This inspection took place 15 November 2018 and was announced.

We had previously carried out an announced comprehensive inspection of this service on 29 January and 22 February 2018. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the safe management of people’s medicines and governance practices.

This focused inspection, 15 November 2018, was prompted by a high volume of concerns and complaints shared with us by people using the service, their relatives and the local authority. These complaints were in relation to the safety and governance of the service. We also checked the provider had followed their action plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for JK Caring for You on our website at www.cqc.org.uk.

During this focused inspection four breaches of legal requirements were found. These breaches were in relation to the safe care and treatment of people, protecting people from abuse, staffing and governance. We found serious shortfalls in the management of risk, insufficient staffing levels and leadership and governance. The overall rating for this service has deteriorated from 'Requires Improvement' to 'Inadequate' and the service is therefore placed in 'special measures'. The overall rating for this service is Inadequate which means it will be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

JK Caring for You is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It is registered to provide a service to older people, younger adults, people with dementia, learning disabilities or autistic spectrum disorder, people with mental health conditions, a physical disability and sensory impairment. At the time of our inspection 61 people were using the service.

Not everyone who uses JK Caring for You may receive 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.

JK Caring is required to have a registered manager in post. They were present for our inspection. A

This inspection took place 29 January 2018 and 22 February 2018 and was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, younger adults, people with dementia, learning disabilities or autistic spectrum disorder, people with mental health conditions, a physical disability and sensory impairment. At the time of our inspection 79 people were using the service.

Not everyone using JK Caring for You may receive a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; for example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The provider of JK Caring for You is registered as an ‘Individual’. Individuals register in their own name with the Care Quality Commission. They are not required to have a registered manager in place because they are directly responsible for carrying on and managing the regulated activity of ‘personal care’. As the ‘registered person’ they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we had rated the service provided as Good. Following this inspection we have changed this rating to Requires Improvement.

People’s medicines were not managed safely. There was a lack of clear guidance for staff to follow with regards to what medicines people were prescribed and the support they needed. Records were not always completed fully or accurately.

Although the provider had systems in place to monitor the provision of the service, these had not ensured the quality and safety of care provided was consistently meeting people's needs.

People were not supported to receive timely care and staff were often late for people’s care calls, which impacted on them and their families. People were not always informed when care staff were running late for their care calls and did not know who would be arriving.

Staff had received training in infection control practices but people gave mixed feedback on staff’s hygiene and cleanliness when they supported them.

When people raised complaints these were addressed and resolved. However, people did not feel the service was always responsive in addressing any verbal concerns they raised.

Although people had care plans in place there was sometimes a lack of focus on people’s own preferences and wishes in relation to how they would like their care delivered. However, where staff had built relationships with people they had got to know their preferences and wishes which helped them to provide person centred care.

People felt communication could be improved from managers and office staff when care staff were going to be late for their care calls. People had difficulty getting through to the office and did not always have their telephone calls returned. They did not always find staff at the office helpful when they telephoned them.

The provider took action when safety or safeguarding incidents happened. Where necessary the provider worked with the person, their relatives and outside agencies in investigating incidents and ensuring the person was kept safe. Where poor staff practice was identified, disciplinary action was taken. The provider understood their responsibilities under the duty of candour.

The provider had systems in place to help safeguard people from abuse. Staff had received training in and understood how to protect people and keep them safe from avoidable harm and abuse. Risks associated with people’s care had been assessed and plans were in place to help minimise these risks.

People’s care needs were assessed and staff that provided people’s care had received training to meet their needs. People were complimentary about the skills of their “regular” carers but did not feel all staf

This inspection took place on 17 September 2015 and was announced.

JK Caring for you is a care service registered to provide personal care and support for people in their own homes in the Bridgnorth and surrounding areas. At the time of our inspection they were providing care and support for 81 people.

There is 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 were protected from harm and abuse because staff had received training and were able to identify and report concerns. Risks relating to people’s care had been identified and information was available to staff to inform them how to support people safely.

People were involved in the planning of their care and in the reviews. The provider encouraged people to raise any issues and people were confident that action would be taken by the management team.

Staff provided care which was kind and compassionate and promoted people’s privacy and dignity.

Staff received induction and ongoing training in order for them to provide care. Staff were supported by the management team and received regular feedback on performance.

Staff did not start work until appropriate checks had been made to make sure they are suitable to support people in their homes. There were enough staff on duty to make sure people had the care and support they needed at the right time.

The provider completed regular quality checks to ensure standards of care were maintained. People’s views were sought on a regular basis and any areas for improvement were identified and acted upon.

The provider took appropriate action when people were unable to make decisions for themselves

We contacted the provider on 10 July 2014 to ensure that support staff would be available to meet with us during our inspection the following day. An adult social care inspector carried out this inspection on 11 July 2014. As part of this inspection we spoke with the registered manager, care manager and trainee care manager, training manager, three support staff and three people who used the service. We also reviewed records relating to the management of the service which included, three care plans, daily care records, training records and audit reports.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

The staff we spoke with had a good understanding of safeguarding procedures. One staff member explained, "I would have no hesitation in reporting any concerns to my manager or CQC.” We saw in the training records that the managers and the support staff all received regular training in safeguarding. This meant that the staff had up to date information on safeguarding procedures.

From our observations and the information we saw in care plans, policies, procedures and audits the provider's safety monitoring systems were robust. The staff showed that they had a clear understanding of their role in providing care and in safeguarding the people they supported.

People's care plans and the staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required. Management had considered the skills and experience staff would need. This showed that the provider had taken steps to ensure the staffing provision was safe and met the needs of each person.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

Documents we reviewed showed support plans and risk assessments were individualised and regularly updated. Support planning matched people's assessed needs. This meant people were protected against ineffective care provision because people's needs were adequately assessed.

There was evidence that people were involved in the assessments of their needs and care plan reviews. We saw in care plans and found from talking with people who used the service that the care provided was being constantly adapted to meet people's needs.

Is the service caring?

We spoke with people who used the service to gain an understanding of their experiences of the support they received. Their responses were all positive. One person told us, "I can’t fault them; they look after me very well." Another person said, “They are wonderful, they never let me down. They are all light hearted and have time to talk to me.”

Staff we spoke with described being respectful to and working with people to understand their needs. One staff member told us, "I love my job and working with the people I support.” The staff we spoke with said that they felt it was important to have time to interact with each person while they were doing their job. They demonstrated that they were aware of potential risks, people's rights and their responsibilities. This showed people were safeguarded against inappropriate care provision because staff understood people's individual needs.

The registered manager told us the importance the provider put upon ensuring that people's dignity was maintained at all times. They told us that this was part of the induction training given to new staff.

We saw copies of the service customer satisfaction surveys. All had positive comments. One person wrote, ‘We are delighted with the service, it has made a big difference to us.’

Is the service responsive?

We found that care plans were person centred and contained detailed information about the person and their choices and preferences. We saw that people's views had been obtained about the type of support each person needed. The customer survey feedback forms showed that staff performance and the care people received had prompted positive responses from the people who used the service.

We saw that the provider was regularly in contact with social care and health professionals that provided support to people. This meant that people's health and welfare was regularly reviewed and monitored.

The staff and people who used the service said that when they had any concerns, they could talk with the manager as they would always listen and address anything they raised.

We saw that the service responded appropriately to complaints received. This followed the service's policy. Responses to issues raised and actions undertaken were recorded. This meant the provider had minimised the risks of unsafe care because complaints had been acted upon

Is the service well-led?

The provider had systems in place to ensure the quality of the service was regularly monitored and reviewed. There were systems in place to provide feedback to staff about changes and developments. We saw evidence that actions had been taken where issues for improvement had been identified. This meant people were protected against inappropriate care because the provider had systems to check the quality of care.

We were shown evidence of complaints that had been handled correctly and in a timely-manner. This meant the service was well-led because people were enabled to make complaints, which managers acted upon.

The registered manager and the staff we spoke with were knowledgeable about the people who used service, changes to legislation and developments in care provision.

All the staff we spoke with said they understood their responsibilities around safeguarding people's welfare. They said that if they witnessed poor practice they would report their concerns.

We saw that incidents and accidents were reported and investigated. Where possible actions had been taken to prevent re-occurrence or to mitigate any risks.

We found that management and support staff received mandatory and specialist training. All the staff held or were working towards vocational qualifications relevant to their role. Staff told us that training was provided to assist in their professional development.

Staff told us that they had worked with the people who used the service for some time and really enjoyed their work. They told us that there was a good team spirit and everyone listened to any concerns raised and acted to resolve these. They said that they felt they were supported and involved in the development of the service.

We had telephone discussions with four people who used the service, four relatives and eight members of staff to ask their views on the quality of the service that the agency provided. We also spoke with office staff and the registered manager for the agency.

Everyone we spoke with told us that they were satisfied with the care and support that they received. One person commented, “They do a smashing job.” Another person said, "They are getting better all the time."

We found that the right people had been involved in making decisions about care and support. This made sure people had enough information to consent to the care and support they required. People told us that they were always asked their agreement in relation to how they received their care and support at the start of every care visit.

We saw service had improved their range of training and development opportunities for staff. This meant they were kept up-to-date with current practice.

We found that the provider was continuing to develop and improve their systems for assessing and monitoring the quality of service they provided. We saw they demonstrated how they learned from feedback to show the service was run for the benefit of the people using it.