We carried out an announced inspection of Efficiency-For Care Limited on 21 May 2018. Efficiency-For Care Limited is registered to provide personal care and treatment of disease, disorder and injury to people in their own homes. At the time of our inspection, the service provided personal care to two people in their homes.

During our last inspection of the service on 9 October 2017, we found significant shortfalls that placed people at risk of harm. The service was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 in association with risk assessments, medicine management, staff training and good governance. Following the inspection, we took urgent enforcement action to ensure the service made improvements. During this inspection, we found improvements had been made and the service has now been rated Good.

The service did not have a registered manager. There was a manager in place who had applied to be registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Relatives told us that medicines were given on time. However, there were discrepancies in people’s medicine records as records had not been kept of topical cream administration. We made a recommendation in this area.

Risks had been identified and information had been included on how to mitigate risks to ensure people received safe care. Staff were aware of how to identify abuse and knew who to report abuse to, both within the organisation and outside the organisation.

Pre-employment checks had been carried out to ensure staff were fit and suitable to provide care and support to people safely. Staff told us they had time to provide person centred care and had enough staff to support people. There were systems in place to reduce the risk and spread of infection. Staff had been trained on infection control and were provided with personal protection equipment to ensure risks of infection were minimised when supporting people.

Staff had received the training required to perform their roles effectively. This also included specialist training to support people with specific health conditions.

Staff had not been trained on the Mental Capacity Act 2005 and some staff we spoke to did not know the principles of the act. After the inspection, we received confirmation that training had been booked in this area. Assessments had been carried out using the MCA principles by the management team and best interest decision made with family and health professionals where people did not have capacity to make certain decisions.

People were cared for by staff who felt supported. Spot checks had been carried out to observe staff performance to ensure people received the required care and support. People’s care and support needs were assessed regularly for effective outcomes. The service worked with health professionals if there were concerns about people’s health. Staff could identify the signs people gave when they were not feeling well and knew who to report to.

People had a positive relationship with staff. Relatives told us that staff were caring. People’s privacy and dignity were respected by staff. People and relatives were involved in making decisions about their care.

Care plans were person centred and detailed people’s preferences, interests and support needs. Relatives knew how to make complaints and staff were aware of how to manage complaints.

Staff told us the culture within the service was open and transparent and told us the service was well-led. Relatives and staff were positive about the management team. People’s feedback was sought from surveys and reviews meetings.

We carried out an announced inspection of Efficiency-For Care Limited on 9 October 2017. Efficiency-For Care Limited is registered to provide personal care to people in their own homes. At the time of our inspection, the service provided personal care to eight people in their homes.

This was the first inspection of the service since the service moved to a new location in September 2017. During this inspection, we found breaches of regulation that may put people at risk of harm. Therefore the service has been rated Inadequate under Safe.

The service had a registered manager. However, we were informed the registered manager had left the service. A new manager had been recruited who was present during the inspection. The provider informed us that an application would be submitted to register the new manager and de-register the previous manager. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks were not always robustly managed. We found care plans did not contain suitable and sufficient risk assessments to effectively manage risks. This placed people at risk of not being supported in a safe way at all times.

People and relatives told us that medicines were given on time. Records confirmed this. However, we were not assured that people’s medicines were appropriately reconciled and there were inconsistencies with people’s risk assessments for medicines.

Staff had not received specialist training, such as ventilator awareness, which they needed to do their jobs effectively. Some staff had not received formal training from the service prior to delivering personal care to people.

Care plans were inconsistent. Some care plans did not include the support people would require in relation to their current circumstances. Pre-assessments forms had not been completed in full to assess people’s needs and their background.

Not all people or their representatives had been involved with decision making of the support people would require.

Quality assurance systems were in place but were not always effective. For example, the audits had not identified the shortfalls we found during the inspection to ensure people were safe at all times.

Accurate and complete records had not been kept to ensure people received high quality care and support.

Staff were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally.

Pre-employment checks had been carried out to ensure staff were suitable to provide care and support to people safely.

There were arrangements in place to ensure staff attended care visits. Staff told us they had time to provide person centred care and the service had enough staff to support people. There had been no missed visits.

Supervisions had been carried out regularly. People were being cared for by staff who felt supported.

Staff knew the principles of the Mental Capacity Act 2005. People had capacity to make their own choices and were independent.

People had the level of support needed to eat and drink enough and were supported with cooking meals when required.

People had access to a range of health care professionals, which included booking appointments on people’s behalf and supporting people to access healthcare services.

People’s privacy and dignity were respected by staff.

Complaints and concerns were investigated and staff were aware on how to manage complaints. People and relatives knew who to raise complaints and concerns with.

Staff told us the culture within the service was like being part a family and were positive about the management. People’s feedback was sought from telephone surveys.

We identified breaches of Health and Social Care Act 2008 (Regulat