This inspection took place on 23, 24 and 29 May 2018 and was announced.

The service was a domiciliary care service with 90 service users at the time of our inspection. It provides personal care to people living in their own houses and flats in the. It provides a service to older adults, younger disabled adults and children.

A registered manager was 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.

On the previous inspection on 18 and 19 September 2017 and 11 October 2017 the provider was in breach of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014.

They were in breach of Regulation 9 Person Centred Care, Regulation 10 Dignity and Respect, Regulation 11 Consent, Regulation 12 Safe Care and Treatment, Regulation 13 Safeguarding, Regulation 16 Complaints, Regulation 17 Good Governance and Regulation 18 for failure to notify under the Registration Regulations. We served enforcement action and imposed a condition on the provider’s registration to prevent them from taking any new care packages or increasing existing care packages without seeking prior permission from the Commission.

On this inspection we found the provider was not in breach of any of the regulations and had met the legal requirement. They had sought the Commission’s permission to increase seven existing care packages since the last inspection and permission had been granted.

Following the last inspection we met with the provider and asked the provider to complete an action plan to show us what they would do and by when to improve the service related to each breach of the regulation. On this inspection we found the provider had implemented all actions set within their action plan according to each key question and breach of the regulation.

The provider had improved the care plans to include likes/dislikes and preferences for a male or female carer. Further improvements were needed to improve times of calls and we made a recommendation about this.

We found the staff were treating people with respect and were promoting people’s dignity. People told us they felt staff respected them. People were being encouraged to be as independent as possible.

People told us they felt safe with the staff providing care and the systems to keep people safe had improved. Analyses of incidents and accidents were being completed.

Further improvements were needed to ensure medication anomalies on medication administration sheets were identified and people received their medicines when they needed to in order to ensure medication practices were always safe.

Recruitment procedures were including checks such as the Disclosure and Barring Service checks. References were sought however, the policy stated two references were needed from previous employers but we found this was not always followed.

Safeguarding procedures were more robust with analyses of safeguarding concerns being undertaken each month.

There were enough staff within the service with no missed care visits evidenced on this inspection. People were not always receiving their care call at a time stipulated in their care plan and we made a recommendation about this.

We viewed people’s daily records and found people were being supported to have enough to eat and drink with monitoring taking place when appropriate.

Healthcare professionals we spoke with spoke highly of the staff and were involved in people’s care.

The service had implemented a new consent form and system of seeking people’s consent for changes to their plan of care. Principles of the Mental Capacity Act 2005 were being followed.

The complaints process was more robust with all complaints seen logged responded t

This announced inspection took place on 18, 19, 20, 21 September and 11 October 2017. The previous inspection in November 2016 found the service to be rated Good.

There was a Registered Manager 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. The registered manager was present for the last day of this inspection but the provider was present throughout each day of the inspection.

Evolving Care Limited is a domiciliary care service providing personal care and support to 124 people at the time of our inspection across Crewe and Cheshire East They had 59 care staff providing care.

We checked whether there were enough staff to meet the care needs of people and found mixed views. One relative who we spoke with raised concern regarding staffing levels and consistency of staff. Another relative told us they were short staffed but staffing had improved. Other people we spoke with said they had consistent carers but there were concerns about cover when they were away.

Staff were receiving safeguarding training and could tell us what they would do if they had a safeguarding concern. There was a system of reporting alleged abuse in place however we found some allegations of neglect had not been reported to the safeguarding authority. Safeguarding concerns and investigations were not being analysed for trends to be identified.

Recruitment practices were not robust enough. We were informed by the service interviews were taking place but there was no documentation in place of interviews. We found two staff files contained evidence of a previous conviction without a detailed risk assessment. The provider took action immediately and ensured a risk assessment with control measures were in place during our inspection.

Risks were not always being identified or mitigated for people. Risk assessments were either absent or not detailed or consistent enough for staff to know how to always deliver safe care. The provider took action immediately and put risk assessments in place when we requested them such as for one person with continuous oxygen.

Incident forms were being completed in people’s care plans and there was an accident book. We found no system of analysing incidents for the provider to then be able to identify any patterns emerging to reduce risks with lessons learnt.

Missed visits were not being collated or analysed. Missed calls/late/early visits were an issue for people. We viewed numerous complaints regarding timings of visits.

Most people we spoke with spoke highly of their regular care staff who provided care. We found people had not always been spoken with appropriately by staff and their dignity not always upheld. One relative expressed concern with us a carer had not acted in their relatives best interests and left them alone when they were unwell.

There was a complaints policy and system in place with a number of complaints seen in the complaints file. There was no analysis of complaints. Not all complaints were taken forward and investigated by the service.

People were being supported to drink, eat and with their meal preparation. We observed one person being provided with a choice of what to eat during our visit in their own home. People did not always receive their food and drink due to missed or late visits.

The process of obtaining consent from people in line with the Mental Capacity Act 2005 did not include specific consent for holding key codes, PRN prescribed medicines, changes to care plans or to the 30 minute waiting period either side care visits.

The care plans we checked in people’s homes at the time of our inspection did not contain enough personalised information such as previous employment, preferences, likes

Evolving Care Limited is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of our visit the agency was providing a service to 105 people.

The inspection was carried out on 17 November 2016 and was announced

There was a registered manager in post who was present during 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.

The provider had not always ensured that staff were effectively deployed to meet people’s needs.

Staff had limited understanding of the Mental Capacity Act and how this affected their practice. Where people lacked the capacity to make their own decisions these were made in their best interest.

People and their relatives told us that they felt the service provided was safe. Staff and the registered manager had received training on how to keep people safe from abuse. They were able to explain the action they would take if they identified any concerns. The provider completed recruitment checks prior to new employees starting work with people to ensure that they were suitable for their role.

Staff were aware of the risks associated with people’s needs and how to minimise these. Staff demonstrated they would take appropriate action in the event of an accident to ensure people’s safety and well-being.

People were satisfied with the support they received to take their medicines. Staff had received training on the safe administration of medicine. Regular competency assessments were completed to ensure they continued to manage medicines safely. Staff monitored people’s health and referred them to health care professionals if they identified any concerns.

People were supported by staff who had received induction into the service and training to meet their individual needs. Staff received support and guidance from management who they found approachable and responsive.

People dietary needs were assessed and monitored and they encouraged people to follow healthy diets to promote their well-being. Where required people were given support to eat and drink.

Staff had developed caring relationships with people and treated people with dignity and respect. People were offered choice and felt listened to.

People were involved in planning and reviewing their care needs. Staff knew people and their preferences well.

People and relatives found staff and management easy to talk with and felt they could raise any concerns they had with them. The provider had a clear complaints process which they followed.

People and their relatives were given opportunities to be involved in the development of the service through care plan reviews, spot checks and yearly surveys of the service.

The provider had a clear vision for the service which was shared by staff. The provider had a range of quality assurance checks to monitor the quality and safety of the service which they used to drive improvements.

We visited one person who used the service in their own home and we spoke with five relatives of people who used the service on the telephone. They all told us that they were happy with the support they received from the agency. One relative told us; “They are excellent – first class. 100% better than what we had previously.”

We looked at the policies and procedures in place to protect people from harm and abuse. We found that the procedures were up to date and all the staff had received training in safeguarding vulnerable people.

We looked at the support that staff received. We looked at the systems in place and found that staff received various types of support which included regular supervision, a yearly appraisal and all mandatory training as well as specific training to meet particular people’s needs.

We looked at the quality assurance systems in place and saw that the service was carrying out sufficient checks to ensure that they were providing a good service.