The inspection took place on 30 March 2017 and was announced.

Complete Professional Care Medway Limited is registered as a domiciliary care agency providing personal care to people living in their own homes. The agency was centrally situated in the Hempstead area of Gillingham in Kent and provided a service to people living in the surrounding areas. There were approximately 34 people receiving support to meet their personal care needs on the day we inspected. Some people were living with dementia and some people had physical health needs, mobility difficulties or were frail.

The provider also ran a small care home and an established small day care centre from the same premises.

We last inspected this service on 23 and 26 February 2016 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 18, Staffing, Regulation 17, Good Governance and Regulation 19, Fit and proper persons employed. Recruitment records were not adequate to keep people safe from receiving care from unsuitable staff. One to one staff supervisions were not held to support and develop staff. The provider did not have a quality monitoring process in place to ensure a safe and good quality service was being provided.

We asked the provider to take action to meet Regulations 17, 18 and 19. At this inspection we found that some improvement had been made to address the breaches from the previous inspection, although other necessary improvements had not been made and further breaches of regulations were found.

The provider did not send an action plan following the publication of their last report as requested and were sent a reminder. We did not receive an action plan but an email, on 17 May 2016, following our reminder, stating they had carried out all the improvements necessary to meet the requirements of the regulations. We asked for further clarification regarding the information set out in the email they sent on 17 May 2016. We sent an email on 02 June 2016 but received no response. We found evidence that the provider had not in fact carried out the actions they said they had undertaken.

There was a registered manager based 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 was absent when we visited, and had been since 27 October 2016. We received a notification to inform us the registered manager was absent, however, this was not sent until 27 March 2017. No arrangements had been made to replace the registered manager to provide the management and leadership of the service in their absence.

During the inspection, as the registered manager nor the provider were available, we had access to the nominated individual of the provider to answer any questions we had. The nominated individual is a person involved with the service that the provider has informed CQC is the individual they have nominated to provide information on their behalf.

We found that recruitment records were now in order and the provider made sure they had a more robust system in place to check that the new staff they were employing were suitable to work with vulnerable people in their own homes.

Some basic individual risk assessments had been undertaken to help keep people safe from circumstances that might harm them. However, when people were faced with risks that were different to those already identified, or when people’s circumstances changed, these were not recorded with measures to control and manage the risk to keep people safe from harm.

When staff administered medicines in people’s own homes this was not managed well. Documents to record when staff had admin

We inspected the service on 23 and 26 February 2016. The inspection was announced.

Complete Professional Care Medway Ltd is a domiciliary care agency which provides personal care to people, including people with dementia and physical disabilities, in their own home. The agency provides care for people in the Medway area and the office is situated in Hempstead, Rainham. There were 32 people receiving support to meet their personal care needs on the day we inspected.

There was a registered manager employed 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 manager had recently been appointed and had been through the CQC registration process. Their application had been successful and they were awaiting their certificate of registration.

The service did not have robust recruitment practices in place to keep people safe from receiving care from unsuitable staff.

Ongoing supervision and appraisal of the manager was not maintained to enable them to carry out their role effectively. Staff did not have adequate one to one supervisions to support them in their role and ensure their personal development needs were taken care of. Observational assessments of staff had not taken place to ensure they were performing well in their role while supporting people in their own home.

People had not had the opportunity to give their views of the service provided either through visits by the manager or provider, or by questionnaires. The provider did not have systems and processes in place to monitor the quality and safety of the service and therefore make improvements.

People were kept safe from abuse by staff who had received the correct training and had access to guidance and advice through an up to date safeguarding procedure. Staff understood their responsibilities in safeguarding vulnerable adults and could give good examples of when they would report concerns.

Staff received regular training in all the mandatory areas with regular updates. Training in more specialist areas such as dementia awareness and sensory impairment were also provided as necessary.

Staff had a good understanding of the basic principles of the Mental capacity Act 2005 (MCA ). However only a minority of staff had received training in the subject. We made a recommendation about this.

Individual risk assessments were person centred and thorough. Staff had the information necessary to make sure they were able to give people safe support that helped to maintain their independence. Environmental risk assessments considered the risks that may be encountered in people’s individual homes and within the local area. These measures helped to keep people and staff safe from potential risks that may be encountered.

There were sufficient staff available to provide the support necessary to people living in their own homes. People and their family members reported that missed calls rarely happened. The manager strived to ensure people had support from the staff they knew and liked best. Most people reported that this was the case.

The provider had a medicines procedure in place and staff received training in order to administer people’s medicines safely. Many people preferred to administer their own medicines. People were supported to remain as independent as possible taking their own medication, with support in place to help them to do this safely.

People were supported to maintain their health and wellbeing and staff were proactive in supporting people to make appointments or referring people themselves to health care professionals.

The staff had a good approach to their role, telling us that they loved their job. We had good feedback from people and their family