The inspection took place on the 22 and 23 August 2018 and was announced. This was the services’ first comprehensive inspection since they registered with the Care Quality Commission on 15 August 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own houses, specialist housing and flats in the community. It provides a service to older adults. At the time of our inspection 50 people were using the service.

The service had not had registered manager for eight months. There was a branch manager who was currently in the process of becoming 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 at the service did not have robust risk assessments as they were not accurate and did not include details about people obtained as part of their needs assessment or initial assessment of need. We found medicine’s, falls and nutritional risk assessments incorrectly completed.

Medicines management was not robust. The level of support people received did not always correspond to the assessment of need. Medicine administration records were not always completed accurately and had medicines listed that were no longer prescribed.

Staff knew what abuse was and who to report an allegation of abuse to. However, not all staff were aware of the whistleblowing procedure and where to report concerns outside of the service.

Staff recruitment improved in later files we viewed. Pre – employment checks and references were now verified in all cases and staff had to complete criminal records checks before commencing employment. The service had introduced competency assessments in maths and English for new staff joining the service.

People told us they felt safe in their home with staff at the service but staff did not always arrive on time especially at weekends.

Staff received a full induction which included mandatory training and training in the care certificate. Staff received regular supervision where they were informed about their current performance and areas for improvement.

People received an assessment of needs and people told us they thought staff were good at their jobs.

People were supported with nutrition and hydration if they had been assessed as needing support in this area. Some nutritional support staff provided was outside the remit recorded in the care plan and risk assessment. We informed the branch manager of this.

People were encouraged to make their own decisions and where people lacked capacity Mental capacity assessments were carried out but in some cases these were not completed correctly. We have made a recommendation about the understanding of the Mental Capacity Act 2005.

People were supported to maintain good health as staff from the service helped them to access health professionals as needed.

People thought staff were kind and caring and respected their privacy and dignity. Relatives were not so positive and had not so good interactions with staff from the service.

People’s spiritual and cultural beliefs were respected and supported by staff and the service was inclusive and non-discriminatory.

People’s confidentiality was respected and staff did not discuss people outside of the service.

Care plans were person centred and gave information about the person so staff at the service could get to know them. However, care plan reviews did not take place in a timely manner and where reviews did take place information from the reviews was not updated promptly on people’s care plan.

Call monitoring records showed that staff were not arriving at the correct times or staying for the duration of the call which meant care was not always responsive to people’s needs.

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