This was the first inspection of the service since the provider registered with the Care Quality Commission (CQC) in November 2017. This inspection took place on 14 November 2018 and was announced. We gave the provider 48 hours' notice of the inspection visit because the registered manager could be out of the office supporting staff or providing care. We needed to be sure that they would be available.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The agency provides a service to adults with physical disabilities and older people, including people living with dementia. Not everyone using HQ Priory Care Services 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. At the time of our inspection 61 people were provided with personal care by the agency. The service had a contract with the local authority to provide people with domiciliary services.

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 felt safe with the care provided and with the staff who supported them. However, the provider’s risk assessments and risk management plans did not have adequate guidance for staff to follow to minimise possible risks to people.

Care plans did not include all the information staff needed to care and support people in line with their needs and preferences. This was despite the service being provided with relevant assessment information from the local authority.

Medicines were not managed in line with current guidance. Incomplete information and lack of instructions on how medicines should be administered meant that people may not always receive their medicines safely and as prescribed.

The principles of the Mental Capacity Act (2005) were not always followed to make sure people's rights were protected.

The provider had some systems in place to monitor and improve service delivery. This included a complaints system, telephone feedback and observations of staff practice. Other quality assurance systems needed development to ensure that all aspects of the service were effective and meeting people’s needs.

Despite the above shortfalls, people and relatives were happy with the care provided and told us they experienced a flexible service. People were treated with kindness and respect and supported by the same staff which provided consistency of care.

People felt that staff respected their privacy and dignity and helped them to remain as independent as they could.

People had information on how to make a complaint and knew how to do so.The provider responded appropriately to any complaints they received.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to managing risk for people using the service, care planning, consent, staff recruitment and governance. We have also made a recommendation about staff training on the management of medicines. You can see what action we told the provider to take at the back of the full version of this report.