We inspected this service on 7 and 8 September 2016. This was an announced inspection and we notified the provider two days before our inspection in order to arrange to meet with people who used the service. Desire provides domiciliary care for people who live in their own home in Burton upon Trent, Derby and Birmingham. At the time of our inspection, fourteen people were receiving personal care support from the provider.

The provider was also the registered manager in the service. 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.

On our last inspection in September 2016, we rated the service as Requires Improvement as we found medication audits had not identified where there were potential errors and action had not been taken to review medicine procedures. Formal systems for staff supervision were not completed to ensure staff development and completion of the care certificate were needed. On this inspection we found improvements had been made in these areas. Further improvements were still needed to ensure systems in place to assess and monitor the quality of care to drive improvements within the service. This included where people’s care had been changed and ensuring all information was reviewed to demonstrate how people were supported to manage any complex behaviour.

People felt safe when they received care. Staff understood how to recognise potential harm and protect people from abuse and knew how to report concerns. Recruitment checks were made to confirm staff were of good character to work with people and sufficient staff were available to meet people's support needs.

People had capacity to make decisions about their own care and staff sought their consent before providing care and support. Staff had effective supervision and their work was reviewed through regular checks on their performance and appraisals. People received an agreed level of staff support at a time they wanted it. People were happy with how the staff supported them and were helped to take their medicine as prescribed.

There was a small team of staff who had the skills to meet their needs. People knew who was delivering their support and the provider was flexible and responsive to changes in people’s needs. People received kind and compassionate care and were supported to maintain their dignity, independence and privacy.

People chose how support was delivered and were positive about the way staff treated them. Staff listened to people’s views and people knew how to make a complaint or raise concerns.

We inspected this service on 15 and 16 September 2016. This was an announced inspection and we notified the provider two days before our inspection in order to arrange to meet with people who used the service. This was the first inspection of this service.

Desire provides domiciliary care for people who live in their own home in Burton upon Trent, Derby and Birmingham. At the time of our inspection, ten people were receiving personal care support from the provider.

The provider was also the registered manager in the service. 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 provider did not have systems in place to assess and monitor the quality of care to drive improvements within the service. Where people’s care had been changed, the provider had not ensured reviews had taken place and the records were not changed to reflect people’s current support. Medication audits had not identified where there were potential errors and action had not been taken to review medicine procedures. Formal systems on staff supervision were not completed to ensure staff development and completion of the care certificate. Quality audits within the registered office had not been carried out to ensure the premises were safe.

When staff started working in the service the provider had not completed all the necessary recruitment to confirm staff were of good character to work with people.

Risks to people had been identified and staff understood how to support people to reduce risk and protect them from potential harm and without restricting their rights. However, the support plans did not always include this information.

People told us they felt safe when being supported by staff and staff knew how to protect people if they suspected they were at risk of abuse or harm. Staff understood how to recognise potential harm and protect people from abuse and knew how to report concerns.

People had capacity to make decisions about their own care and their consent was sought before staff provided any care and support. People were supported in such a way as to retain as much control and independence over their lives as they wanted. There was a small team of staff who worked flexibly to enable people to choose when they wanted to be supported.

People were positive about the way staff treated them and said staff were kind and compassionate. People felt comfortable raising any issues or concerns and there were arrangements in place to deal with people's complaints.

People were happy with the staff and felt they were treated in a caring and kind way. People told us staff knew them well. People were encouraged to be independent and their privacy and dignity was upheld in their homes. When people needed support with mealtimes or access to health professionals it was provided for them.

We found 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.