The inspection took place between 25 January 2017 and 30 January 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary service in people’s own homes and we needed to be sure that someone would be present at the service’s office.

Palmerstone Homecare provides personal care to people in their own homes. At the time of inspection 178 people were using the service.

We carried out an announced comprehensive inspection of this service in July 2016 at their old location 8th Floor, North Suite, Terminus House, Terminus Street, Harlow, CM20 1XA due to concerns raised about the care and support provided. We reported that the registered provider was in breach of the Health and Social Care Act 2008 registration and regulated activities regulations.

Regulation 18 Registration Regulations 2009 Notifications of other incidents

Regulation 16 HSCA RA Regulations 2014 Receiving and acting on complaints

Regulation 17 HSCA RA Regulations 2014 Good Governance

Regulation 16 – Receiving and Acting on Complaints, Regulation 18 HSCA RA Regulations 2014 Staffing.

We took enforcement action and served two Warning Notice against two more serious breaches that we found in respect of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment, and Regulation 19 HSCA RA Regulations 2014 Fit and proper persons employed. We gave the provider until 1 November 2016 to ensure they complied with the Warning Notices.

We asked the registered provider to make improvements and they sent us a comprehensive plan with the actions they intended to take. At this inspection, we found the service had made significant improvements and that all the breaches of regulation found in our visit in July 2016 had now been met.

There was a registered manager in post at the service. The registered manager was also the registered provider. 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 and associated Regulations about how the service is run.

There were new systems in place to monitor the quality of the service and a new computer system had been purchased which was intended to address many of the concerns we had raised previously. A significant number of changes had been introduced over a relatively short period of time. As a result, additional time was needed for these to become fully embedded and for the manager to be able to demonstrate that improvements were sustainable.

The registered manager and staff had taken steps to ensure that accurate medicines records were maintained and improved checks helped ensure people were receiving the medicines they needed. The registered manager had taken steps to ensure staff were aware of incidents that required notification to the Care Quality Commission (CQC) and the local safeguarding team. Management arrangements had been strengthened

Improvements had been made to the checks carried out on new staff to ensure recruitment was robust and safe.

The manager had revised risk assessments to ensure they were aware of how to support people to remain safe in their homes. There were sufficient staff to meet people’s needs and to manage risk safely.

Staff had access to relevant training and regular supervision to equip them with the knowledge and skills to care and support people effectively.

The legal requirements of the Mental Capacity Act 2005 (MCA) were followed when people were unable to make specific decisions about their care. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves.

People who needed support to ensure they had sufficient food and drinks received this. Staff kept records in relation to this, and where they had concerns, raised this appropriat