This inspection visit took place on 19th November 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. At the time of the inspection around 30 people were using the service.

There was a registered manager working at the service. 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 at this service was also the provider and will be referred to as such throughout this report.

At the last inspection of this service, we rated the service overall as requires improvement. This was because people had not received good quality care and risks to their safety had not been managed well. This resulted in the provider being in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of care to at least good. At this inspection we found that the required improvements had not been made. The provider continued to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one regulation of the Care Quality Commission Registration Regulations 2009. Therefore, the overall rating for the service is now inadequate and the service 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 act 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 provider had continued to fail to ensure that robust governance systems were in place to monitor the quality and safety of care people received. Due to these poor systems, the provider could not be assured that people had received their medicines correctly. Also, people had been exposed to risks to their safety which had resulted either in actual harm or risk of harm.

Analysis of incidents, accidents and concerns raised had not taken place to promote a learning culture. CQC had not been notified of some incidents that we are required to be notified by law. Where we had been notified, this had not been completed in a timely manner.

The provider had not ensured there were enough care staff working for the service to cover the care visits requi

This announced inspection took place on 9 November 2017. Charing Cross Centre provides support to people in their own homes. It does not provide nursing care. At the time of our inspection, the service was supporting approximately 28 people. The inspection was carried out in order to follow up some concerns we have received since our last inspection which took place in February 2017.

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.

At this inspection we found five 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

The appropriate pre-employment recruitment checks had not always been completed for new staff, such as references and a DBS (Disclosure and Barring list check) before staff began working in the service.

Risk assessments were not always completed concerning people’s individual conditions and staff had not always followed recommendations from health care professionals.

Staff did not always receive adequate training to deliver their roles effectively. Some staff had limited English language skills which meant they were not always able to understand and communicate about training.

There were no effective quality assurance systems in place to assess, monitor and improve the service. Accurate records were not always kept in respect of people’s care. There were no systems in place to check that the content of care plans was relevant with enough individualised guidance for staff about people. Checking of staff competency had not been recorded, and it had not been identified where gaps were found in people’s recruitment files.

Staff did not all have knowledge of safeguarding and how to report concerns. Medicines were administered as prescribed, but improvements were needed around the care planning of some medicines taken as required (PRN).

Care plans contained information about the care that people required, however they were not always reviewed and updated. Care plans did not contain any information about people’s mental capacity.

There were enough staff to complete the visits planned. Staff were split into teams to ensure as much consistency as possible.

Staff were caring and respected people’s dignity, privacy and independence. They involved people’s families in the care planning and delivery where appropriate. Staff gave people choice and were flexible in their approach. However, there were not systems in place which ensured staff were caring and compassionate.

This announced inspection took place on 22 February 2017. Charing Cross Centre provides support to people in their own homes. It does not provide nursing care. At the time of our inspection the service was supporting approximately 19 people.

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.

People and relatives felt people receiving the service were safe. Risks to people were identified and responded to. Staff demonstrated an awareness of adult safeguarding and knew how to report concerns. Medicines were managed appropriately and there were checks in place to help ensure this.

People and relatives told us timing of calls could sometimes be an issue as sometimes staff were later than expected. Most people and relatives we spoke with told us this did not cause a significant problem. Where people required support with eating and drinking this was provided. Staff liaised with healthcare professionals, where appropriate, to ensure people received the health care required.

Most of the staff had received the training the provider had identified as mandatory. However, we found some occasions where staff had not received this training, although they had prior experience and training from previous roles. We have made a recommendation that the provider take action to ensure that staff working in the service has received the training that the service has identified is required.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA. Staff and the management team understood the MCA and how this impacted on the support they provided.

The provider had in place a clear ethos of providing compassionate and caring support. We found staff demonstrated these values. People and relatives confirmed that support was provided in a kind, caring, and respectful manner. Staff supported people to be as independent as possible and consulted them regarding the support provided.

People and relatives felt involved in the planning and provision of the support. The provider ensured staff knew people’s individual preferences and needs. Support was provided in a way that met these.

The provider responded to complaints and took action to resolve issues. People and relatives told us they knew how to raise complaints and felt comfortable to do so.

The service understood the importance of a positive culture. They had developed values and an ethos which included the manner in which they wanted staff to work. They took action to ensure sure staff understood this.

People and staff were involved in the service; their opinions and comments were listened to and used to help develop the service. Staff, people, and relatives, were positive about the registered manager and their leadership. The registered manager monitored the quality of the service and took action when needed.