The announced inspection site visit took place on 21 November 2018. Grace Integrated Care Limited is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection, the service was providing support for three people residing in Northamptonshire. People's care was provided by the nominated individual, the registered manager and five members of staff.

Grace Integrated Care Limited 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.

Grace Integrated Care Limited was previously inspected by the Care Quality Commission on 27 September 2017 and the report published on 31October 2017. We found three breaches of the regulations. The overall rating for the service was requires improvement.

Following the last inspection of 27 September 2017, we asked the provider to complete an action plan to show what they would do and by when to improve medicine systems and processes, ensure staff recruitment was robust and to ensure effective governance of the service. We found improvements had been made.

People’s records provided information as to the medicine they were prescribed and who was responsible for its administration, such as family members or staff. We found staff were responsible for applying prescribed creams and and this was recorded within people’s records.

Staff recruitment records evidenced necessary pre-employment checks had been carried out prior to the commencement of their employment.

Systems to monitor the quality of the service were found to be effective. Where shortfalls were noted by the registered manager action was taken by them to bring about improvement. The action taken was recorded and communicated with staff.

This inspection has found the service has improved its overall rating from requires improvement to good.

People’s safety was promoted by staff who implemented the guidance as detailed within people’s risk assessments and care plans. Staff were knowledgeable about people’s care and support and the importance of using equipment to support in the delivery of care safely. Family members spoke positively about the consistency of a small team of staff in the provision of care, which meant their relatives were comfortable and relaxed when personal care was delivered.

People’s needs were assessed to ensure the service and staff could meet their needs. We found, people were supported to have maximum choice and control of their lives and staff supported them in the least restrict way possible; the policies and systems in the service supported this practice.

Staff received support from the registered manager, through supervision and checks to ensure they were competent to carry out their roles effectively. Staff received the training they needed to provide safe and effective care to people.

Family members spoke of the positive relationships they had developed with staff. People’s dignity and privacy was promoted and people were aware of how confidential information would be stored and the circumstances in which it would be shared.

People’s views and those of their family members had been sought to develop their care plans, which were regularly reviewed by the registered manager. People’s care plans had considered the individual needs of each person and the role of staff in meeting these. Concerns had been investigated and documents supported this, which included the action taken to address the issues raised.

Systems were in place to monitor the quality of the care being provided, which included seeking the views of those using the service and family members. A range of audits were undertaken to evidence the quality of the care and the accuracy

Grace Integrated Care Limited is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were seven people using the service, all of whom resided within Northamptonshire. People's packages of care varied dependent upon their needs. People's care was provided by the nominated individual, the registered manager and five members of staff.

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.

The overall rating of requires improvement that was awarded following the CQC's previous comprehensive inspection of 22 September 2016 and was available in the office. Grace Integrated Care Limited continues to have an overall rating of requires improvement.

We found information within people’s records was not sufficiently detailed to promote their health and welfare. The medicine people were prescribed was not always detailed within their care plan, and records did not concisely provide sufficient information to ensure staff administered people’s medicine safely.

The nominated individual and registered manager had not assured themselves of the suitability of staff to work with people as they had not followed their policy and procedure for the recruitment of staff. Potential staff had been recruited with references that were not from the person’s current or previous employer or their place of education.

The nominated individual and registered manager had not followed the policy and procedure when a concern had been raised by a person using the service. They had undertaken an investigation as a result of the information; however they had not made a safeguarding referral to the local authority.

People's records included information as to potential risks, which were supported by assessments and care plans. These records provided information for staff as to how they should provide care and support to people safely, for example through the use of equipment when assisting people to mobilise and the number of staff needed to be involved to promote safety.

People’s safety and welfare was promoted by staff that understood and had received training on their role in protecting people from risk. Safety and welfare was further promoted through the assessment and on-going review of potential risks to people. Where risks had been identified measures had been put into place, which included the use of equipment to reduce the likelihood of risk and were recorded within people’s records and understood and implemented by staff.

People’s needs were effectively communicated and recorded and understood by staff, to ensure people’s needs were met. People’s care and support needs were recorded by staff which provided a clear record as to the support and care people received.

Staff understood the importance of seeking people’s consent prior to providing care and support. Staff liaised with health care professionals where necessary and kept in contact with people’s family members where they had concerns about people’s health. People received support with the preparation, cooking and eating of meals where needed to ensure people’s nutritional needs were met.

People spoke positively about the caring approach of the registered manager and staff. Staff spoke about their role in maintaining people's privacy and dignity and supporting people to make choices about their care. The staff liaised with health care professionals, where required to do so which included contacting health care professionals when people were unwell.

People were involved in their initial assessment and the development and reviewing of their care plan, which meant people's care reflected their individua

This inspection took place on the 22 September 2016 and was announced.

Grace Integrated Care Limited is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were nine people using the service, all of whom resided within Northamptonshire. People's packages of care varied dependent upon their needs. People’s care was provided by the nominated individual, the registered manager and two members of staff.

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’s records did not always provide consistent and sufficient information about the support people required with their medicines and we found the policy and procedure for medicine management to be out of date. This meant there was a potential for people’s medicine not to be managed safely.

Staff did not fully understand their role in keeping people safe, which meant there was a potential for people’s safety and rights not to be promoted. Staff were not able to tell us how they would recognise the signs of abuse and know in sufficient detail what they should do if they had any concerns. We found the provider’s policy and procedure for safeguarding people to be out of date and not reflective of current guidance.

People’s records included information as to potential risks, which were supported by assessments and care plans. These records provided information for staff as to how they should provide care and support to people safely, for example through the use of equipment when assisting people to mobilise and the number of staff needed to be involved to promote safety.

Staff underwent a robust recruitment process, which included pre-employment checks to help the provider to determine their suitability to work with people who use care services. Staff underwent a period of induction and training, a part of which was used to introduce them to those using the service. This provided an opportunity for staff and those using the service to meet before the staff member provided their care. Staff were positive about the support they received from the registered manager, saying they were always available should they need advice.

People spoke positively about the caring approach of the registered manager and staff. Staff spoke passionately about their role in maintaining people’s privacy and dignity and supporting people to make choices about their care.

The staff liaised with health care professionals to support people in accessing health care services, which included contacting people’s doctors when they were unwell and arranging appointments on their behalf, with their permission.

People were involved in their initial assessment and the development and reviewing of their care plan, which meant people’s care reflected their individual needs and expectations. People were in the main complimentary about the care they received. However some people we spoke with said staff would sometimes arrive late at their home. In a majority of instances they were informed by the registered manager that staff would be late. We found the provider had received a recent complaint from a relative who had not been informed. The relative had received an apology from the registered manager.

We found improvements were needed to the quality monitoring system as it had not identified areas for improvement and this had the potential to impact on the quality of care people received. We found the provider and registered manager were unaware that some of their policies and procedures were out of date and did not reflect current guidance or legislation. Discussions with the registered manager found they could not accou