About the service: The service is a domiciliary care agency which provides personal care to people living in their own homes throughout Northumberland. At the time of this inspection there were 60 people using the service.

People's experience of using this service: There were significant shortfalls in the leadership and management of the service which impacted on the quality of care people received. The provider and registered manager failed to adhere to registration regulatory requirements. Robust governance was not in place and subsequently audits and checks had been ineffective in driving the necessary improvements.

Policies and procedures were not properly implemented or followed by staff. Consequently, there were many aspects of the service which were non-compliant with regulations and exposed people to the risk of harm. Most relatives raised concerns about the care their family members received and several whistleblowing allegations were made by staff.

The service was not safe. Systems to identify, monitor, record and report matters which could be a safeguarding issue were not followed properly. Safeguarding incidents and allegations of abuse had not always been properly managed or reported as necessary to the relevant authorities which meant people were at risk of a reoccurrence.

Risks to people's health, safety and welfare had not been adequately assessed. Specific risks were not recorded, meaning people were not protected as much as possible from harm. Medicines were not managed properly which led to multiple errors.

Recruitment processes were not robust. Recruitment checks were not always followed up. There were not enough staff employed to meet people’s needs and wishes. Staff were not properly inducted or suitably trained to ensure they had the skills and competence to carry out their role.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice .

Formal consent to care and treatment was not always sought. Relatives who did not hold the legal right to make decisions were instructing staff on how to deliver care to their family member. Assessments of people’s needs and the care arranged did not always meet best practice guidance. Staff were not always proactive with referring people for additional help from external professionals.

Complaints were not always managed in line with the company policy and procedure. Relatives told us they had frequently complained about the service and expressed dissatisfaction with the service their family members received.

Person-centred care planning was not embedded into the service. Care records were often generic and not related specifically to each individual. Records were not always accurate or completed.

People supported by regular, experienced care workers experienced better outcomes than those who were not. Although there had been allegations of neglect and ill-treatment of people, there were other people who told us their privacy and dignity was respected and their care workers were caring and kind.

We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, safeguarding, complaints, good governance, staffing, recruitment and consent. We also identified one breach of the Care Quality Commission (Registration) Regulations 2009, entitled, Notification of other incidents.

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

Rating at last inspection: This was our first inspection of this service since it’s registration in March 2018.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections