The inspection took place on 18, 19 and 23 January 2018 and the first day was unannounced.

At the previous inspection in September 2016 we found breaches of legal requirements in relation to notifications of incidents, staff recruitment, risk assessments and governance systems. At this inspection, we noted some improvements had been made with regards to meeting some of these requirements. However further improvements were required.

We asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Response and Well Led to at least good. We found the provider had implemented some actions, we found insufficient improvement had been made in some areas. Further information about these is identified within this summary and the full report. This is the second time the service has been rated ‘Requires Improvement’ overall.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to younger and older adults, some of whom are living with dementia, with a variety of needs. Support provided includes assistance with personal care, domestic tasks and outings into the community. At the time of this inspection the service supported 62 people.

There was a manager in post who had been registered with CQC since October 2010. A registered manager is a person who has registered with 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.

Not everyone using Harbex Nursing & Care receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We found six breaches of the Health and Social Care Act regulations in relation to recruitment processes, staffing training, risk assessments, need for consent, person-centred care, managing complaints and quality assurance. This is the second consecutive rating of ‘Requires Improvement’ for this service. You can see what action we told the provider to take at the back of the full version of the report.

We made one recommendation that the provider ensures all staff were trained in topic areas relevant to the population served.

We found the service was not always safe in some respects though people told us they felt safe with the staff who supported them. Generally, people were supported by a consistent staff team and the provider had suitable systems in place to take action to protect people from abuse including accidents and incidents.

Recruitment processes were not robust. This was a continued breach of the relevant regulation and meant people were not protected from risk of unsuitable staff being employed.

Risk assessments were not always up to date and risks to some people had not been assessed and recorded. This meant staff did not have sufficient information to ensure people were supported people safely.

A few people told us they had experienced missed visits. Most people we spoke with said staff were often late for their visits and the reason for this was not always explained. This meant people did not consistently receive care and support as agreed and in line with their needs.

Where assessed, people were supported by competent staff to take their medicines safely.

The registered manager and staff demonstrated some awareness of the Mental Capacity Act and we saw there was a policy in place to guide practice. However, we found the service did not work consistently within the principles of the MCA principles and this was a continued breach of the regulation.

Staff received an induction, training that the provider considered mandatory and shadowed

We inspected Harbex Nursing and Care on 20, 21 and 23 September 2016 and the first day of our inspection was unannounced. Harbex Nursing and Care is a domiciliary care service which provides personal care to people living in their own home. They also provide practical and domestic support such as shopping, cleaning, and financial and social support services to people. Their office is located in Urmston, Manchester and the company provides care and support to people living in Manchester and Stockport. At the time of our inspection the service was supporting about 70 people.

The previous inspection took place in July 2013. At that inspection, we found that the service had met all regulatory requirements.

The service had a registered manager who had been in post since October 2010. A registered manager is a person who has registered with the Care Quality Commission (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.

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the end of the full report.

People told us they felt safe with the care and support they received from Harbex Nursing and Care. Staff we spoke with could tell us about the types of abuse and what action they would take if they suspected that abuse was taking place. We found that the service could not demonstrate that all staff members were up to date with safeguarding training. This meant people using the service may be at risk of harm due to lack of staff knowledge and awareness in this subject. Risk assessments were vague and lacked person-centred information to help staff minimise or control identified or potential risks. We noted that risk assessments needed to be reviewed and updated more consistently. This meant that people were still at risk because staff were either unaware of their current circumstances or did not have sufficient information to manage risk safely.

There were recruitment processes in place; these needed to be more robust to help ensure that people were supported by care staff that were suitable to work with vulnerable people. This meant that people were potentially at risk of harm because the provider had not ensured suitable staff were employed. The service did not have many missed visits. The manager credited this to the use of an electronic monitoring system. People told us however that many times their care staff were late. This meant that people were not receiving care and support at times that suited them. People were generally satisfied with the consistency of care and told us they had regular care staff supporting them.

There were systems in place to help support people to take their medication safely. Medication errors were thoroughly investigated and staff members had to undergo refresher medication training and be assessed as competent before they could administer medicines. This should help to ensure that people received their medication safely. People told us care staff had good hygiene practices and wore personal protective equipment when carrying out their duties. This should help to ensure that people were protected from the risk of infection. Accidents and incidents were recorded and the service took appropriate action to help ensure people were kept safe.

People felt that care staff had the right skills and knowledge needed to undertake their caring role. The service had systems in place to deliver the Care Certificate induction standards to new recruits. We saw that people’s consent to care and support was sought correctly. People’s consent to receive care was sought appropriately. However, staff had not yet done training in the Mental Capa

We spoke with staff and asked them to tell us how they ensured service users received safe and person centred care. One staff member told us “I use the care file, it is spot on, it provides proof of the visit and you need to have all the information about people in place. You need a care file so that others following you will know the changes, I also inform the on call”.

We spoke with 12 service users. All told us they felt safe. One person told us “I feel safe; the staff speak to me very respectfully I am treated very well by them”. Another said “I feel safe and well cared for “. A relative of one service user we spoke with confirmed staff spoke with their X respectfully”.

All service users we spoke with who received assistance with their medication from care staff confirmed they always received their medications on time and staff discussed medicines with them. One person we spoke with told us, “The staff talk to me about my medication and they ask permission, I have the leaflets about my medicines and I read them”.

We looked at four staff files and saw evidence of training recorded and we were shown a training matrix and saw relevant and recent training had been undertaken.

The staff we spoke with were complimentary about the manager. Some comments received were “The manager is lovely she is always here, she is a really good manager and supportive she is always on hand for you” and “The manager is very nice and supportive I can go to her with any problems”.

We did not speak with any people who use the service as part of this inspection.