This announced comprehensive inspection took place on 18, 19 and 20 September 2018.

ICRIT is a domiciliary care agency, providing personal care to people living in their own homes in the community. They provide support to; older adults, including people living with dementia, people with physical disabilities, and people with learning disabilities. At the time of our inspection there were 27 people in receipt of a regulated activity.

At the last inspection in September 2017 the service was found to be in breach of the regulations; in relation to staffing and governance, and were rated as requires improvement overall. The service submitted an action plan which described the actions they would take to improve the service. We reviewed how this had progressed at our inspection. We found there had been significant improvements in the training staff received and they were no longer in breach of this regulation. There were some ongoing concerns in relation to governance.

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. The registered manager was supported by shift coordinators and senior care staff.

The service had not consistently met peoples' needs safely. One person had been assessed as needing two carers to support them with all transfers but told us, that until recently, transfers had regularly been performed by one carer. A visiting social worker had raised a safeguarding concern. Bolton Council had suspended the commissioning of new packages of care until the safeguarding investigations had been concluded. We were confident the person had been supported safely since then because the procedure had been improved. The person told us they were always supported by two carers now.

Staff were knowledgeable about how to protect people from the risk of harm and abuse. Staff knew how to recognise and raise any safeguarding concerns. Risk assessments had been completed in people's care plans and had been reviewed and updated regularly.

Staff had been recruited safely with all necessary checks completed before they started working with people who used the service.

There were sufficient staff to support people safely. Staff we spoke with confirmed this. People who received a package of care also confirmed staff were not rushed. Medicines were managed safely. Staff had received training in infection control and could describe the steps they took to minimise the risks of infection.

Accidents and incidents had been recorded and actions taken to ensure the risk of reoccurrence was minimised. Lessons learned from incidents were recorded and discussed in team meetings.

People's needs were assessed prior to their package of care starting. Assessments included all the persons' health and social care needs. People, their relatives and other professionals had been involved in the assessment and care planning processes.

Staff who had started working for the service since the last inspection praised the quality of the induction programme they had undertaken. People who used the service said they felt staff were knowledgeable and knew how to support them.

There was a supervision policy in place. We could see staff had received supervision regularly to discuss their practice and development. Staff we spoke with reported benefitting from regular supervision.

At the time of this inspection no one was subject to restrictive practices amounting to a deprivation of liberty. The service continued to work within the principles of the Mental Capacity Act 2005. People had signed consent to receive care and support. Staff understood the importance of getting people's consent before they provided personal care or support.

Wher

This inspection took place on 16 August 2017. We gave the service 48 hours’ notice of the inspection because it is a domiciliary service and the manager is often out of the office supporting staff. We needed to be sure that they would be in.

ICRIT Healthcare is a privately owned domiciliary care agency. They are situated in Bolton. The agency provides care staff to support people in their own homes. They provide assistance with tasks such as personal care, food preparation, medication administration and household chores. The service supports people around Bolton. Services are provided to older adults, adults with physical disabilities, adults with memory loss or living with dementia, adults with complex needs and adults with specific conditions such as substance misuse. At the time of our inspection the service supported 15 people and employed 11 care staff.

The service had 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.

This inspection was the first inspection since the service was registered with the Commission on 10 February 2016. During this inspection we found the service was in breach of two regulations relating to staff training and development and good governance. These were breaches of regulation 17 and 18 of the Health and Social Care Act Regulated Activities (Regulations) 2014 with regards to good governance and staffing.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found there were policies and procedures on safeguarding people. Five staff had received training in safeguarding adults and they showed awareness of signs of abuse and what actions to take if they witnessed someone being ill-treated.

Concerns were raised by local commissioners and safeguarding professionals regarding risks associated with moving and handling people. Safeguarding incidents had been investigated and documented, showing the support people were getting after incidents. Staff had sought advice from other health and social care professionals where necessary. Internal investigations had been undertaken where incidents had been reported. There were risk assessments which had been undertaken. Plans to minimise or remove risks had been drawn and reviewed in line with the organisation’s policy. Improvements were required in this area to ensure that risk assessments were robust and covered all risks associated with people’s care and treatment.

Lone working and environmental risk assessments were in place to ensure the safety of care staff and people they support. During the inspection we observed staff were visiting people at the planned and agreed times. There was a system for checking whether staff had visited as planned which had been implemented and monitored.

There was a medicines policy in place and staff had been trained to safely support people with their medicines.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely for the protection and wellbeing of people who used the service. Records we saw and conversations with staff showed the service had adequate care staff to ensure that people's needs were sufficiently met.

We found care planning was done in line with the Mental Capacity Act, 2005. Staff showed awareness of the Mental Capacity Act, 2005 and how to support people who lacked capacity to make particular decisions. However consistence was required in the records and provider had not provided staff with training this area.

The feedback from people about care staff and the organisation was