We inspected NR Care Head Office on 20 and 21 September 2018. We returned on 25 September to provide feedback to the management team. The inspection was announced so we could ensure someone would be available in the office to support the inspection.

We last inspected the service in August 2017 where five breaches to the regulations were found. At this inspection we found four of the previous breaches remained. We have also made three recommendations to help drive improvement.

This service 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, some of whom were living with dementia and had physical disabilities.

At the time of the inspection NR Care Head office was supporting 105 people in their own homes. NR Care had an accessible office where staff were available during office hours. A managed out of hours on call service was also available to support staff and people in receipt of the service.

Not everyone using NR Care received 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 consider any wider social care provided.

NR Care had 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 was about to go on an extended period of leave and a replacement manager had been recruited to cover their absence.

We had previously noted the service had not acquired consent from people to share information with other professionals. The service had developed and acquired this consent at this inspection but had not taken the steps required to ensure all consent was acquired in line with the principles of the Mental Capacity Act. This included assessment to determine someone’s capacity to give consent when this was in doubt.

People were mostly supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did not always support this practice. This meant that appropriate assessment and decision-making procedures had not routinely been followed.

It was noted at the last inspection the service was not managing complaints in line with the regulation. This was still the case and we found the provider had not developed a system to manage complaints in line with their own procedure. This meant that when complaints were received they were not routinely; responded to, investigated and managed as the service’s policy dictated.

Notifications for certain incidents including potential safeguarding concerns are required to be sent to the CQC. At this inspection we saw the provider was reporting incidents to the Local Authority safeguarding team in line with their guidance. Where the safeguarding team had notified them, an incident was not being investigated further they had failed to notify the CQC. Notifications should be made to both the safeguarding team and the CQC in line with their associated guidance.

At the last inspection we found that there was not a developed system of quality audit. We found improvements had been made in this area and some audit and reviews had improved. However, some consisted of only the simple collation of figures and basic detail. The analysis of this information required further development to drive improvements and prevent reoccurrences if possible.

At this inspection we have made recommendations to support the provider in the area of contingency planning to ensure the risks are managed to prevent a major incident; also in care planning areas ar

The inspection took place on 6 and 7 July 2017 and was announced.

NR Care provides a domiciliary care service in people’s own homes. The service was supporting 130 people with their personal care needs at the time of this inspection. NR Care supports older people, some of whom are living with different forms of dementia, people with physical disabilities and people with mental health needs.

The registered manager left NR Care a month before we inspected the service. There was an acting manager in place who was applying to become the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The nominated individual and provider were involved in the day to day running of the service. A nominated individual also has a legal responsibility for the service to meet the legal requirements and regulations.

At this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the end of this report.

People were not always protected from the risk of harm or abuse. A person had made an allegation about a member of staff harming them, but the appropriate processes were not followed. No investigation took place to find out what had happened, and to ensure people were protected against this risk in the future.

People were supported by staff who sought people’s consent before supporting them. However, the service was contacting health and social care professionals on their behalf without obtaining people’s consent to do this. Staff were also making a certain decision on behalf of a person and restricting their freedom, without following the guidelines of the Mental Capacity Act 2005.

Complaints and concerns were not managed in an appropriate way to respond, address, and investigate what had happened and try and prevent it from happening again.

Systems were either not in place or the monitoring of the quality of the care and service provided was not robust. Audits were either not taking place or they were not effective in identifying where improvements were required. When issues had been identified there was no evidence to demonstrate that action had been taken to address these issues, to prevent them from happening again.

The nominated individual and the provider did not have a robust overview about the quality of the service provided and where the service needed to make improvements.

The CQC was not informed about a potential safeguarding event, which by law, the then registered manager or the nominated individual should have notified us about.

There were no effective systems in place for the office staff to follow if concerns were raised about staff practice, when they were supporting people. We found examples of when people had informed the service about potential concerns relating to the staff who supported them. Appropriate action was not taken to investigate, monitor staff, and address staff practices.

Staff knew how to identify if a person was experiencing harm or abuse in some way and knew to report this to the manager. However, staff did not know of the outside agencies they could also their report concerns to.

Plans to manage the risks which people faced were not always robust. These risks were not always identified and explored sufficiently when the service assessed people’s needs. However, people told us that they felt safe when they received support from staff.

Staff had a thorough induction to their work, had regular training, and supervisions. However, the training provided did not always take into account people’s specific individual needs. There were limited checks to evaluate the competency of