This inspection took place on 10 July 2018 and was announced. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. The inspection team consisted of one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Dresden Care Limited is registered to provide the regulated activity of personal care. This service 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 and younger adults. There were 35 people using this service at the time of our inspection.

Not everyone using Dresden Care Limited receives the 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 last inspection in April 2017, we judged the service as requires improvement in the key questions of safe and well-led and we rated the service Requires Improvement overall. We were concerned because the provider had failed to assess all risks to health and safety and failed to manage medicines. We also had concerns that the provider’s governance system of checks and audits continued to require further improvement.

At this inspection in July 2018 we found some improvements had been made in some of these areas however we still had concerns about the provider's system of checks and audits and also, we had additional concerns. As a result, the service has continued to be rated as Requires Improvement. Despite previous inspections identifying shortfalls in governance systems, we found that insufficient progress or improvement had not been made to the systems and processes to audit and monitor the quality of care provided at Dresden Care Services Limited and to meet the Regulations. We are considering what further action to take.

There was a registered manager in post at the time of the inspection. 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 consistently protected from potential harm due to the provider failing to recognise, report and notify the appropriate safeguarding authorities of potential safeguarding concerns. Risks to people's health and safety were not sufficiently identified and robust risk management plans were not consistently in place. Incidents had not been analysed to identify trends to help prevent the risk of similar occurrences in future. Systems were in place to ensure staff were suitable to work with people in their own homes. People told us there were enough staff available to meet their individual needs. People received their medicines as prescribed.

Staff had not consistently received observational competency assessments to monitor their practice. For example, moving and handling. People told us that staff sought their permission before providing care and support. However, we identified that the registered provider had not consistently understood their obligations under the Mental Capacity Act (2005). People told us they enjoyed the food prepared for them and they chose what they preferred. People were supported to meet their health care needs, when necessary.

People told us that staff who regularly supported them were kind, polite and respected their privacy. People told us they made decisions about how they wanted their care provided. Staff described people’s likes and dislikes and preferred routines.

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Dresden Care Services Limited are registered to provide personal care. They provide care to people who live in their own homes within the community. There were 33 people using this service at the time of our inspection.

At our last comprehensive inspection in January 2016 we found that the registered provider was in breach of regulations. This was because people were not kept safe from the risk of actual and potential harm. Known risks to people were not properly assessed, reviewed or managed. The management of medicines was not safe which meant there was a risk that people would not get their medicines as prescribed. Staff employed by the service had not received sufficient training, development, assessment of competence and supervision. In addition the registered provider did not have robust systems in place to monitor the quality of the service and had not ensured that all complaints, incidents and accidents were reviewed and analysed. Feedback was not being used effectively to support the continual drive of improvement. Following the inspection we met with the registered provider who submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook this announced inspection on 04 April 2017 to check that the provider had followed their own plans to meet the breaches of regulations and legal requirements. We found that the registered provider had addressed some of the concerns that we had identified at our last inspection and had met their action plan and the breaches of regulation. We found that the provider had further improvements to make in respect of medicine management and auditing processes.

There was a registered manager in post who was present throughout the inspection. 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 who received support with their medicines were satisfied but improvement was needed to ensure safe medicine guidance and best practice was followed. People who used the service felt safe because they were supported by consistent and reliable staff. Staff understood their duty and responsibilities to report any allegation or suspicion of poor practice and abuse. There were sufficient numbers of staff working at the service. Where risks had been identified there were plans in place to manage them.

People were supported by staff who were equipped to undertake their role. Staff received training, observational checks and supervision. New staff were supported to complete an induction programme. Staff understood the principles of the Mental Capacity Act (MCA) and respected people’s decisions and gained consent before they provided personal care and support. People’s needs in relation to nutrition and hydration were documented and the staff we spoke were aware of them.

People told us that they were supported by staff who were compassionate and caring. Staff told us that they listened to people and encouraged them to make decisions about how their care was provided. People told us that staff treated them with dignity and respect and their privacy was assured when personal care was being provided.

People told us that they received care and support that reflected their expressed needs and preferences. People told us that the service were responsive to their changing needs. Care plans were personalised and people contributed to these. People knew how to complain and felt confident that concerns identified would be responded to in a timely and accepting manner.

People and staff were confident in how the service was led and the management team abilities. The audit and monitoring processes in place had improved; however

We carried out an announced comprehensive inspection of this service on 12 January 2016. During that inspection breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. At that time systems and processes were not in place to effectively assess, monitor and mitigate risks relating to the health, safety and welfare of people who used the services. Staff had not received adequate training to support them to develop the knowledge and skills required for their roles and there were ineffective quality assurance systems in place for the effective running of the service.

We undertook this focused inspection on the 22 September 2016 to check that they had followed their plan and to confirm that they now met legal requirements. Whilst we found that some improvements had been in some areas, systems in place to monitor and improve the service were not being used as had been planned. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dresden Care Services Limited on our website at www.cqc.org.uk

Dresden Care Services Limited are registered to provide personal care. They provide care to people who live in their own homes within the community. There were 25 people using this service at the time of our inspection.

The registered manager was present during our inspection. 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 had some systems in place to enable them to assess and monitor the quality of the service provided, but these systems were not being used effectively to manage all aspects of the service. People’s experience and views of the service had been sought but feedback received had not been used effectively to continually drive up improvements. Risks associated with people’s care needs were not always appropriately identified in care records.

People told us that they felt safe using the service and that they received care and support from a consistent and reliable staff team. People and their relatives told us there were sufficient numbers of staff to meet people’s individual needs. People told us that they received their medicines as prescribed.

People told us that they were being supported by staff who knew them well and had the appropriate skills to support them. Staff told us that they were being provided with training to enhance their knowledge. We found that some staff had not received training in some key subject areas.

Staff knew how to safeguard people from potential harm and abuse. The provider’s recruitment process had not been consistently applied to ensure that people were supported by suitable staff.

People told us that they received a responsive and effective service to meet their individual needs. People and their relatives spoke positively about the management team.

You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 12 January 2016 and was announced. We gave the provider 48 hours’ notice of our visit because the location provides a domiciliary care service; we needed to make sure that there would be someone in the office at the time of our visit.

Dresden Care Services Limited provides personal care for people in their own home. Dresden Care Services was registered with CQC in December 2014 and this was the service’s first inspection since they were registered. The providers’ representative told us that they did not start providing personal care for people until August 2015. There were nine people using this service at the time of our inspection.

The registered manager was present during our inspection. 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.

Our inspection identified that while some people received good care that met their needs, the quality and safety of the service was not underpinned by systems.

People using this service could not be confident that the provider would be able to keep them safe. People were placed at risk by the lack of clear systems and records to detail what medicines staff were administering. Staff did not receive sufficient medication training and were not checked to see if they were competent to administer medicines. Risk assessments had not been completed to ensure the potential risks to people and staff providing care and support were minimised.

Staff had been appropriately recruited but had not received adequate induction, training and ongoing support to ensure that they had the skills needed to safely support people. Staff did not receive formal supervision, support and appraisal of their performance.

There were a lack of effective systems, processes and oversight by the provider to ensure that they could effectively operate the service. The systems in place had failed to identify that improvements were needed to audit and monitoring systems in respect of medicine administration, development of staff training and support. Monitoring systems needed to be developed; these included a quality assurance system, assessment, monitoring and review of risks to people, and ensuring the service had systems in place to meet the requirements of the Mental Capacity Act 2005.

We found the provider was in breach of Regulations. You can see what action we told the provider to take at the back of the full version of this report.

People who used the service told us that they felt safe when staff were in their home. Staff could describe the systems that were in place to report any allegations of potential harm to people. People we spoke with told us there were sufficient staff to support them and meet their individual needs.

Staff that we spoke with had limited knowledge and had received limited training of how to apply the Mental Capacity Act 2005 guidelines into their practice. Systems were not effective in demonstrating people’s level of capacity and how staff should gain people’s consent when they were unable to make an informed decision.

People were supported with the preparation of meals when necessary. Staff understood the importance of promoting fluids to prevent people from dehydrating. People told us they had access to health care professionals when they required support.

People told us consistently that staff treated them with respect and dignity whilst in their home. Staff knew people well and valued the importance of people making their own decisions.

People told us that the service had been responsive to their changing needs and had responded to their requests when made. People were involved in the initial planning of their care and support needs. People were not always involved or contributed to the reviewing of their individual needs.

People were unsure of the provider’s complaints procedure, but were able to describe who they would report to if they had any concerns or were unhappy with the service provided.