About the service: Continuity Healthcare Services Ltd is a domiciliary care agency. It is registered to provide personal care to people in their own homes, including, older people, people with mental health care needs, and people living with dementia. At the time of the inspection visit the service supported 120 people.

People’s experience of using this service:

• People had not always received their care visits at the times expected.

• Staff understood how to keep people safe and protect them from avoidable harm.

• People’s needs were assessed to ensure they could be met by the service.

• Staff knew about the risks associated with people’s care and management plans had been completed for all identified risks.

• Staff were recruited safely, and there were enough staff to provide the care and support people required.

• Staff completed training to support people with medicines, but staff competency was not checked to ensure they did this safely.

• There were safe procedures to prevent the spread of infection.

• Staff received training and support to be effective in their role.

• People made their own decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.

• Where required people were supported to meet their nutritional needs and to maintain their health and well-being.

• Staff were caring and respected people’s rights to privacy and dignity.

• People were involved in planning their care and were consulted about the care provided,

• Care plans contained the information staff needed to provide personalised care.

• Systems were in place to manage and respond to any complaints or concerns raised.

• The provider understood their regulatory responsibilities and had effective processes for assessing and monitoring the quality of the service.

Rating at last inspection: Requires Improvement. We rated the service requires improvement in all areas and found two breaches of the regulations. The last inspection report was published on 4 May 2018.

Why we inspected: This was a planned inspection based on the date and the rating of the previous inspection. We had also received concerns about the service that we had referred to the local authority and to the provider to investigate which we needed to review. The overall rating for the service has changed to good, with improvements required in the key area of safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

The inspection site visit took place on 27 and 28 February and 3 April 2018 and was announced. The inspection was prompted in part by information of concern received from a member of the public, about the standard of care being provided.

Continuity Healthcare Services is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to adults with different needs, including dementia, physical disabilities and learning disabilities. The service provides twenty four hour support to two people. There were 38 people using the service at the time of our inspection visit.

At the last inspection in January 2017, the service was rated Good overall. However at this inspection we found improvements were required in the provider’s understanding of their responsibilities as the registered person. They had not ensured that systems were established and carried out to effectively assess, monitor and improve the safety of the service, or assess, monitor and mitigate the risks relating to the health and safety of people who used the service. They had not maintained accurate and complete records for people and their governance system did not ensure their practice was always evaluated or improved. Therefore the rating has changed since our previous inspection, from Good to Requires Improvement overall. This is the first time the service has been rated Requires Improvement.

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 registered manager was also the provider, therefore we will refer to them as the provider throughout the report.

The provider lacked some understanding of their responsibilities as a registered person to have oversight and to ensure that systems were maintained to effectively manage events to keep people safe and to evaluate events to make improvements to the service. An allegation of abuse had not been referred to the appropriate authorities. Some staff had gaps in their knowledge of essential issues, such as safeguarding adults. There was a lack of consistent and central recording of events, including incidents, safeguarding concerns, complaints and medicine errors.

We found processes to monitor the quality of service were not always effective and improvements were required in the way the service assessed, monitored and improved the quality and safety of the service for people. Audits were not always followed up to ensure action had been taken where improvements were required.

People’s records were not always complete and accessible. Care plans contained gaps and were not always accurate. We found some identified risks relating to people’s needs had not been assessed in full on their care plans. Staff records contained gaps. It was not clear what care qualifications staff had or when the provider had checked staff’s suitability to work with people who used the service.

There were gaps in the provider’s understanding of their responsibilities in relation to the Mental Capacity Act 2005 [MCA] and improvements were required to ensure people’s capacity was assessed where required and consents were obtained in accordance with the MCA.

People told us individual staff members were caring. Staff knew people well and understood their likes, dislikes and preferences for how they wanted to be cared for and supported. Staff respected people’s right to privacy. People were supported to eat and drink a diet that met their needs and preferences. They were supported to maintain their health.

People were confident to raise any concerns or complaints about the service, however improvements were required in the way people’s feedback about the service was manage

Continuity Healthcare Limited is registered as a domiciliary care service to provide personal care and support to people in their own homes. At the time of our inspection visit the agency supported 16 people with personal care and employed 12 care workers.

We visited the offices of Continuity Healthcare Limited on 18 January 2017. We told the registered manager before the inspection visit we were coming so they could arrange for care workers to be available to talk with us.

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 2008 and associated Regulations about how the service is run

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely.

Care workers understood how to protect people from the risk of abuse and keep people safe. Care workers suitability and character was checked during the recruitment process to make sure they were suitable to work with people who used the service.

The registered manager understood the principles of the Mental Capacity Act 2005 (MCA), and care workers respected people’s decisions and gained people’s consent before they provided personal care.

There were enough care workers to deliver the care and support people required. People told us care workers arrived at the time expected and stayed long enough to complete the care people required. People said they were supported by care workers who they knew and felt comfortable with. People told us care workers were kind and knew how they liked to receive their care.

Care workers received an induction when they started working for the service and completed regular training to support them in meeting people’s individual needs effectively. People told us care workers had the right skills to provide the care and support they required. Support plans and risk assessments contained relevant information for staff to help them provide the care people needed in a way they preferred.

People knew how to complain and information about making a complaint was available for people. Care workers said they could raise any concerns or issues with the management team, knowing they would be listened to and acted on.

Staff felt supported to do their work and people felt able to contact the office and management at any time. There were systems to monitor and review the quality of service people received and understand the experiences of people who used the service. This was through regular communication with people and staff, returned surveys, spot checks on care workers and a programme of other checks and audits.