The inspection took place on 5 May 2016 and was announced.

Jark Healthcare - King's Lynn operates from an office in the centre of the town and provides care and support to people living in their own homes. At the time of this inspection, there were 12 people receiving services.

There was no registered manager in post in day-to-day charge of the service as required by the provider's registration conditions. 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. Although a manager remained registered on our database it was clear from discussions at the agency that the person had not fulfilled that role since April 2015. A new manager had been appointed and started work at the agency in February 2016 but was not yet registered.

People experienced a service that promoted their safety. They received assistance from sufficient numbers of staff to meet their needs and to keep them safe. There were robust recruitment processes in operation, which contributed to protecting people from the employment of staff who were unsuitable to work in care. Staff were aware of their obligations to report any concerns that people may be being abused. Risks to people were assessed and there was guidance for staff about how they should minimise these risks while they were delivering care.

Staff were trained to administer medicines safely but there were few people using the service for whom they needed to assume this responsibility. The way that the competence of staff to administer medicines safely was assessed needed improvement and the manager had plans to address this.

The service was not wholly effective. Some training identified as required as part of people's care packages had not been provided and some guidance from a health professional had not been properly incorporated into a plan of care. This had not had an adverse effect on anyone at the time of the inspection but presented a potential risk that people's complex health needs may not be fully met by competent staff.

People received support from staff who were polite, respectful and kind. Staff were aware of the importance of promoting people's privacy, dignity and their independence as far as practicable. Staff were aware of people's individual needs and preferences for the way they wanted their care to be delivered. Staff also understood the importance of seeking people's permission before delivering personal care.

People and their relatives were confident that, if they had any concerns or complaints, the management team would take these seriously and respond to them.

Almost all of the staff had joined the service recently so had only worked with the current manager who they felt was supportive. They were well-motivated and enthusiastic about their work. However, frequent changes in management and leadership over the last year compromised the ability of the service to properly and robustly monitor the quality of the service people received, taking into account people's views.

The provider had failed to comply with the rules about events they needed to tell us about by law and had failed to provide us with required information about the service. Inconsistent arrangements for leading the service during 2015 may have contributed to these failings. We have told the provider that they must improve in this area.

You can see what action we told the provider to take at the back of the full version of the report.

We looked at the care plan for the one person who was receiving support from the agency. Records clearly explained how the person preferred to be supported. We saw information about the choices that had been made. This showed us that the person was fully consulted at every stage of their care. During our conversation the person using the agency told us, “I have a wonderful team” and “I just mention anything and it is sorted out.”

The provider had a robust system to manage medication safely and there was a policy in place for staff to follow. The provider and manager carried out spot checks on all medication records and this was completed at least monthly. The medical administration records (MAR) sheets had been fully completed and we saw these were orderly and had no corrections or errors.

The provider had an effective system to regularly assess and monitor the quality of the service that people received.

We found that the provider managed risk effectively through care records; this was because we found evidence which demonstrated to us that the provider maintained and monitored personalised care records for people who used the service.

We could not gather any information as there were no people using the service at the time of this review.

At the time of our visit, this service was providing personal care to one person. We spoke with them by telephone and found they were very satisfied with the care and support they were receiving. However when we checked the care records we found that risk assessments for their personal care needs had not been assessed and the care plans did not provide sufficient detail to guide staff in how to meet the person's needs.

We spoke with a community nurse to ask about their views of the care and support provided by this service. They told us the care staff were very supportive but at times, they did not meet the persons’ needs in a timely way.

Staff records that we checked showed that all staff had received training in the management of medicines. There were appropriate arrangements in place in relation to obtaining medicine. However, there were inappropriate arrangements in place in relation to the recording of medicines.

We found there were appropriate arrangements in place for the recruitment and selection of staff.

The environmental risks to people who used the service and it's staff were not identified, assessed and managed to ensure the safety of people who used the service and others.

Care records that we checked lacked detail and were not accurate. Staff recruitment files and some training records that we checked were up to date and complete.