We carried out an announced inspection at Community Care Worker on the 28 September, 1 October 2018 and 3 October 2018. At the last inspection on the 9 August 2017, we found breaches in regulations. Regulation 13 because people were not always safeguarded from potential abuse and Regulation 19 because the provider did not have effective systems in place to ensure staff were safely recruited. 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 question of safe to at least good. We served a warning notice under Regulation 19 which asked the provider to take immediate action to make improvements. We found improvements had been made to Regulation 13. However, we found there was a continued breach in Regulation 19 and the provider needed to make improvements to the way the service was managed. This is the fourth 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 in the community. It provides a service to older adults and younger adults who have a physical or learning disability. At the time of the inspection there were 20 people receiving a service of personal care within their own homes.

Not everyone using Community Care Worker receives regulated activity; 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.

There was a registered manager at the service who is also the provider. 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.

There was a lack of structure and organisation within the service, which impacted on the monitoring of some people’s care and led to breaches in regulations. Improvements at the service had not been acted on in a timely manner to ensure regulations were met and lessons had not been learnt when things went wrong.

Staff felt the registered manager was not always approachable and did not always listen to them when they raised concerns.

Records were not stored securely and improvements were needed to ensure records were accurate and accessible in the absence of the registered person.

The provider was not meeting the conditions of their registration because they were storing documents at an unregistered address.

The provider had not made the necessary improvements since the last inspection to ensure staff were consistently recruited safely.

Improvements were needed to ensure actions in place as a result of complaints were recorded in care records for staff to follow.

Staff were aware of their responsibilities to protect people from the risk of harm. Staff knew people’s risks and supported them to remain as independent as possible whilst protecting their safety.

There were enough staff available to meet people’s needs in a timely way. Medicines were managed safely and infection control measures were in place to protect people from the potential risk of cross infection.

People’s cultural and diverse needs were planned for to enable a fully individualised care provision that met people’s preferences.

The provider was following the principles of the Mental Capacity Act 2005. This meant that people were receiving care that was in their best interests. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s care was reviewed. However, this information had not always been included in people’s records to ensure t

We completed an unannounced inspection of Community Care Worker Limited on 9 August 2017. At our last inspection in November 2016, the service was rated, ‘requires improvement’. No Regulatory breaches were identified at that inspection.

At this inspection, we identified Regulatory Breaches. You can see what action we told the provider to take at the back of the full version of the report.

The service is registered to provide personal care to people in their own homes. At the time of our inspection eight people were in receipt of personal care from the service.

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 requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Safe recruitment systems were not in place to ensure that staff were suitable to work at the service.

Incidents of potential abuse and neglect were not always reported to the local safeguarding team in accordance with local and national guidance.

Action was not always taken in response to safety incidents to reduce the risk of further incidents occurring. Health and medical advice was not always sought in response to significant safety incidents.

People did not always receive their care at the agreed time as travel time between calls was not always accurately planned for.

The systems used to assess and monitor the quality of care were not always effective in identifying improvements needed.

People received their medicines as prescribed. However, improvements were needed to the way that medicines administration was recorded.

People’s ability to consent to their care was assessed and consent to care was gained. Staff knew how to meet the requirements of the Mental Capacity Act 2005 in the event that a person could no longer make decisions about their care.

Staff were trained to provide care and support and staff were supported by the registered manager to carry out their roles.

People were involved in the assessment, planning and review of their care and staff supported people in accordance with their care preferences. This included the support they received to eat and drink.

Staff promoted people’s privacy and dignity and people told us they were treated with kindness and respect.

Complaints were managed effectively to improve people’s care experiences.

People’s feedback about their care was regular sought to help assess the quality of care.

The registered manager and provider displayed their last inspection rating as required.

We carried out unannounced comprehensive inspections of this service on 19 January 2016 and 25 July 2016 and breaches of legal requirements were found. After the comprehensive inspections, the provider wrote to us to say what they would do to meet the legal requirements. 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 Community Care Worker Limited on our website at www.cqc.org.uk.

As a result of our last inspections, this provider was placed into special measures by CQC. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Community Care Worker Limited are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported four people in their own homes.

There was a registered manager at the service who was also the provider. 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’s risks had been planned for and staff knew how to support people safely. We found that some improvements were needed to ensure that all records contained up to date information about people’s risks.

Systems had been put in place to ensure that medicines were administered and managed safely. However, some further improvements were needed to ensure that there was detailed guidance for staff to follow when administering topical creams.

Improvements had been made to the systems in place to assess and monitor the quality of the service. However, some improvements were needed to ensure these were consistently effective and the monitoring of the service was sustained.

People were protected from the risk of abuse because staff understood their responsibilities and actions required to safeguard people from the risk of harm.

There were enough suitably trained staff available to meet people’s assessed needs. The provider had safe recruitment procedures in place and we found that required checks had been carried out on all staff to ensure that staff were suitable and of good character to provide care to people who used the service.

People had been asked to provide feedback about the quality of service they received. Where people had given feedback this had been recorded and acted upon by the registered manager.

We completed an unannounced inspection at Community Care Worker Limited on 25 July 2016. At the last inspection on the 19 January and 20 January 2016 we identified multiple breaches in regulations. We found that the service was not safe, effective, caring, responsive or well-led. As a result of our last inspection, this provider was placed into special measures by CQC. The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 .

Community Care Worker Limited are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported five people in their own homes.

There was a registered manager at the service who was also the provider. 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’s risks had not always been planned or managed to keep people safe. Records gave inconsistent accounts of people’s risks and how staff needed to support people to reduce their risks.

Effective systems were not in place to ensure that medicines were administered and managed safely.

Improvements had been made to the systems in place to assess and monitor the quality of the service. However, these were not effective and the concerns we raised at the inspection had not been identified by the registered manager. Risks had not always been mitigated to ensure people were receiving safe care.

People and their relatives were involved in the planning of their care and some improvements had been made to show people’s preferences in how they received their care.

Reviews of people’s care needs had been carried out. However, further improvements were needed to ensure that people’s changing needs were updated.

People were protected from the risk of abuse because staff understood their responsibil

We completed an unannounced inspection at Community Care Worker Limited on 19 January 2016 and 20 January 2016. This was the first inspection since the service was registered with us (CQC) on 28 September 2015, we looked to see if the service was meeting the required standards.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009. The overall rating for this service is 'Inadequate' and the service is therefore 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 .

Community Care Worker Limited are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported 14 people in their own homes.

There was a registered manager at the service who was also the provider. 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 protected from the risk of harm because staff did not understand their responsibilities and actions required to safeguard people from the risk of abuse.

People’s risks had not been assessed or monitored effectively to keep people safe. Staff did not give consistent accounts of people’s risks and how these needed to be managed to keep them safe.

The provider did not have a system in place to monitor incidents and accidents to lower risks and ensure that people were protected from the risk of further occurrences.

There were not enough staff available to meet people’s assessed needs. The provider did not have an effective system in place to monitor the staffing levels against the needs of people who used the service.

The provider had unsafe recruitment procedures and we found that the required checks had not been carried out on all staff to ensure that staff were suitable and of good character to provide care to people who used the service.

Systems were not in place to ensure that medicines were managed safely and in a way that they had been prescribed.

Staff had received some training before they provided care but we found that they had not received training in impo