The inspection took place on 4 and 5 September 2018 and was announced. At the previous inspection we found medicines were not always managed safely and concluded this was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found issues still existed around the management of medicines. The provider remained in breach of this regulation.

At the previous inspection we found the provider had not submitted all relevant notifications to the CQC. We found this was a breach of Regulation 18 CQC (Registration) Regulations 2009 Notification of other incidents. We found improvements had been made and the provider was no longer in breach of this regulation.

Home Instead Senior Care (Calderdale and Spen Valley) 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 older adults. Not everyone using Home Instead Senior Care (Calderdale and Spen Valley) 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. There were 71 people using the service at the time of inspection, 34 of whom were receiving personal care.

Since the last inspection the ownership of the Home Instead Senior Care (Calderdale) had changed. A new nominated individual was registered with the CQC. There was no registered manager in post at the time of 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.

The systems and processes in place to manage medicines were not always safe or effective. Risks associated with people's care were not always identified and managed. We concluded these demonstrated a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Safeguarding incidents were recorded and responded to appropriately. People told us they felt safe using the service and with staff. Staff were familiar with signs of abuse and the company’s safeguarding policy.

People were supported by sufficient numbers of staff to meet their needs. Staff recruitment records demonstrated the service was ensuring staff were subject to the appropriate scrutiny prior to providing care. Staff received appropriate training. Staff felt supported and able to raise issues, however formal supervisions were not regularly taking place.

We found the service was working within the principles of the Mental Capacity Act. The provider had recorded which people had lasting powers of attorney in place and were in the process of obtaining confirmation of this. People told us that they were involved in their care, and that their consent was always sought. There was evidence within the care records that people were involved in their care planning and best interest decisions were made where appropriate.

People were supported to eat and drink. However, we found food and fluid charts had not been put in place for all people that needed potential monitoring for their food and fluid intake. We made a recommendation that the provider reviews the use of food and fluid charts and ensures there is an effective auditing system in place.

People told us they were treated with kindness, respect and compassion. Staff told us having calls that were a minimum of one hour allowed them get to know people and ensure that all of their needs were attended to without rushing. People told us the management team always tried their best to accommodate their wishes and were flexible with call times. Staff and people who use the service tol

This inspection took place on 1 June 2017. The provider was given 48 hours’ notice of the inspection.

This was the first inspection of the service under its current registration.

Home Instead Senior Care is a domiciliary care agency which provides care services to people in their own homes. When we visited the office the registered manager told us 53 people were receiving a personal care service. The agency provides a service to adults, older people, people living with dementia, people with physical disabilities, learning disabilities, sensory impairment and people with mental health needs.

There was a registered manager in place. 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.

Most of the people we spoke with told us they felt safe. Staff knew how to report concerns about people’s safety and welfare within the organisation. However, safeguarding alerts where people may have been at risk had not always been made by the registered manager and the registered manager had not routinely notified CQC of safeguarding issues.

People reported having experienced missed calls.

Medicines were not always managed safely and risks to people’s safety and welfare were not always identified within care records.

Sufficient numbers of staff were deployed to provide people with the care and support they needed. The required checks were done before new staff started work and this helped to keep people safe. Staff were provided with training and support to help them carry out their roles.

Where necessary, people were supported with their nutrition and hydration. People told us how staff always made sure they had drinks available to them.

We found the service was working in accordance with the Mental Capacity Act 2005 and this helped to make sure people’s rights were protected. People told us their consent was sought but we saw the consent on one occasion had been sought from people's relatives even though the person had capacity to do this

People's ‘Do Not Attempt Resuscitation’ (DNAR) orders were not included in their care records which meant their wishes may not be complied with.

Changes to people's needs were not always communicated to staff.

People who used the service were supported in their health and welfare needs.

People who used the service had mixed views about staff approach. Some found staff to be caring and respectful of their privacy and dignity needs but others did not.

Some people said staff communicated with them very well whilst others had experienced problems with this.

People told us staff supported them in maintaining their independence.

Some people told us they had been involved in the development and review of their care plans whilst others said they had not.

Care plans were not person centred and did not always contain the level of detail staff needed to make sure they delivered the care and support people needed at each visit.

Reviews of people's care were not always incorporated into the care plans. This meant care plans did not always reflect current needs.

There was a system in place to respond to and manage complaints. Some people we spoke with were happy about the way their complaints had been managed but others felt they had not been responded to.

There were systems in place to monitor and improve the quality and safety of the services provided. However these were not sufficiently robust and had not identified issues we found during the inspection.

People we spoke with had mixed views about the effectiveness of the management of the service.

We found two breaches of regulation. These were in relation to safe management of medicines and notification of incidents.