This comprehensive inspection took place on the 22 and 26 November 2018.

Holistic recruiters are 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 older and younger people some of whom may have a physical disability. At the time of our inspection the service provided a regulated activity to 13 people.

There was a registered manager who was also the sole director of the company. 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.

This was the first inspection of this service since registration with CQC on the 31 May 2017. We identified major concerns in relation to the quality and safety monitoring of the service. Immediately following our inspection, we wrote to the provider requiring them to inform us of the actions they would take to meet the requirements of the law. We also required the provider to provide us with full information in relation to the numbers of staff employed and details of the people receiving a service. Following their response, we informed the local authority commissioners of our concerns who responded by finding alternative providers for all of the people receiving a service on the same day.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The registered manager did not promote a culture that encouraged candour, openness and honesty at all levels. Throughout our inspection the registered manager provided inconsistent, conflicting, information. They did not have effective systems in place to ensure overall governance of the service and identify the shortfalls we found at this inspection.

People were placed at risk as staff were not provided with the training, guidance and information they needed to keep people safe. Risk assessments were not always in place to address people's needs and reduce the risk of harm. Widespread significant shortfalls in the service meant that people's health, safety and welfare was not upheld.

People were at risk of not receiving their medicines as prescribed. Not all staff who administered medicines had been trained and had their competency assessed to ensure they were safe to do so. Staff did not demonstrate the required knowledge to ensure the safe management of people’s medicines.

There were insufficient numbers of suitably qualified staff to meet people’s needs. Staff were not recruited safely in accordance with the provider's own policy and procedure. Systems to check that people were being supported by staff who had the suitable skills, knowledge and qualifications to meet their needs were not robust. Induction training and safety and competence checks had not always been completed before staff were left unsupervised to care for people in their own homes.

Accidents and incidents people told us had taken place were not recorded. Record keeping in relation to the care provided to people was poor and inconsistent. Guidance was not always provided to staff with action they should take to reduce risks to people’s safety.

The Mental Capacity Act (MCA) 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The registered manager did not understand their role and responsibilities. People’s capacity had not been assessed with information provided to staff in meeting their needs.

Whilst some staff were seen to be kind and caring, people were not always treated with dignity. Further work was needed to embed a culture of caring throughout the service.

There was a poli