The inspection took place on 10 and 11 July 2018.

Direct Health Leicester is a ‘domiciliary care service.’ People receive personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates the care provided, and this was looked at during this inspection. The service provides personal care for older people and younger adults. This was the first inspection of the service. It was a comprehensive inspection. The quality compliance manager stated that 67 people were receiving a personal care service at the time of the inspection.

The inspection was announced because we wanted to make sure that the registered manager was available to conduct the inspection. The registered manager was returning to work after special leave so the inspection was mainly carried out with the care services director and the quality compliance manager.

A registered manager was in post. This is a condition of the registration of 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 and associated Regulations about how the service is run.

We identified concerns about a number of issues. Three requirement notices have been issued due to breaches of regulations in relation to the service not meeting requirements of safe care and treatment, person centred care and good governance.

Staffing was not always in place to always provide people with a safe personal care they needed. Risk assessments were not always comprehensively in place to protect people from risks to their health and welfare.

Policies set out that when a safeguarding incident occurred management needed to take appropriate action by referring to the relevant safeguarding agency. However, some incidents had not been reported to us at the time the service had been aware of them, as legally required.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives. Staff had asked people’s consent when they provided personal care. A capacity assessment was in place to assess whether any restrictions on choice were needed in the person’s best interests.

Staff had largely received training to ensure they had skills and knowledge to meet people's needs, though training on some other relevant issues had not yet been provided.

People and relatives told us that most staff were friendly, kind, positive and caring, though some staff rushed people when providing personal care. Some said they had not been involved in making decisions about how and what personal care was needed to meet any identified needs.

Care plans did not always contain detailed information individual to the people using the service, to ensure that their needs were met. Care plans were not always available to people and staff, which meant a risk that people’s individual care needs would not be met.

People and relatives were not always confident that concerns had been followed up. They were not always satisfied with how the service was run.

Some staff members said they had not been fully supported in their work by management.

Management had not carried out comprehensive audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service.

Staff recruitment checks were in place to protect people from receiving personal care from unsuitable staff.

Most people and their relatives told us that they thought staff provided safe personal care when they were with them. If personal care is not delivered at assessed critical times, then people’s safety cannot be guaranteed.

Staff had been trained in safeguarding (protecting people fro