of records.

People received their care and treatment from a small team of regular staff and new staff shadowed more experienced staff. Office staff were described as pleasant and always available to answer the phone. People knew what a care plan was and where it was kept. They knew how to make a complaint, and one relative said they had no need to complain as their concerns were acted upon promptly.

Staff were knowledgeable about the safeguarding of vulnerable adults from abuse procedures. They knew the types of abuse and how to identify them and the reporting procedures for alleged abuse.

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 at the back of the full version of this report. We made recommendation on care planning.