The inspection visit took place on 26 September 2018 and phone calls were made to people who used the service on 1 October 2018. The service was last inspected in September 2017, when it was rated ‘Requires Improvement’. This is the third time the service had been rated ‘requires improvement’. At the last inspection it was found to be in breach of two regulations of the Health and Social Care Act 2008 (Regulations) 2014. At this inspection we found the service remained in breach of these regulations and found a further breach. You can see what action we asked the provider to take at the end of the full report.

The service is a community based service registered to provide care and support to people in their own homes. It currently provides care for 90 people who live in their own home. Not everyone using Compassionate Care Team Ltd, receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’ - help with tasks related to personal hygiene, medicines and eating. Where people receive personal care we also take into account any wider social care provided.

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 service was not consistently safe. Risks to people were not always identified and risk assessments were not always updated in a timely way. Staff did not always have time to stay for the full call and were often task focused. Sometimes only one staff member attended a care call where two were required. Medicines were generally managed well; however, improvements were required to how the service managed ‘as required’ medicines. Safe recruitment practice was not followed and some staff were working without all pre-employment checks having been completed. Lessons were not always learnt from incidents or mistakes. Policies were in place for the prevention and control of infection.

The service was not always effective. Not all people who required support to prepare and cook meals, had the meals they preferred. Some staff did not have the skills to support people with specialist diets or who preferred meals cooked from fresh ingredients. Care plans were developed with people and were focused on supporting independence and choice.

The service was caring. Many people told us staff were kind and caring; and promoted their independence and dignity. However, we found some occasions when people did not feel that staff listened to them and they were not happy with changes to their care. On these occasions we found staff had not always respected people’s views and preferences.

The service was not consistently responsive to individual needs and preferences. There was no process for capturing people’s comments and suggestions and people often felt their views were ignored. Complaints were not processed effectively and some people were left dissatisfied with their care. Feedback was not used as a learning opportunity to improve people’s care experience. Staff tried to support people’s cultural needs but found it difficult to engage with some people due to language differences. Where possible, people were supported to remain in their own homes at the end of their life, if they wished.

The service was not well led. Although there had been some improvements in medicines management since the last inspection; there was still no policy for the use of PRN medicines. There had not been sufficient improvement in overall governance and quality assurance. Quality assurance processes were still not effective and had not identified some of the concerns we had. The registered manager said they had recruited to new roles and had been focusing on staff development but now they

This inspection took place on 5 September 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to visit the office, talk with staff and review records. Phone calls to people and staff were completed on 6 and 8 September 2017.

The service provides personal care and support to people who live in their homes in and around the Bassetlaw and Sherwood area of Nottinghamshire. At the time of this inspection between 90 and 100 people received support from the agency, most of whom received support with their personal care needs.

The service is required to have 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 2008 and associated Regulations about how the service is run. At the time of our inspection there was a registered manager in post.

Improvements were required to some records to ensure they were accurate and complete; including medicines administration record (MAR) charts, care plans, risk assessments and investigations into complaints. In addition, systems and processes designed to assess, monitor, improve services and reduce risks to people were not always effective. Some policies and procedures contained out of date information and did not always fully cover the procedures operated by the service.

Risks were not always fully identified and information on the actions required to reduce risks had not always been included in people’s care plans and risk assessments.

There was a risk that people would not receive their medicines consistently and as prescribed as care plans were not in place for when people received care with their medicines and creams. Records for medicines administration were not always complete or accurate.

People felt safe with the care staff provided and staff had been trained in how to identify and act on any suspected signs of abuse. Staff had been trained in areas relevant to people’s needs and their competency to provide care to people was checked.

Sufficient numbers of staff were suitably deployed to meet people’s needs. Recruitment processes were in place and had been followed. Staff received supervision and feedback on their performance; any shortfalls were identified with individual staff so they had the opportunity to develop and improve. Staff felt supported by the registered manager.

Staff checked people consented to their care before this was provided. Where a person lacked the capacity to consent to their care, the provider had a policy and procedure in place to follow to ensure their care would be provided in line with the Mental Capacity Act 2005.

People were cared for by staff who were kind and thoughtful. Staff promoted people’s dignity and privacy. People were involved in planning and reviews of their care and support and their views were respected.

People received care so that they received sufficient food and drink that met with people’s known preferences. Staff understood when to involve other healthcare professionals to ensure people maintained good health.

People received personalised and responsive care and were involved in reviewing what care they needed. People knew how to raise any worries or concerns should that be needed. A process was in place to investigate and respond to complaints. The registered manager was approachable and sought people’s views on the quality of the service.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.