This inspection started on 5 December 2018 and was announced. We gave the service 24 hours notice of the start of the inspection because we wanted key people to be available. The service was last inspected in April 2018. At that time, we found there were four breaches of regulations. The service was rated as Inadequate and was placed in special measures.

When we place services in special measures we expect providers to take action to significantly improve the quality and safety of their service. Services placed in special measures will be inspected within six months and kept under review during this period. The purpose of this inspection is to check the service had improved and to provide a new quality rating. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the time of this inspection the service was providing support to 36 people who lived in their own homes. The service had previously handed back, to both Bristol City Council and South Gloucestershire Council, funded care packages to enable the service to stabilise and improve. The service was provided to people who lived within the South Gloucestershire and Bristol local authorities. The service employed 23 care staff but were actively recruiting to enable the service to expand again.

There was no registered manager in post, however an application to be registered with CQC had already been submitted and accepted. 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 manager will be registered to carry on the regulated activity at two branches – Bristol and Birmingham. They will be supported by a deputy manager in both branches.

The findings from the inspection have been very positive. Significant improvements have been made. The office had been tidied up and was organised. The atmosphere in the office was good and the staff were working together for the benefit of the people they were providing a service to.

Why we have rated the service Good ?

The service was safe. Care staff had received further training about safeguarding adults and were fully aware of their responsibilities to protect people. They knew what to do if safeguarding concerns were raised. The service followed safe recruitment procedures to ensure unsuitable staff were not employed.

The management of medicines had been significantly improved and care staff had been trained to administer medicines safely with their competence checked. However, we recommend that protocols be put in place to give guidance to care staff where they need to help people with ‘as required’ medicines.

The service was responsive. Significant improvements had been made to ensure that people received a person centred service. People’s care and support needs were assessed so that their care plan could be agreed with them. People were involved in making decisions about how they wanted to be looked after. Risks to people’s health and welfare were assessed and measures put in place to reduce or eliminate the risks. Where people needed support with their meals and drinks, their needs were assessed and detailed in their care plan. Care staff assisted people to make contact with any health care professionals and their GP as necessary. People’s care and support needs were reviewed and their care plans were amended as necessary.

The service was effective. The provider had a four day induction training for new staff to complete and this was in line with the Care Certificate. All other staff had a programme of refresher training to complete and re

This inspection started on 6 April 2018 and was announced. We gave the service 24 hours notice of the start of the inspection because we wanted key people to be available. The service was last inspected in November 2015. There were no breaches of the regulations and the service was rated as Good.

At the time of this inspection the service was providing support to 55 people who lived in their own homes. However the service had recently handed back, to both Bristol City Council and South Gloucestershire Council, funded care packages the service was no longer able to cover. This was because about 10 home care assistants had left Kensington Community Care (Gloucester). The service was provided to people who lived within the South Gloucestershire and Bristol areas. The service employed 30 care staff (some on a bank staff status). Throughout the report we have referred to the service as Kensington Community Care.

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 however, is not present every day in the service because they were now the registered manager for the Birmingham branch. A new manager for this branch has already been appointed and was making application to CQC to be the registered manager (referred to throughout the report as the manager).

The management of medicines was not safe. Home care assistants did not receive adequate training in order to be able to administer medicines safely or understand the reasons why the completion of records was important. The manager had found that medicine records contained a lot of gaps with missing staff signatures. Many of the staff team were not up to date with their safeguarding adults training and a significant number of safeguarding concerns had been raised with the local authority.

People did not receive a person centred service. Care calls were often not scheduled at the time which had been agreed during assessment. Some home care assistants did not stay for the agreed length of time. On occasions relatives had been asked to cover care calls because staff were not available. This had improved recently because a number of care packages had been handed over to other care providers. People and their relatives were concerned that home care assistants often told them of their concerns about their work and difficulties working for Kensington and off-loaded on to them.

New staff to the service had three day induction training to complete and all staff had refresher training to complete. However, many staff had not had any training for a number of years. Compliance with the requirements of the Care Certificate required improvement. Staff were not supervised or their work performance spot checked. No annual appraisals had been completed in 2017.

People’s care and support needs were not reviewed and their care plans were not kept up to date. Some of the care plans we looked at were out of date and did not reflect the service provided. This had the potential to mean people could receive the wrong care and support.

Complaints were not handled correctly despite there being a complaints procedure in place. People and their relatives told us about concerns and complaints they had raised but these had not all been logged. For four complaints there was a record of action taken by the manager however the response had not covered all the issues and had resulted in just a one line apology.

The service did not have measures in place to monitor the quality, safety and ‘customer’ satisfaction with the service provision. People had not been asked to provide feedback regarding their views and opinions of the service.

The inspection took place on 17 and 18 November 2015 and was announced. We gave the provider 48 hours notice of the inspection to ensure that the people we needed to meet with were available.

The agency was providing support to 97 people who lived in their own homes, at the time of the inspection. These people lived in the South Gloucestershire and Bristol area.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were safe with the care staff who were supporting them. Staff were trained to use any moving and handling equipment they needed to use. They had received training to ensure they were aware of safeguarding issues and knew how to report any concerns. Staff were recruited following robust recruitment procedures. Risk assessments were undertaken and plans to manage any risks were put in place. Those who needed help with their medicines were looked after by staff who had received training and were competent in the administration of medicines.

People were looked after by the least number of care staff which meant they were able to get to know them. People had good relationships with the staff who were supporting them. People were treated with kindness and respect.

People were involved in the process of deciding what care and support they needed and received the service they expected and had agreed. The service used a call monitoring system in order to ensure people received the service they expected. Staff were knowledgeable about the people they supported. They received the appropriate training and support to enable them to undertake their roles effectively. Where people were assessed as needing support with food and drink, they were provided with the service they needed. People were supported to access health care services as required.

Assessment and care planning processes ensured that each person received the service they needed and met their individual needs. The package of support provided to each person was kept under regular review and amended as and when necessary. People’s preferences and choices were respected. People were provided with copies of their plans, knew what service was provided and who was going to support them.

People and staff said the service was well-led and they were encouraged to provide feedback.  The quality and safety of the service was regularly monitored and used to make improvements.  The service had a plan in place for making improvements and was already implementing some of those changes.