About the service: Kris Carers Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection 38 people were using the service and all received personal care.

People’s experience of using this service:

¿The governance system used to monitor quality of service remained fragmented and there were failings as a result of this.

¿The registered manager, who is also the provider, was not open and transparent in relation to complaints and concerns in line with the Duty of Candour.

¿ People told us the service was not well managed. The registered manager was not always available or responsive and there was an over reliance on the office staff to manage the service on a day to day basis.

¿Staff supported people with their medicines, but records were not always completed to confirm this.

¿ Staff recruitment procedure was not always followed to protect people from unsuitable staff.

¿ There were enough staff to support people. However, staff were not always reliable or on time to meet people’s needs.

¿ The system to ensure staff were trained for their role was not sufficiently robust. Training was not monitored, and some staff training was overdue in areas such as mental capacity and safeguarding people from abuse. Staff were supported individually, and their practices were checked.

¿ People not confident that their complaint would be addressed. Records showed the complaint procedure was not followed and improvements were limited.

¿ People’s care files showed risk were assessed and managed in a safe way.

¿ People told us they felt safe and protected from discrimination. Staff knew what abuse looked like and the action they should take.

¿ People were not always involved in the reviewing of their care to ensure they received person centred and responsive care as their needs changed.

¿ People’s dietary needs were assessed. Staff prepared meals and drinks where required.

¿ People were supported to access health care services as required.

¿ People’s rights to make their own decisions were respected. Mental capacity assessments were completed as required. Staff sought consent before care was provided.

¿ People’s diverse needs were met.

¿ People’s wishes about their end of life was not always documented.

¿ People were supported by kind and caring staff.

¿ People’s privacy and dignity was protected. People’s independence was promoted by staff.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published June 2018).

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection. At that inspection the domains of safe, effective, responsive and well led were rated as requires improvement.

Enforcement: Action we told provider to take (refer to end of full report).

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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

Kris Carers Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

At the last comprehensive inspection on 25 and 28 October 2015 the service was rated Good.

This is the second comprehensive inspection of the service. This took place on 9 and 10 April 2018 and was announced. At the time of our inspection 50 people were receiving care.

At this inspection the service had deteriorated to ‘Requires Improvement’.

The provider and registered manager had not consistently met the regulatory responsibilities. They had not provided us with the key information about the service when required, which we took into account when making judgement about the service.

The registered manager had not fully understood and met all the legal requirements with regards to their registration. The provider had moved to new premises but had failed to submit the relevant notification and applications to maintain their registration. The registered manager had not accessed relevant training to maintain their knowledge about the changes in legislation and best practice. The registered manager assured us they would access training.

Following our inspection visit the provider submitted relevant notifications and applications ensure they were registered correctly.

The provider had not notified the Care Quality Commission of significant events as they are required to do. The provider's system to monitor the quality of care provision was not in place. Some internal checks were carried out but they did not drive improvements. Policies, procedures and guidance for staff did not reflect current professional guidance and best practice.

Where people required support with their medicines, staff had been trained in the safe handling of medicine. However, we found some gaps in the medicine administration records. These had been identified by the registered manager and staff received further training and records were monitored.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, information in the care plans about how to support people to make decisions was not always clearly recorded. The frequency of reviewing people’s care varied and care plans were not always updated to ensure staff had guidance to support people. The registered manager assured us they would address the issues raised.

People continued to receive safe care. People needs were assessed and they continued to be involved in the development of their care plan. People continued to be protected from avoidable risks. A range of risks assessments were completed and preventative action was taken to reduce the risk of harm to people. People were supported to maintain good health and nutrition.

People continued to receive effective care and support. Staff recruitment processes were followed and ensured that people were protected from being cared for by unsuitable staff. There were enough staff to provide care and support to people to meet their needs safely. Staff continued to receive a range of training for their role and to protect people from avoidable harm. Staff understood their responsibilities to work effectively. Staff practices were checked regularly and when required additional training and support was provided.

People continued to receive good care. Despite the quality of information in people’s care plans staff knew people well and how to support them. They had developed positive relationship with the staff who understood their needs. Staff were kind, caring and treated people with dignity and respect.

Care plans and relevant information was made available in accessible formats to help people understand the care and support agreed. Staff worked in a flexible way and took account of people’s diverse and cultural needs to ensu

When we visited the service on 10 July 2012, there were 5 people using the service. We spoke with two family members of people who used the service about their experiences.

When asked about the service provided, one relative said, “I can’t think of anyone better”. They also said the staff were, “absolutely marvellous”.

Another relative we spoke with said they were, “very pleased with them” and “they are the best care company we have had.”

However, we found that the lack of care planning and assessment of risk had the potential to negatively affect people’s experiences, safety and welfare.

This inspection took place on 26 and 28 October 2015 and was announced. The provider was given 48 hours’ notice because the location provides domiciliary care service and we needed to be sure that someone would be at the office.

Kris Carers Ltd is a domiciliary care service providing care and support to people living in their own homes. The office is based in the city of Leicester and the service currently provides care and support to people living in Leicester and Leicestershire. At the time of our inspection there were 12 people using the service.

A registered manager was 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 told us they felt safe with the staff that supported them. Staff were trained in safeguarding (protecting people who used care services from abuse) procedures. Staff were confident that if they had any concerns about people’s safety, health or welfare then they would know what action to take, which would include reporting their concerns to the registered manager or to the relevant external agencies.

People were involved in making decisions about their care and support needs and in the development of their care plan. Potential risk to people’s health had been assessed and measures in place were detailed in the care plans for staff to refer to.

Staff were recruited safely to help ensure they were suitable to work unsupervised with people who use care services. There were sufficient numbers of staff employed by the service to meet the needs of people.

The service ensured the needs of people were met by staff with the appropriate knowledge and skills, and matched with any known requirements such as individual preferences, cultural or diverse needs. Staff had induction and on-going training that equipped them to support people safely. Staff were supported regularly through supervisions and staff meetings and checks were carried out on their practices.

People were prompted to take their medicines by staff where people’s assessed needs and care plans required this. Staff supported people to liaise with health care professionals if there were any concerns about their health.

People made decisions about their care needs and support needs. People told us that staff sought consent before they were helped and that staff always respected their choices and decisions.

Staff supported some people with their meals and drinks. Staff were trained to prepare meals, which met people’s nutritional and cultural dietary needs.

People told us that they were happy with the support they received and the staff. People were complimentary about the staff and found them to be kind and caring and had developed positive relationships with them. People’s privacy and dignity was maintained, their choice of lifestyle was respected and their independence was promoted.

Staff were knowledgeable about the needs of people and took account of their preferences such as times, cultural and diverse needs. Staff employed by the service spoke a number of other languages reflective of the people living in the local community. The registered manager has put in place systems to ensure regular reviews of people’s needs and their care plans to ensure they remain appropriate.

People told us they were aware of how to raise concern. They were confident that any concerns raised would be responded to by the registered manager and the provider.

People who used the service and relatives told us that their views about the service were sought regularly. People told us that they were happy with how the service was managed.

There were systems in place to assess and monitor the service, which included checks on staff delivering care and support to people and review of people’s care. People told us that the registered manager visited them regularly to check on their wellbeing and also monitor the care and support provided by the staff. The provider had systems in place to assess and monitor the quality of services provided.