This inspection took place on 19 and 20 April 2017 and was announced. The provider was given 48 hours’ notice because the location provides domiciliary care services; we needed to be sure that someone would be in. Custom Care (Stoke) provides personal care for people in their own homes. At the time of the inspection there were 124 people using the service.

A registered manager was 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.

We carried out a comprehensive inspection on 22 September 2016 and we found the provider was not meeting some of the regulations and the service was placed in special measures. At this inspection we checked to see if the provider was meeting the regulations and we found the provider had taken action to make all the improvements required.

People had confidence in the service and felt safe and secure when receiving support. People told us staff were prompt with attending calls and staff said they did not feel as though they had to rush people with their care. People had risks to their health assessed and staff were knowledgeable about how to minimise the risks. People received support to take their prescribed medicines and staff understood how to administer these safely.

Staff were trained to carry out their role and had the skills to support people effectively. People told us they were supported to maintain a healthy diet and could access health professionals with support from staff as required. We could see people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported by a staff group that were kind and caring and people told us they had developed good relationships with staff. We found people were supported to make choices about their care and support and were enabled to maintain and maximise their independence. People told us their privacy and dignity was protected by staff supporting them.

People received responsive care and support and were involved in their assessment and care planning. Staff took time to get to know people and they were aware of people’s interests. People understood how to make a complaint and they told us they felt complaints would be responded to effectively.

People, relatives and staff all told us they felt the service was open and inclusive. We found the management team were supportive and accessible to people and staff. We found there were systems in place which supported good communication and helped to manage the service effectively. There were quality checks undertaken and these were used to drive continuous improvement.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We completed an announced inspection at Custom Care (Stoke) on 22 September 2016. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to speak with us.

The service provides personal care to people who live in their own homes. At the time of the inspection there were 146 people using the service. There was a branch manager in place who was going through the process of registering with us. 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 on 16 March 2016, we found the provider was not meeting the required standards. At this inspection we needed to check whether the provider had met the requirements of the warning notices which we had issued, following the inspection. The warning notices were issued in respect of Regulation 11 (Need for consent), Regulation 16 (Receiving and acting on complaints) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 and associated regulations 2014. This was because we had concerns that people were not always receiving their care as planned due to the way call times were managed. We also had concerns that medicine recordings were not always accurate. The provider was not always checking if relatives had the legal powers to consent to their relations care. We had further concerns that the provider did not have a process for receiving and handling complaints and that the provider's systems to monitor the quality of the service were ineffective. We undertook this inspection to check that they had followed their action plan and to confirm that they now met the legal requirements. People were still not receiving their care at the agreed times due to the way call times were managed, and due to insufficient staff. People’s risks were not assessed effectively to keep them safe. People were at risk of harm because care records did not always match the support that staff told us people needed to keep them safe.

Medicines were not managed safely as we could not

This inspection took place on 16 March 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to speak with us.

The service provides personal care to people who live in their own homes. At the time of the inspection there were 161 people using the service.

There was a branch manager in place but they were not registered with us. 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.

There was a lack of leadership at the service and although the provider was aware of many of the issues raised during the inspection, there was no one person clearly responsible for driving improvements. People remained unhappy with the service they received and the responses to their concerns, despite the provider having plans for improvement in place.

People told us that staff did not always arrive at the agreed time or stay for the stipulated amount of time. Some people felt that there were not enough staff to provide them with a consistent staff team.

When staff supported them, people told us they got their medicines when they needed them. However we saw that there were gaps in the recording of topical creams for people who required these which meant that people could not be assured that they had received their creams as prescribed.

Care staff knew how to recognise and report suspected abuse to senior staff members, however the manager told us that concerns reported over the weekend would wait until Monday before being reported to the local authority. This was not in line with local safeguarding adults’ procedures and meant there was a risk that immediate concerns to people’s safety and wellbeing may not be addressed.

We found that the principles of the Mental Capacity Act 2005 were not always followed to ensure that people's legal and human rights were respected and consent was not always sought from the relevant person.

People knew how to raise a concern or make a complaint but we found that people did not always receive satisfactory responses when they had done this. There was no effective system in place to receive, investigate and respond to complaints.

People told us they had been involved in the development of their care plans and the plans contained enough information for staff to be able to support them effectively. However, people were not always asked for their preferences in relation to the gender of staff who supported them.

Effective systems for monitoring the quality and safety of the service provided were not in place.

Some people told us they were treated with kindness and compassion and valued the relationships with their regular staff. However, many people did not have a regular staff team and felt anxious that they did not know who would arrive to support them and when.

People told us that staff mostly treated them with respect and dignity and supported them to be as independent as they could be.

Safe recruitment practices were followed and the provider was in the process of recruiting more suitable staff. People’s risks were assessed and monitored.

People told us that staff had the right skills to support them and we saw that staff had completed training and received supervision to support them in their roles. People were supported to eat and drink sufficient amounts and people were supported to access healthcare professionals when required.

We identified three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.