This inspection took place on 14 September 2017 and was announced. We gave the provider 48 hours’ notice that we would be visiting. This was because the provider offers a support service to people living in their own homes and we wanted to make sure that people and staff would be available to speak with us.

Great Care Home Health Care Services Ltd is a community based adult social care service, registered to provide personal care for persons within their own home. They currently provide a service for 20 people.

There was a registered manager in post at the time of our 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.

Great Care was last inspected in July 2017. This inspection was prompted in part by the notification of an incident notifying us of the death of a person that was receiving a service. This incident is still being investigated and as a result this inspection did not examine the circumstances surrounding the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of the service and the safety of

people. The service was placed in to special measures and served with a warning notice under Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Good Governance. And Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Safe Care and Treatment.

At this inspection we saw that the provider had met the requirements of the warning notices and will be exiting special measures.

There were quality assurance and auditing systems in place to ensure continual development of the service for the people being supported by the provider, although improvement needed to be made regarding their implementation.

People were kept safe. Staff had received training and understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm. People were kept safe by staff that were able to recognise the signs of abuse and raise concerns if needed. Staff were provided with sufficient guidance on how to support people’s medical needs.

People were supported by staff that had been safely recruited. People felt they were supported by staff with the appropriate skills and knowledge to care and support them.

Staff had the knowledge and skills to enable them to care for people in a way that met their individual needs and preferences. People were supported to make choices and were involved in the care and support they received. Staff had an awareness of the Mental Capacity Act and Deprivation of Liberty Safeguarding (DoLS).

People and relatives were involved in the development of care plans. People’s specific needs were identified and personalised care was provided in line with their needs.

Staff were caring and treated people with dignity and respect. People’s choices and independence were respected and promoted and staff responded to people’s care and support needs.

People and staff felt they could speak with the provider about any concerns and felt they would be listened to and their concerns would be addressed.

This inspection took place on 26 and 28 June 2017 and 04 July 2017 and was announced. Great Care Home Health Care Services Limited is a domiciliary care service which offers support to people in their own homes.

At the time of our inspection there was a registered manager in post. 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.

People were not always kept safe because staff practices had not always ensured security was maintained when staff visited people by ensuring doors were locked and keys kept safe. Staff had received the appropriate training so they knew how to recognise any form of abuse. However, some staff were not sure where the information should be recorded to protect a person from further harm. People did not always receive their calls as planned and systems were not effective to ensure missed calls were identified, so that people were at risk of not having their care call.

Recruitment and induction processes were in place but the necessary monitoring to ensure that staff did not work alone until all the checks had been completed was not undertaken.

Risk were not always managed effectively to ensure people were kept safe. Risks to people who were supported to take their medicines had not been identified to ensure staff supported people to take their medicine as prescribed.

People were treated with respect and dignity at all times but staff did not fully understand person centred care so that people were provided with care that met their individual needs, preferences and choices.

People's capacity to make decisions was not always assessed and the provider’s systems meant that people were not consistently involved in planning their care.

Complaints were not monitored to prevent reoccurrences and records management in relation to complaints received did not evidence that they had been investigated and action taken.

Quality monitoring and audits had failed to identify that a number of areas of the service provision was not meeting the fundamental standards of care. Information provided by the registered manager was unreliable and didn’t reflect the findings of this inspection.

You can see what action we told the provider to take at the back of this report.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Our inspection was announced and took place on 22 February 2016. This was our first inspection of this service.

The provider is registered to provide personal care to adults. Care was provided to people who had a range of needs relating to old age, physical disability and dementia. People who used the service received their support and care in their own homes in the community. At the time of our inspection 15 people received personal care and support.

The manager was registered with us as is required by law. 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.

Systems did not always confirm that people were given their medicine as they had been prescribed by their doctor.

Staff worked in a way that prevented people from being at risk of accident and injury.

People and their relatives felt that there were enough staff available to meet their [or their family members] individual needs.

Staff felt that the induction training they received the support they had on a day to day basis and the supervision sessions offered ensured they did their job safely and in the way that people preferred.

Some required training had not been offered to staff but the provider was in the process of addressing this.

The provider and registered manager understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They knew that regarding personal care services any DoLS referral would have to be made to and approved by the court of protection.

Staff supported people to have the diet and fluids that they liked to prevent ill health.

People were enabled to make decisions about their care and they and their families were involved in how their care was planned and delivered.

Staff supported people to be as independent as possible. People were encouraged and supported to undertake daily tasks and attend to their own personal hygiene needs.

Complaints processes were in place for people and their relatives to access if they were dissatisfied with any aspect of the service provision.

People told us that they felt that the quality of service was good. This was also the view of relatives and staff we spoke with.