At our last inspection on 26 April 2017, the service was rated requires improvement overall but with one key question, well-led, rated as inadequate. This meant the service remained in Special Measures. We undertook this inspection to check that improvements had been made.

During this inspection the service demonstrated to us that some improvements have been made and it is no longer rated as inadequate in well-led. Therefore, this service is now out of Special Measures. We will keep the service under review to ensure improvements continue.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults, people with a physical disability and people with dementia. At the time of our inspection the service was supporting approximately 54 people receiving support.

There was a Registered Manager in post 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 principles of the Mental Capacity Act (2005) were not always being followed, but some improvements had been made since the last inspection.

Quality monitoring systems were not always effective in identifying omissions but new systems were being introduced.

Overall people felt there were enough staff to meet their needs and staff felt their rotas were manageable. Staff were recruited safely and appropriate checks were carried out.

People told us they felt safe. Risk assessments and plans were in place to guide staff and staff knew people’s needs.

People were appropriately supported with their medicines.

Infection control measures were in place and people told us staff used appropriate personal protective equipment.

Actions had been put in place when things had gone wrong to try to reduce the likelihood of a similar incident occurring.

People were asked for their consent prior to being supported by staff.

People and relatives felt staff were well-trained and staff felt supported to carry out their role effectively.

Assessments took place to ensure the service could support people and plans of care were developed.

People were supported to eat and drink sufficient amounts.

People had access to other health professionals when necessary.

People all told us they were treated with dignity and respect whilst being supported to maintain their independence. People could make decisions about their own care.

Staff knew people well and care plans had personal details so staff could get to know how people liked to be supported.

People knew how to complain and felt able to. Complaints had been responded to where necessary.

The service had considered what support people might need near the end of their life.

People were asked for their opinion about their care and found the registered manager and staff approachable. Staff felt supported by the registered manager.

Notifications were submitted where necessary.

We carried out an announced comprehensive inspection of this service on 6 October 2016 and breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that improvements had been made in relation to two of the four previous breaches, so those regulations were no longer being breached. However, we identified two continued breaches and one additional breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

During this inspection the service demonstrated to us that some improvements have been made and it is no longer rated as inadequate overall however one of the key questions still has a rating of inadequate. Therefore, this service is still in Special Measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The office inspection took place on 26 April 2017, with follow up phone calls to people, relatives and staff following this. We gave the provider 48 hours’ notice. This was to ensure that someone would be available in the office as it is a domiciliary care service. At the time of our inspection there were approximately 47 people using the service with a range of support needs such as people living with dementia, physical disability and older people.

There was a Registered Manager in post 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.

People were not always protected from alleged abuse as some concerns had not been reported to the management and the local safeguarding authority for them to look into.

Guidance was not always available for staff to follow to protect some people’s skin integrity.

People’s medicines were not always managed safely as there were not always instructions available for staff to follow and there were not always explanations when medicines had not been administered.

People were not always prote

The inspection took place on 6 October 2016 and we gave the provider 48 hours’ notice. This was to ensure that someone would be available in the office as it is a domiciliary care service. The service has not been previously inspected. At the time of our inspection there were approximately 67 people using the service with a range of support needs such as dementia, physical disability and older people.

There was no registered manager in post 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.

At this inspection we identified 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 the report.

The service was not consistently safe. There were safeguarding incidents that we were made aware of that had not been reported to the local safeguarding authority in order to protect people who used the service. Not all staff were aware of what constituted abuse and not all staff had undertaken safeguarding training. Staff had not always recognised when abuse was occurring.

Risk assessments lacked detail and often there were no mitigating plans in order to reduce the risk for people and staff. Some people had support needs which had not been taken into account in the risk assessments, such as equipment used for mobilising and help to keep skin healthy.

Medicines were not always managed safely. People who required support with their medicines did not always have this recorded within their care plan and risk assessments and there was information missing from some medicine records so there was a risk of staff not giving medicines as prescribed. There were also no protocols in place for medicine that were ‘as and when required’ (PRN) so this put people at risk of not having their medicines when they needed them.

There were not always enough staff so that people received the amount of support they needed, with staff they knew and at the time they expected. Some calls had been planned to take place at the same time and date as other calls so staff were expected to be undertaking two visits at the same time on occasion.

Staff were not always sufficiently trained. New staff did not have a formal induction process and were taught whilst accompanying other staff members whilst out on calls. Staff told us they did not feel that the training they had received was enough to help them be effective in their role to care for people safely and well. This also did not equip them with the skills to provide training for new staff members.

Plans were not in place to provide guidance for staff about how to manage behaviours associated with caring for people who became anxious when support was provided. This put both people and staff at risk as staff were not always aware of how to support people effectively.

Staff did not feel fully supported in their role and not all had received supervisions to ensure they were effective in their role. Staff had limited opportunities to discuss their own training and development needs.

Mental capacity assessments were not consistently carried out and some of those that had been carried out had not been completed correctly. Checks regarding relative’s legal authority to make decisions on a person’s behalf had not been made so people’s legal rights were not being protected. People and staff confirmed that people were supported to make their own decisions and consent was gained before staff gave support. Therefore not all of the principles of the Mental Capacity Act 2005 (MCA 2005) were being consistently followed.

People told us they were regularly asked for their opinion about the service