We undertook an unannounced inspection on 1 February 2018. At our previous inspection on 24 and 25 January 2017 we rated the service ‘requires improvement’ and identified five breaches of legal requirements. These related to making appropriate notifications to the Care Quality Commission about serious incidents, person centred care, safe arrangements for administering medicines, good governance and ensuring robust and appropriate arrangements for staff recruitment. We undertook this inspection to review the quality and safety of the service and to ensure action had been taken to address the breaches identified at our previous inspection.

Elite Careplus Ltd is a service which is registered to provide personal care to adults in their own home. At the time of our inspection there were 48 people using this service.

The registered manager remained in post. 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.

At this inspection we found the provider had taken sufficient action to address the breaches of regulation identified at our previous inspection. We also saw the provider had taken sufficient action to improve their rating to ‘good’ for the key questions ‘safe’, ‘effective’, ‘caring’, responsive’ and ‘well led’. However we found the provider was still rated as ‘requires improvement’ for the key question ‘caring’.

Following the last inspection the provider undertook a review of the way new staff were recruited and of the procedures to do with the safe administration by staff of medicines to people. At this inspection we found the provider made significant improvements in both these areas. The new recruitment procedures were robust and ‘fit for purpose’ as were the procedures operated by staff for the safe administration of medicines. This showed the provider had taken appropriate steps to protect people from the risks previously identified.

People told us they felt safe. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

The risks to people's safety and wellbeing were assessed and regularly reviewed. People were supported to manage their own safety and remain as independent as they could be. The provider had processes in place for the recording and investigation of incidents and accidents.

Staff followed good practice in order to prevent and control the risk of infections.

People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

People who were cared for and supported by regular staff said they were happy with their support and that staff knew them well. People told us staff who were not regular were not always aware of the care and support people they visited needed. People also told us there were occasions when these staff seemed cold and distant in their approach to people. Regular staff treated people with dignity and respect. People's views were actively sought and they were involved in making decisions about their care and support.

People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were given information about how to make a complaint and the people we spoke with knew how to go about making a complaint and were confident that they would be responded to appropriately

This inspection took place on 24 and 25 January 2017 and was announced. We told the provider 24 hours before our visit that we would be coming. This is the first inspection for this service which was registered in October 2015, at a previous address of 98 Stafford Road, Wallington. They moved to their current location in May 2016 and their registration with the Care Quality Commission (CQC) was adjusted to reflect this change of address. The registered manager is also a director of Elite Careplus Ltd.

Elite Careplus Ltd provides a domiciliary care service and a recruitment agency to supply nurses to care homes. The domiciliary care service provides personal care to 15 people living in their own homes in the Sutton area. This service includes assistance with bathing, dressing, eating and medicines, home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by CQC.

The service had a registered manager. 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the recruitment processes were not safe. Not all the checks made before a person started to work for Elite Careplus had been completed. Specifically, criminal records checks were not in place for all staff and nor had the provider obtained two references from people’s former employers before they started working for the agency. Without these checks the provider could not be assured that people would be kept safe by the people they employed.

Medicines were not administered safely. Medicines administration records [MAR] were not completed correctly. Staff had not always signed MAR charts correctly to evidence they had administered the person’s medicines. The recording errors we saw could mean people did not receive their medicines as prescribed by their GP. We judged these concerns to be serious enough we reported them to the local authority as a safeguarding alert.

We found the support plans we looked at were not as comprehensive as they could be. They did not describe who the person was, the daily support they needed and how they would like to receive that support. None of the support plans we looked at had been signed by the person receiving the support or their representative to show they had agreed to these. Elite Careplus matched a person to staff by staff availability only and did not consider the person’s support needs, background history, cultural or religious needs. This meant there were risks that a person and the assigned staff were not compatible, which could adversely impact the delivery of care and support to the person.

Care files and staff records were not stored securely. We found care files and staff records were kept in a lockable cupboard but we also found other files containing personal information of staff or people who used the service on the floor of the office in a large cardboard box.

The registered manager had not submitted to CQC the notifications of relevant events and changes as they are required to do by law. The provider did not have effective quality monitoring systems in place so as to identify the issues we found during our inspection. Monthly audits the provider conducted were not effective. Systems to monitor and improve the quality of the service were not effective in gaining the views of people or staff, to help monitor and improve the quality of the service delivered.

Despite our findings above we received positive comments from people using the service and their relatives. Comments included “I have the best carer, she does any job needed and is always smiling” and “Staff are very good, really