The unannounced inspection visit to the office to look at records and speak with the nominated individual and the registered manager was scheduled to take place on 20 June 2018. However, when the inspectors arrived they found the offices shut up and staff unable to access them. The nominated individual and the registered manager were both away from the service for a few days special leave. We arranged by phone to carry out a visit to a person who used the service on 20 June and to return to inspect records at the office the following Tuesday 26 June on their return. We also carried out a visit to another person who used the service on 27 June and returned to the office that day to provide high level feedback on the inspection.

We last inspected the service on 8 and 9 February 2018 and 2 March 2018. At that inspection we rated the service as Inadequate and we identified seven breaches of regulation relating to safety, staffing, recruitment of staff, person centred care, complaints, displaying the rating and overall leadership. The service remained in special measures having been previously placed into special measures after the inspection carried out in August 2017. When a service is placed in special measures the expectation is that providers found to have been providing inadequate care should have made significant improvements by the time we carry out our next inspection. Following the August 2017 inspection we also placed conditions on the provider’s registration which were designed to ensure people who used the service were safe. The provider remains bound by these conditions and is not free to taken on any new care packages without the permission of the Care Quality Commission (CQC).

Fortress Care Services is a domiciliary care agency. It provides personal care to people living in their own homes. It provides people with both daily care visits and also live-in care. At the time of our inspection five people were using the service.

The service had a registered manager in post but day to day leadership of the service was provided by the nominated individual of the business due to the registered manager’s continued ill health. 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.

It was clear to us at this inspection that the provider had worked hard on certain areas of the business and we found some significant improvements. We also found that, as with previous inspections, in the majority of cases people received good quality care from regular carers who knew them well. We did however identify concerns around people’s safety, the management of risk and the promptness of the response to incidents and safeguarding matters. These areas continue to need further improvement and we have identified a continued breach of regulation relating to the safety of the service.

We noted a positive change in the way staff were safely recruited, inducted, trained and supported. Staff all received training in core subjects from a recognised training provider. This equipped them to carry out their roles and some had additional training. All staff felt supported and good systems were in place to provide supervision and support, although one staff member was not well supported in managing care for one particular person.

Staff received training in safeguarding people from the risk of abuse. The provider had raised no safeguarding concerns since our last inspection. However, they had not acted promptly to refer someone, who may have been at risk of neglect. The provider had tried to raise the concern but they, and the staff on duty, had not acted promptly and effectively which left the person at further potential risk.

Risks to people’s health and safety were a

The inspection visit to the office to look at records and speak with the provider took place on 8 February 2018 and was announced. We contacted the provider on 5 February to give them advanced notice of our intention to inspect the following day. We did this to make sure someone would be available to show us the records we needed to see. The provider asked for us to delay our inspection visit as they had an important appointment and we agreed to move our inspection to 8 February. We also carried out visits to people who used the service, and their relatives, on 8 and 9 February 2018 and spoke to a relative by phone on 2 March 2018.

We last inspected the service on 8, 9, 23 and 25 August 2017. We rated the service Inadequate overall and identified multiple breaches of regulation relating to safeguarding, the recruitment, skills and availability of staff, leadership, consent, person centred care and the management of complaints and of risk. The provider had also failed to notify the Care Quality Commission (CQC) about the absence of the registered manager from the service.

Following the inspection we placed the service into special measures. When a service is placed in special measures the expectation is that providers found to have been providing inadequate care should have made significant improvements by the time we carry out our next inspection. At this inspection we found that the service had not made sufficient progress in the intervening months. We were still not assured that people would always receive a consistently safe and high quality service which met their individual needs.

Fortress Care Services is a domiciliary care agency. It provides personal care to people living in their own homes. It provides people with both daily care visits and also live-in care. At the time of our inspection six people were using the service.

The service had a registered manager in post but leadership of the service was provided by the nominated individual of the business. 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.

Staff received training in safeguarding people from the risk of abuse. The provider had raised no safeguarding concerns since our last inspection but had not acted promptly to refer someone, who may have posed a risk to people who used the service, to the Disclosure and Barring Service (DBS). This demonstrated a failure to take all possible actions to protect people from the risk of harm.

Risks to people’s health and safety were poorly assessed and managed, especially related to people’s risk of falls. Information about risk was confusing and new staff would not have all the information they needed to protect people.

Staff who supported people regularly demonstrated a good understanding of people’s needs but there was a lack of a clear strategy for covering staff absence, especially that at short notice.

No new staff had been recruited since our last inspection but those already in post and those who had transferred from the provider’s recruitment agency had not all been safely recruited. Records did not clearly demonstrate that all staff had the required DBS checks in place before they took up their post and two references had not always been sourced. This meant the provider was not acting in accordance with their own recruitment policy.

Medicines were administered by trained staff but a lack of stocktaking measures meant we could not be assured that people always received their medicines correctly. The provider did not carry out a robust audit of medication records or staff competence to administer medicines. The provider did not have sufficient oversight of the safety of medicines at the service.

The provider carried ou

This inspection was unannounced on 9 and 23 August but was announced on 17 and 25 August 2017.

Fortress Care services is a service that provides personal care to people in their own homes. At the time of the inspection nine people were receiving support from the service.

There was a registered manager in place. They were also the owner and director of the business. 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 and associated Regulations about how the service is run. At the time of our inspection the registered manager was on long term leave and we did not speak with them. The business was being run by their partner, who was also the owner and nominated individual of the business, which meant they had a legal responsibility for the service.

At our last inspection on 23 April 2015 we rated the service as Good. This scheduled inspection was arranged to assess the quality of care currently being delivered and to address some concerns which had been raised with us.

At this inspection we had serious concerns about the quality and safety of the service.

The service failed to provide consistently safe care. People were not protected from the risk of abuse as the provider failed to operate a robust recruitment procedure. Required checks to make sure staff were safe and legal to work at the service had not been carried out thoroughly. Staff, who were the subject of a current safeguarding investigation were working unsupervised without the risk being assessed and action taken to mitigate it.

Accidents and incidents were not well managed and the provider failed to notify the appropriate authorities or to carry out investigations when people’s safety had been placed at risk.

There was no effective staffing strategy in place to cover emergencies and staff annual leave. This meant that people received inconsistent care or did not receive the care they needed.

Medicines were managed safely and people received their medicines according to the prescriber’s instructions.

Staff training, including medicines training, was in place but the provider could not supply accurate records to confirm when staff had received their training. Staff had not had some specific training, such as training for particular health conditions.

Records did not demonstrate that people had consented to their care. The service was not operating in line with the Mental Capacity Act 2005 (MCA).The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process.

People were supported with their eating and drinking and were positive about this aspect of their care. Healthcare needs were mostly met but records for some people, who had 24 hour live-in care packages, did not show that their health needs were well monitored by other health professionals such as dentists and opticians.

Staff were mostly very caring and held in very high regard by people who used the service. People felt their dignity and privacy was maintained. Feedback about some staff’s disrespectful language and behaviour was negative.

People did not receive care which reflected their individual needs and preferences. Some care was delivered according to the availability of staff rather than the preferences of the person who used the service.

People were not clear about how they should make a complaint. Some people who used the service, and their relatives, had significant and serious complaints and we were not clear why they had not felt able to raise these with the provider.

Ultimately the service was not well-le

This inspection took place on 23 April 2015 and was announced. Fortress Care Services is a domiciliary care agency providing care and support for people. The agency was providing care and support to two people at the time of our inspection.

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

People told us they felt safe and that staff supported them in a way that they liked. Staff were aware of safeguarding people from abuse. Individual risks to people were assessed and these assessments provided guidance to reduce the risk to staff members.

There were enough staff available to meet people’s needs.

The required recruitment checks had been obtained for staff.

Staff had received medicines training and medicines were administered safely.

The staff member received induction training, refresher training and additional training to ensure they had the knowledge and skills to meet people’s care needs. Staff were provided with effective supervision and support.

Staff understood the Mental Capacity Act. People’s consent was obtained before care was given.

There was enough information available for staff members to contact health care professionals on behalf of people.

Staff were caring, kind, respectful and courteous. Staff members listened to people’s preferences and involved them and their relatives in their care.

People’s needs were responded to well and care tasks were carried out as required by staff. Care plans contained enough information to provide staff with guidance about how to meet people’s needs.

A complaints procedure was available to people, no complaints had been made.

The staff member worked in an improving environment, with support from management staff.

The service monitored care and other records, but did not always follow up or address issues identified in surveys.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well led?

As part of this inspection we spoke with one person who used the service and two people’s relatives. We also spoke with the provider’s representative and two members of staff. We reviewed records relating to the management of the service which included four care plans, daily records, staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risk assessments for people’s care needs were available but had not been completed with enough information to identify the specific risks to each person or how they should be reduced.

Information was available in people’s care records to provide guidance to staff members regarding which health care professionals the person visited or had involvement with. However, there was no other information in care records to guide staff about people’s health needs.

Medicine administration records were not maintained and care plans did not show that people received their medicines in a safe way.

Not all of the required recruitment checks had been obtained or completed to an acceptable standard to ensure new staff members were safe to work with vulnerable people.

Is the service effective?

People told us that staff members helped them with everything they needed assistance with.

Staff members received supervision and basic induction training from the provider’s representative or from the manager. However, competency checks were not completed for all staff to ensure they had the skills to properly carry out their roles and care for people.

Is the service caring?

People said that staff members were polite and kind; they respected people's privacy and dignity, and involved them in their care. Staff members knew people's care needs and their personal preferences when we spoke with them.

Is the service responsive?

We saw that people's individual physical Support and care needs were not properly planned for. There was little information about their individual choices and preferences regarding their support and care in care records.

Is the service well led?

There were inadequate systems in place to gather people’s or staff members' views about the quality of the service. Other systems were not in place to monitor and assess the quality of the service provided and none of the issues found at this inspection had been identified by the provider.