This inspection took place on 29 August 2018 and was announced.

When we last visited in July 2017, the provider was found in breach of three legal requirements. These were Regulation 11, Consent to care and treatment; Regulation 12, Safe care and treatment; and Regulation 17, Good Governance. We asked the provider to complete an improvement action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive, and Well-led to at least good. During this inspection visit we found the provider had improved.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to both older and younger adults with a range of needs. At the time of our visit, the service supported 44 people.

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.

There continued to be some people who experienced calls not at the time they expected, but the provider had recently recruited new staff and they hoped this would improve staff attending calls at the expected times. There had not been any recent missed calls.

Medicines were administered as prescribed although staff did not always complete the medicine administration records correctly.

Staff understood the importance of good hygiene and used personal protective equipment such as disposable gloves and aprons to keep people safe from infection.

The provider ensured the risks to people’s health and welfare were identified and staff understood the actions required to reduce any risks to people's health.

Staff recruitment processes reduced the risk of employing staff unsuitable to provide care to people.

The registered manager and their staff team understood the importance of safeguarding people from harm, and how to notify the safeguarding authorities if they were concerned people were not safe.

People received care from staff who were trained to support people’s health and welfare; and who understood the provider’s policies and procedures. Staff understood the importance of confidentiality.

Staff received support in their work through regular meetings with their line manager and through team meetings.

The service was working within the principles of the Mental Capacity Act. People had been assessed to determine whether they could make, and understand the decisions they had made. Staff did not carry out care unless people or their representatives agreed to care provided.

People were satisfied with the support they received from staff in heating and preparing their meals and drinks.

Staff ensured people who were unwell received support from medical services.

People thought staff were kind and caring. Staff were trained to ensure people received care in a respectful way, and one where their dignity was maintained.

People and their advocates were involved in their initial assessments, care planning and care reviews. Care plans provided staff with detailed information about what people’s care needs were, and how they would like staff to support them in their delivery.

People knew how to make complaints, and had opportunities to inform the provider of their views of the service through entries in log books, returns of quality assurance questionnaires, and through care reviews.

The management of the service had improved. The provider had sent an action plan to the CQC following the previous inspection visit, and had worked to the action plan to improve the service provided.

The registered manager met their legal obligations to notify us of events which impacted on people who used the service; and to have their inspection rating easily accessible t

We inspected Hales Group Leicester on 4 and 5 July 2017 and our visit was announced. We spoke with people who used the service on the telephone on 11 and 12 July 2017 to seek their feedback. We gave the provider of the service 48 hours’ notice of the inspection. This was because the location provides a domiciliary care service. We need to be sure that the registered manager would be available to speak with us.

At our last inspection on 5, 6 and 7 December 2016 we found seven breaches of legal requirements. After this inspection the provider wrote to us to say what they would do to meet legal requirements in relation to a breach in Person centred care, Need for consent, Safe care and treatment, Safeguarding service users from abuse and improper treatment, Good governance and Staffing. The service was also in breach of the registration regulations failing to notify the Commission of events affecting people. At this inspection we found that provider had made some of the required improvements. However, we found that further improvements were required and three continuing breaches of the Regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Hales Group Leicester provides personal care for people aged 18 years or over who need care or support at home. At the time of the inspection there were 44 people using the service. The majority of people who used the service had their care funded by the local authority.

There was a registered manager at the service. There was also a branch manager in post who had submitted an application to become the registered manager to take over this role from the current 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 were not consistently protected from risks relating to their health and safety. Assessments of people’s needs had not been completed fully. There was a lack of consistency in the information that had been recorded in assessments of need, care plans and risk assessments. We found that risks associated with some people's care needs had not been assessed. Where people had risk assessments these were not always specific to the person and their individual needs. Guidance for staff was not detailed enough to ensure that staff knew how to meet people’s needs safely.

Staff could identify the potential signs of abuse and knew how to report any concerns. Where incidents had occurred that may cause concern these had been reported appropriately.

People told us that there were usually enough staff to meet their needs. However they told us that the staff were still sometimes late for calls. There was a system in place to record if staff were late or missed a care call. This had not consistently identified where a person’s call had been missed except for when an alert had been put on the system. Alerts were used when people had received a high number of missed calls or needed their care at a specific time. This is a significant reduction from the amount that had happened at the time of our last visit. However this is still a high number of missed calls.

People were at risk of not receiving their medicines as prescribed. The medicine administration record charts were handwritten and the information recorded in these was not always consistent with the prescriber’s instructions. Where people had med

Hales Group Leicester provides personal care for people aged 18 years of over who need care or support at home. At the time of the inspection there were196 people using the service. However 100 of these people were receiving support from another homecare agency through a sub-contracting arrangement. The majority of people who used the service had their care funded by the local authority.

The inspection took place on 5, 6 and 7 December 2016 and was announced. We gave the provider of the service 48 hours’ notice of the inspection. This was because the location provides a domiciliary care service. We need to be sure that the manager would be available to speak with us. Prior to our visit we had received information of concern about the quality and safety of the service provided. This information prompted our visit.

The month prior to our inspection Hales Group Limited - Leicester had secured a large contract to provide care packages to people who had previously received their care from other providers. This meant that they were providing over double the care calls in the second week of November than they had the previous week. As part of this process Hales Group Limited Leicester had transferred a number of staff from other providers to be employed by the,. We had received feedback from people using the service, their relatives and staff that there were concerns about the quality of the care provided and significant disruption to people's care packages.

There was a registered manager at the service however they had submitted an application to de-register. The registered manager was on leave at the time of the inspection. There was a branch manager in post who had submitted an application to become the 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 were not protected from abuse. People told us that staff were often late for calls and that they had missed calls completely. We found that there was a high number of missed calls. The irregularity of visits meant that people did not receive care that was vital to their physical health and did not receive food or drink. This is neglectful practice but had not been recognised as such. Incidents of missed calls had not been reported or investigated appropriately. The provider had not checked on people’s welfare to make sure that they were safe when they had not received their care.

Some people had been left in degrading situations, for example, not having their continence needs met.

People were not consistently protected from risks relating to their health and safety. Risks had not always been assessed. People had not had their needs assessed or plans of care put in place to enable staff to understand and meet their needs safely.

There were not enough staff to meet the needs of the people who used the service. There was a system in place to record if staff were late or missed a call however this was not being used to monitor that people were receiving the care that they required.

People were at risk of not receiving their medicines as prescribed. Due to the missed and late calls medicines were not given at the agreed times. We also found that staff had not all received training to administer medicines. People’s care plans did not always give staff guidance on how people should be given their medicines.

People received care from staff that had not always undergone the appropriate pre-employment checks. Staff had not received appropriate training and support to enable them to fulfil their roles.

The service was not working within the principles of the Mental Capacity Act 2005. People had been determined to not have the capacity to make a specific decision withou