This was an announced inspection which took place on 20 September 2018.

Dravens Healthcare is a is a domiciliary care agency. It provides personal care to people living in their own homes. It currently, provides a regulated activity to 30 people with various needs.

At the last inspection, on 03 and 04 July 2017, the service was based in the West Midlands and rated as requires improvement in all five domains. This meant that the service was rated as overall 'Requires Improvement.' There were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to make improvements to the areas we identified as requiring attention. It was intended that any improvements made should be to at least a Good rating.

We received a provider action plan in August 2017 to tell us how they would meet the relevant legal requirements. That is, how they would use safe recruitment procedures, how they would ensure staff were competent to carry out their role and how they would monitor the quality and safety of the services they provide.

They told us they would complete these actions by of the end of January 2018. We found that these actions had been completed.

At this inspection the service had moved and was based in Buckinghamshire; it had been dormant from October 2017 to January 2018. We found four domains had improved to Good. This meant that the overall rating had improved to Good.

Staff were safely recruited and all necessary checks were completed. People were protected from abuse. Staff understood their responsibilities and what action to take if they identified any concerns. The service identified health and safety, safe working practices and individual risks to people. However, written individual risk assessments were not always detailed. The service did not administer people’s medicines. However, they did prompt people to take them and their responsibilities with regard to people’s medicines was not always clear.

The staff team were inducted and trained to enable them to offer people effective care. They met people’s diverse needs including their current and changing health and emotional well-being needs. The service worked with health and other professionals to ensure they offered individuals appropriate care.

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 supported this practice.

The staff were kind and caring and promoted people’s privacy and dignity. The same staff provided support to people as much as possible which assisted people and staff to develop positive working relationships.

The service was person-centred and responsive to people’s diverse, individualised needs. Care planning was individualised and regularly reviewed which ensured people’s current needs were met and their equality and diversity was respected.

The registered manager (who was also the provider) was described as supportive and approachable by the staff team. They had been leading the team since 2017. The registered manager did not tolerate any form of discrimination relating to staff or people who use the service. The quality of care the service provided was assessed, reviewed and improved, as necessary.

This inspection took place on 03 and 04 July 2017 and was announced. This was the first inspection since this service was registered in April 2017. We brought the inspection of this service forward as a local authority told us they had suspended this service due their concerns.

Dravens Healthcare is a domiciliary care service registered to provide personal care to people within their own homes. At the time of the inspection the service was providing support and personal care to seven people.

The service had a registered manager who was also the registered provider for this 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.

People were not supported by staff that had been safely recruited. Assessments of risk had not been completed by trained competent people and these assessments did not provide staff with detailed guidance about how to reduce and manage these risks. People were supported by a small team of staff including the registered provider. This meant she was not able to manage the service effectively. People told us they felt safe when being supported by staff providing their care.

Staff had not completed an induction with the provider but some staff had completed training in their previous employment. Not all staff had completed training in relation to the Mental Capacity Act and staff were not fully aware of the principles of the act but knew they must obtain people’s consent before providing their care. Some staff supported people with their food preparation when they had not completed essential training to ensure they did this safely. Detailed information was not available for staff to refer to about people’s specific dietary requirements and preferences.

The lack of systems in place had not impacted on the care people received who told us that staff were kind, caring and promoted their dignity. People and relatives were happy with the care that was provided and told us they felt involved in the way their care was delivered.

People’s care plans were task focused and lacked personalised information about them for the staff to refer to. People and relatives confirmed they had been involved in the assessment and care planning process and confirmed that people’s needs were met. A complaints procedure was in place and people and relatives had no concerns to share but felt confident to raise any issues.

The provider was not initially able to join us for our inspection so we gave them time to make suitable arrangements to enable them to be present. The provider failed to send us all of the required information we had asked for within the timescales we gave. The provider had not completed any audits or had effective systems in place to enable them to assess, and monitor the quality and safety of the service provided. Staff felt supported but there were no formal systems currently in place to demonstrate how this support was provided. People and relatives told us they felt the registered manager [the provider] was approachable and they were happy with the service they received.

We found the provider was in breach of some of the Health and Social Care Act 2008 regulations. You can see what action we took in response to these breaches at the back of this report.