We inspected Direct Source Limited on 4 and 20 December 2018. Direct Source Limited provides domiciliary care and support for people living in their own homes. Direct Source provides a service to people living in Gloucester, Cheltenham, Stroud and Tetbury. At the time of our inspection there were 22 people who were receiving personal care. The service provided care for people with long term health care conditions, older people, people with physical disabilities and people living with dementia. Care staff provide a service to people who need assistance with aspects of their care including mobility needs, personal hygiene and eating and drinking.

We last inspected the service in April 2018 and found that the provider was not meeting the requirements of the regulations. We therefore rated the service as ‘Inadequate’ at the previous inspection. We found the provider had not always ensured staff were competent, suitably qualified and skilled to complete their work. There were inadequate and non-existent systems with ineffective leadership to ensure compliance with the legal requirements. All staff employed did not have appropriate security checks in place. Care and treatment was not provided in a safe way and people were not always protected from potential abuse or harm. The provider had not ensured that the care and support people received met their needs and reflected their preferences. People’s complaints were not investigated fully.

Following our inspection in April 2018, the service entered Special Measures.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. We imposed a number of conditions on the registration of the location following our April 2018 inspection to ensure the provider made the required improvements. These included seeking agreement from CQC for any new packages of care and providing us with regular service improvement updates. Following the inspection, we met with the provider discuss the actions they were planning to take to meet the regulations.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At our inspection on 4 and 20 December 2018, there was a registered manager in post. The registered manager was also the provider. They had appointed a manager, who they were supporting through the registration process with CQC. 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.

Following our previous inspection the provider had implemented systems to monitor and improve the quality of service people received. Some of these systems had been used to drive improvements around the management of people’s prescribed medicines. However, some systems had only recently been implemented and therefore more time was needed before we could ascertain the impact they had on driving the quality of the service. Additionally, some systems required additional work to ensure they were effective.

People and their relatives spoke extremely positively about the care they received and how staff cared for them. They felt their views and concerns were responded to. The provider ensured people’s complaints, concerns and views were recorded and acted upon. People felt safe when being assisted by staff and felt staff had the skills and support to meet their needs.

Staff were positive about working for the provider. Staff were being supported to attend and complete training and had access to the support they required. Followin

Direct Source is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

Not everyone using Direct Source receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of this inspection Direct Source were supporting 28 people. The majority of these people were living in the county of Gloucestershire.

We carried out a comprehensive inspection of this service on 27 April 2018. We carried out this inspection due to concerns raised by the local authority safeguarding team, contracts team and the police. This was Direct Sources’ first inspection since they were registered with the Care Quality Commission (CQC). 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.

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.

A potential safeguarding event had been inappropriately managed by the registered manager. Their actions could have put other people who used the service at risk of experiencing harm. The registered manager had not consulted with the appropriate agencies and followed their advice. They had not checked or taken action to ensure that people were safe who received support from Direct Source. Staff also had a limited knowledge about the actions they could take to respond to safeguarding concerns about people potentially experiencing abuse and harm.

Required checks for new staff were not always completed. Staff did not have full employment histories with any gaps in their employment histories identified and explained. Sources of references were not clarified and other security checks were not in place, when staff started working at the service. Concerns raised did not alert the registered manager to review Direct Sources’ recruitment practices.

People did not have full and detailed risk assessments with a detail