About the service:

• Harp Care is a small home care service that was providing personal care to 13 people at the time of the inspection.

People’s experience of using this service:

• The necessary checks had not been made to ensure staff were of good character before they started working within people’s homes. We found repeated concerns in this area that had been identified at a previous inspection of the service in December 2016. This demonstrated a lack of robust monitoring within this area.

• The provider had not ensured that all appropriate records had been kept in relation to staff recruitment and the management of the service.

• Processes had not been followed in line with best practice where medicines had been given covertly (hidden in food or drink). We have made a recommendation the provider seeks relevant guidance in this area.

• People were very happy with the quality of care they received.

• Risks to people’s individual safety had been assessed and staff acted to reduce these where possible.

• There were enough staff working at the service to ensure people received their care visits when needed.

• Staff used good practice to reduce the risk of the spread of infection.

• People received their medicines when they needed them.

• Staff had received enough training and supervision to provide people with safe and effective care that met their needs and preferences.

• People were supported to have maximum choice and control of their lives and had been involved in the planning of their care. They told us they were encouraged to give their views about the quality of care they received.

• Where staff supported people to eat and drink, this was completed to meet people’s needs.

• People told us they received support to maintain their health when needed and the care they received enhanced their wellbeing.

• Staff worked well with other professionals to ensure that people received the care they needed at the time they required it.

• There was an open culture at the service. The management team and staff were approachable, and people and staff told us they could contact them when they needed to.

Rating at last inspection:

Requires Improvement (Published April 2018). The overall rating has remained as Requires Improvement and this is the third consecutive time it has been given this rating.

Why we inspected:

This was a planned inspection based on the period since the last report was published by CQC.

Follow up:

We will consider the action we will take due to the service being rated as requires improvement again. We will also continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

The inspection was announced and took place on 26 February 2018.

Harp Care is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides personal care to people with a variety of needs including older people, younger adults, people with a learning disability and physical disability. At the time of the inspection, 13 people were using the service.

Not everyone using Harp Care receives a 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. Twelve people were being provided with ‘personal care’.

At the last announced comprehensive inspection in December 2016, we judged that improvements were required in delivering a safe and well-led service. During that inspection we found the provider to be in breach of the regulation related to fit and proper person’s employed. This was because the registered manager had not completed all the appropriate and standard safety recruitment checks to ensure staff were safe to provide care to people. We also found the provider to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘is the service safe’ and 'is the service well-led' to at least good.

At this inspection we found that improvements had been made to promote the safety and quality of the service. We found that the provider was now compliant with both regulations, however further required improvements were needed and we found one new breach of regulation.

We were told one of the three partners of Harp Care, was also a care worker. We found the partner had not ensured they were appropriately trained to deliver the regulated activity they were providing. We could not asses if people being cared for had been impacted by this and have covered this in the key question, ‘is the service well-led’. This resulted in one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. A service cannot have an overall rating of ‘Good’ with a breach of one or more regulations in any one key question.

Regular audits and quality assurance checks required further development in order for the service to improve.

The registered manager was unable to explain her responsibilities under the duty of candour. We recommended the registered manager seek guidance on the duty of candour from the Commission’s published guidance for providers.

Staff told us they felt supported and people felt able to contact the office in the knowledge they would be listened to. People who used the service, relatives and care workers all spoke positively of the registered manager and their commitment to the service and people who used it.

There was a registered manager in post. 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 protected from abuse. Staff followed the provider’s safeguarding procedures to identify and report concerns to people’s well-being and safety.

Appropriate risk management systems were in place. Staff followed the guidance in place to support people's safely in line with the risks identified to each person’s health and well-being.

People were supported by a suf

The inspection took place on the 16 December 2016. We contacted the service before we visited to announce the inspection. This was because the service provides a domiciliary care service to people in their own homes. We wanted to ensure that we could access the service’s office and speak with the manager and staff.

Harp Care provides personal care to around 14 people who live in their own homes in Norwich and the surrounding area. With domiciliary care services the CQC only regulates personal care. This was the service’s first inspection.

There was a registered manager in place. 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. For the purpose of this report the registered manager will be referred to as the manager. The service also had two senior members of staff.

People were supported by staff who had not been safely recruited. The manager had not completed all the appropriate and standard safety recruitment checks to ensure staff were safe to provide care to people.

The manager was not auditing people’s medication administration records in a robust way. There was limited quality monitoring audits taking place. This is to improve and monitor the quality of the service provided. Staff did not receive supervisions, staff knowledge and competency was not consistently checked and monitored. Not every person the service supported had reviews of the care they received.

These issues all contributed to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Staff were knowledgeable in their roles and demonstrated the skills required. Staff and the manager were motivated to provide good care to people. Staff understood the importance of responding to concerns about people’s health. There was a training system in place and staff spoke positively about the training they received. Staff had a thorough induction to the service and their role. New staff were introduced to the people they were going to be supporting before care visits began.

The manager and staff demonstrated they understood how to protect people from the risk of abuse. Staff were aware of this potential issue and knew what to do if they had concerns. People were protected from the potential risk of harm as the service had identified and assessed the risks people faced. People had assessments which were person centred.

People benefited from staff who felt valued and important to the service. Staff worked closely with the manager and found them approachable and supportive. The manager and staff had confidence in the service they were providing. People said they saw the same care staff at regular times, and did not have missed care visits. People also told us that staff stayed longer at their care visits, if this was needed.

Staff understood the importance of promoting and protecting people’s dignity, privacy and independence. People and their relatives gave many positive examples of the caring and empathetic approach of staff. People told us they were treated with dignity and in a caring and kind way. People told us they formed positive relationships with the staff who supported them.

Staff had received training in the Mental Capacity Act 2005 (MCA) and demonstrated they understood the importance of gaining people’s consent before assisting them.

Staff assisted people, where necessary, to access healthcare services. Staff had a good understanding of people’s healthcare needs. Staff had the knowledge and confidence to manage emergency situations.

The manager and staff supported people in a practical way to avoid social isolation. People felt comfortable spea