We carried out an announced inspection of Chenai Holistic Homecare Agency on 27 November 2018. The inspection was partly prompted by concerns received from a local authority. Chenai Holistic Homecare Agency is registered to provide personal care to people in their own homes. The CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, the service provided personal care to 78 people in their homes.

At our last inspection on 5 April 2017, we rated the service ‘Good’. At this inspection, we found concerns with care plans, risk assessments, medicine management and quality assurance systems therefore the service has been rated ‘Requires Improvement’.

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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks to people were not always robustly managed. We found some care plans did not contain suitable and sufficient risk assessments to effectively manage risks. This placed people at risk of not being supported in a safe way at all times.

Staff had been trained to manage medicines safely. However, we found gaps in some people’s medicine records. We also found that staff were administering medicines without recording this on people’s MAR.

Effective quality assurance systems were not in place. Audits had not identified the shortfalls we found during the inspection.

Accurate and complete records had not been kept to ensure people received high quality care and support.

Care plans were inconsistent as some care plans did not include accurate information and to ensure people received person centred care. People’s ability to communicate were recorded in their care plans.

Although staff had received mandatory training to perform their roles, specialist training in area’s such as catheter care had not been delivered by a qualified person. We made a recommendation in this area.

Staff time-keeping and attendance was being monitored. We noted where staff were late, this was not being pursued by office staff to minimise risk of late calls or missed visits. Staff also raised concerns on the lack of travel time to get to care appointments. We made a recommendation in this area.

We received mixed feedback from staff, relatives and people about the management team. People’s feedback was sought from surveys. However, the surveys were not being analysed to ascertain what the service was doing well in and what area’s required improvement. We made a recommendation in this area.

Staff had been trained on safeguarding. However, not all staff were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally.

Pre-employment checks had been carried out, which ensured staff were suitable and of good character to support people in a safe way.

Pre-assessment forms had been completed to assess people’s needs and their background before they started using the service. However, were there were issues, this had not been followed up during the referral stage.

Regular supervisions were being carried out.

People’s privacy and dignity were respected by staff. People and relatives told us that staff were caring and they had a good relationship with them.

Complaints received had been investigated and relevant action had been taken. Staff were aware of how to manage complaints.

Spot checks of staff supporting people had been carried out to observe staff performance.

We identified two breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk management,

We inspected Chenai Holistic on 5 April 2017. This was an announced inspection. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. Chenai Holistic provides care and support to people in their own homes. At the time of our inspection, the service was caring for approximately 58 people.

There was a registered manager at the service at the time of our inspection. 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 service was safe and had practices in place to protect people from harm. Staff were knowledgeable about safeguarding and what to do if they had any concerns and how to report them.

Risk assessments were thorough and staff knew what to do in an emergency situation.

Staffing levels were meeting the needs of the people who used the service and staff demonstrated that they had the relevant knowledge to support people with their care.

Recruitment practices were safe and records confirmed this.

Medicines were managed and administered safely and audited on a regular basis.

Newly recruited care staff received an induction and shadowed senior members of staff. Training for care staff was provided on a regular basis and updated on a monthly basis. The registered manager had qualifications to train staff and did so on a monthly basis.

Care staff demonstrated an understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was recorded in people’s care plans.

People were supported with maintaining a balanced diet and the people who used the service chose their meals and expressed their preferences accordingly.

People were supported to have access to healthcare services and receive on-going support. The service made referrals to healthcare professionals when necessary.

Positive relationships were formed between care staff and the people who used the service and care staff demonstrated how well they knew the people they cared for.

The service supported people to express their views and be actively involved in making decisions about their care. People who used the service told us they felt in control of their care.

The service promoted the independence of the people who used the service.

Care plans were detailed and contained relevant information about people who used the service and their needs. Care plans were reviewed and documented accordingly.

Concerns and complaints were encouraged and listened to and records confirmed this. People who used the service and their relatives told us they knew how to make a complaint.

The registered manager for the service had a good relationship with staff and the people using the service and their relatives. There was open communications between all parties.

The service had effective quality assurance methods in place.