About the service: Immaculate Grace Care Ltd is a domiciliary care agency. It is registered to provide personal care to people in their own homes, including, older people, people with mental health problems, and people living with dementia. At the time of the inspection visit the service supported 19 people.

People’s experience of using this service:

• People had not always received visits from consistent staff, at the times arranged. People told us this had improved in the last few weeks.

• Staff understood how to keep people safe and protect them from avoidable harm.

• People’s needs were assessed to ensure they could be met by the service.

• Staff knew about the risks associated with people’s care, but management plans had not been completed for all identified risks.

• Staff were recruited safely, and there were enough staff to provide the care and support people required.

• There were safe procedures to manage people’s medicines and to prevent the spread of infection.

• Staff received training to be effective in their role. Some people had been concerned about the level of staff skills, but told us these had improved recently.

• There were processes to support staff, but these had not been implemented regularly.

• People made their own decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.

• Staff were caring and respected people’s rights to privacy and dignity.

• People were involved in planning their care and were regularly consulted about the care provided,

• Care plans contained the information staff needed to provide personalised care.

• Systems were in place to manage and respond to any complaints or concerns raised, but how complaints were recorded needed improvement.

• The provider had processes for assessing and monitoring the quality of the service. Improvement was required to ensure effective oversight of the service.

Rating at last inspection: Requires Improvement. The last inspection report was published on 18 May 2018.

Why we inspected: This was a planned inspection based on the date and the rating of the previous inspection. We had also received concerns about the service that we had referred to the local authority and to the provider to investigate which we needed to review. The overall rating for the service has not changed and remains requires improvement.

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Immaculate Grace Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own home. At the time of this inspection visit they provided personal care to 30 people and employed approximately 28 care staff.

At the last comprehensive inspection in October 2015, we rated effective as requires improvement as we found care staff had not always received an induction at the start of their employment that prepared them for their role, or received the training required to effectively carry out the duties they were employed to perform. This was a breach of the regulations. We undertook a focused inspection in December 2016 to check the provider had made the required improvements and found they had met their legal requirements and were no longer in breach of the regulations and we rated the service as good.

Since our last inspection we have reviewed and refined our assessment framework, which was published in October 2017. For this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

The office visit took place on 11 and 12 April 2018 and was announced. We told the provider we were coming so they could arrange to be there and arrange for staff to be available to talk with us about the service. The provider and registered manager were unavailable on the first day of inspection but were available on the second day.

Prior to our inspection visit we had received complaints from some relatives about the care and support provided to their family members. Their concerns were mainly about inconsistency of care staff and visit times, and staff not using a hoist safely. We referred the complaints to the local authority for investigation. People we contacted during our inspection reported similar concerns. We reviewed people’s concerns during our inspection.

A requirement of the provider’s registration is that they have a registered manager. There was a registered manager in post at the time of our 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.

There were enough staff to provide the care and support people required. However, people had different experiences in the punctuality and continuity of care staff. Some people received care from staff they knew well and who arrived around the time expected. Others had experienced late calls and received care from unfamiliar staff, particularly at weekends. All the people we spoke with said care staff stayed long enough to provide the care they required.

People's right to make their own decisions about their care were supported by managers who understood the principles of the Mental Capacity Act. Some staff had little understanding of the Act, however, they respected decisions people made about their care and gained consent before assisting people with care or support. Care plans did not include an assessment of people’s capacity to make decisions or, where required, how people were supported to make decisions about their care and support.

People said they felt safe using the service and staff understood how to keep people safe from abuse. There were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. The suitability of staff was checked during recruitment procedures to make sure they were safe to work with people who used the service.

Staff received an induction when they started working for the service and completed training to support them in meeting people’s needs effectively. Most people said staff had the right skills to

We carried out a comprehensive inspection of Immaculate Grace Care Ltd on 16 October 2015. At this inspection we found a breach of the legal requirements. This was because staff had not received the induction and training required to carry out their roles and provide safe, effective care to people.

After the comprehensive inspection, the provider sent us a plan of action to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 16 December 2016 to check that they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Immaculate Grace Care Ltd’ on our website at www.cqc.org.uk’

At our focused inspection on 16 December 2016, we found the provider had followed their plan of action and the legal requirements had been met.

Immaculate Grace Care Ltd is a domiciliary care agency which is registered to provide personal care support to people in their own homes. At the time of our visit the agency supported 16 people with personal care and employed 17 care staff.

Staff received an induction when they started to work for the service and completed training to make sure they had the skills and knowledge to provide the safe, effective care people required. Training was updated to keep staff skills up to date.

There was a registered manager in post at the service. 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 is also the owner/provider of the service. The registered manager was unavailable on the day of our visit.

Immaculate Grace Care Ltd is a domiciliary care agency which provides personal care support to people in their own homes. This was the first inspection of the service since they were registered in July 2014. At the time of our visit the agency supported 8 people with personal care and employed 13 care workers.

We visited the offices of Immaculate Grace Care Ltd on 16 October 2015. We told the provider 48 hours before the visit we were coming so they could arrange for staff to be available to talk with us about the service.

The service has a registered manager. 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.

Not all care workers had received the induction and training required to meet people’s needs safely and effectively.

People and their relatives told us they felt safe using the service and care workers understood how to protect people from abuse. There were processes to minimise risks to people’s safety; these included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Checks were carried out prior to care workers starting work to ensure their suitability to work with people who used the service.

The registered manager understood the principles of the Mental Capacity Act (MCA), and care workers respected people’s decisions and gained people’s consent before they provided personal care.

There were enough care workers to provide care to people and most people had consistent care workers who usually arrived on time and stayed the agreed length of time. People told us care workers were kind and knew how they liked to receive their care. People who required support had enough to eat and drink during the day and were assisted to manage their health needs, if this was part of their care plan.

Care plans and risk assessments contained relevant information for care workers to help them provide the care people required. People knew how to complain and were able to share their views and opinions about the service they received. Care workers were confident they could raise any concerns or issues with the registered manager, but some felt they were not always listened to.

There were processes to monitor the quality of the service provided and understand the experiences of people who used the service. This was through communication with people and staff, returned surveys, spot checks on care workers and a programme of other checks and audits.

We found a 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.