The inspection took place on 19 September 2018 and was announced.

This service is a domiciliary care agency. It provides personal care to older people living in their own homes. The agency provided personal care to 23 people at the time of our inspection.

There was a registered manager in place. 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 our last inspection we identified concerns in relation to the agency’s recruitment procedures. We also found medicines were not managed safely and that people’s care plans were not reviewed regularly enough to ensure they reflected their needs. Staff had no travelling time between their scheduled care visits, which meant people’s visits were often delayed. Staff did not have opportunities to discuss their performance or their training and development needs with their managers. Spot checks had not been carried out on some staff, which meant the registered manager could not be sure they were providing consistent and effective care. Some people were dissatisfied with the agency’s communication with them.

At this inspection we found improvements had been made. Staff had been recruited safely and people’s medicines were being audited to ensure they were being administered correctly. People’s care plans had been reviewed and updated where necessary. Staff had travelling time built into their rotas. Staff had received one-to-one supervision, which provided them with opportunities to discuss their professional development and training needs. Spot checks had been carried out to check that staff were providing care safely and in the way people preferred. A care co-ordinator had been recruited, who had contacted all the people using the agency to hear their views about the service they received.

Although improvements had been made in these areas, we identified further improvements that the registered manager needed to make to ensure the service was well-led. Most people reported that communication from the agency’s office had improved since our last inspection and that, as a result, they could access the information they wanted when they needed it. However, some people told us that they could not always contact the office when they needed to and had to leave messages, which were not always responded to. We have made a recommendation about this.

Staff attended safeguarding training and understood their responsibilities in terms of recognising and reporting abuse. Staff understood any risks involved in people’s care and managed these well. The provider had developed a contingency plan, which prioritised the delivery of care to people most at risk in the event of an emergency. Staff helped people keep their homes clean and maintained appropriate standards of infection control.

Staff had access to the training they needed to carry out their roles. People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff had received training on the MCA and understood its principles. People’s nutritional needs were assessed during their initial assessment and any dietary needs recorded in their care plans. Staff understood people’s healthcare needs and supported them to maintain good health.

Staff were kind and caring. People had developed positive relationships with their care workers and enjoyed their company. Relatives said staff treated their family members with respect and maintained their dignity when providing care. Staff supported people to maintain their independence wherever possible.

Care plans provided guidance for staff about people’s needs and the way they preferred their care to be provided. The agency was not providing end-of-life care at the time of our inspection, alth

The inspection took place on 13 April 2018 and was announced.

Crest Care Services Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults, some of whom may be living with dementia, and younger disabled adults. There were 31 people using the agency at the time of our inspection and ten staff were employed to provide their care. Most of the people who used the service were older people but some were younger adults.

There was a registered manager in place at the time of our inspection who was also the agency’s owner. 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 last inspection of the service on 1 December 2016 the provider was breaching three regulations of the Health and Social Care Act 2008. The provider had not informed CQC or the local authority when an allegation of abuse was made. The provider had failed to ensure that staff had completed appropriate training for the work they performed. The provider had not established systems to assess, monitor and improve the quality of the service.

Following our last inspection the registered manager sent us an action plan setting out how they planned to address the concerns identified.

At this inspection we found that not all the actions the registered manager said they would take to improve had been implemented. For example the action plan stated that spot checks on staff would be increased to ensure that the care people received was safe and effective. We found at this inspection that spot checks had not been carried out as the action plan said they would.

We also identified concerns in relation to the safety and effectiveness of the service. The registered manager had not ensured that all relevant checks had been carried out on staff before they provided people’s care. Staff attended online medicines training but the registered manager was unable to demonstrate that their competency had been properly assessed before they began to administer medicines. The registered manager told us that medicines audits were completed each month but there was no evidence that a medicines audit had been carried out since May 2017.

Staff did not have sufficient opportunities to discuss their performance or their training and development needs. The Provider Information Return (PIR) returned by the registered manager stated that staff had regular supervisions but we found this not to be the case. All the recorded supervisions had been carried out by the assistant manager, who left the agency in July 2017, or the care co-ordinator, who left the agency in December 2017. The registered manager told us they had not carried out any supervisions themselves and staff feedback indicated that they did not receive regular supervision.

Although each person had a care plan, we found that these had not been reviewed often enough to ensure they accurately reflected people’s needs. The registered manager stated in the PIR that people’s care plans were regularly reviewed but there was no evidence to support this statement. Staff had no travelling time between their scheduled care visits which meant people’s care visits were sometimes delayed.

Since the resignations of the agency’s assistant manager and care co-ordinator the registered manager had assumed sole responsibility for the management of the agency. Some people told us this had negatively affected their experience with the agency. They said the registered manager was not always helpful when they wished to discuss issues with them. Some people told us they could not always get a response from the office when they needed to and that messages

The inspection took place on 1 December 2016 and was announced.

Crest Care Services provides care and support to people in their own homes. The service provided personal care to 32 people at the time of our inspection. Most of the people who used the service were older people but some were younger adults who needed support due to disability.

The provider had not acted appropriately when safeguarding concerns were raised. The provider had recently been made aware of an allegation made about one member of staff. The provider had not followed the local multi-agency safeguarding procedures or notified CQC about the allegation.

Since our inspection, the provider has referred the allegation to the local safeguarding authority and submitted a statutory notification to CQC.

Staff were aware of their responsibility to report any signs or allegations of abuse and how to report these concerns. The provider carried out appropriate checks to ensure they employed only suitable staff. People who received support with their medicines said staff gave supported them to take their medicines safely and on time.

The provider had not always ensured that staff had the training they needed to deliver care effectively. Staff who had worked for other care agencies told us they had completed all elements of mandatory training with another employer. They said they had not attended mandatory training since joining Crest Care Services or been required to provide evidence that they had this training.

There were some inconsistencies in the monitoring of the care provided by staff. Some staff had been assessed in ‘spot checks’ carried out by the provider but others had not had a spot check since they started work for the agency.

Care had not always been planned effectively in the past, which had affected the service people received. Several people said they had difficulty getting through to the office and often had to leave messages. Some people told us their messages were responded to but other people said their calls were not returned.

People told us they felt safe when staff provided their care. They said staff understood how to support them safely. People said staff took appropriate steps to keep their property secure. Risk assessments had been carried out to ensure that people receiving care and the staff supporting them were kept safe and staff knew how to respond in the event of an emergency.

People usually received their care from staff who were familiar to them, which they told us was important to them. They said their regular carers understood their needs and knew how to provide care in the way their family members preferred. Some people said new staff were not always adequately briefed before they provided their care. They said this meant they had to instruct new staff how to provide the care they needed.

People told us their care workers had never missed a visit. They said their care workers stayed for the allocated time of the visit and confirmed this was sufficient to provide all the care they needed. Staff attended an induction when they began work, which had included shadowing an experienced colleague. Staff had access to appropriate management support from the provider.

The provider worked with the local authority to ensure people’s care was provided in line with the Mental Capacity Act 2005. Staff understood they should not provide care without consent and people said their care workers always asked for their permission before they provided their care.

People who received support with meal preparation were happy with this aspect of their care. The agency worked co-operatively with people’s families to ensure their healthcare needs were met. Relatives said staff responded appropriately if their family member became unwell and kept their families informed.

People were supported by kind and caring staff. People said staff were friendly and treated them and their property with respect. They told us staff treated them as in