The inspection took place on 1 February 2017 and was announced. Passion 4 Care provides personal care to people in their own homes. At the time of our inspection 221 people were using the service.

There was a registered manager in place who was present during our inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was also the nominated individual for the service.

We last inspected this service in July 2016 and found that the provider was breaching five of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had found that the provider had failed to ensure that actions were taken to safeguard people in line with the local safeguarding policy and procedures. There was no effective system in place for receiving and responding to all complaints received. Recruitment processes had not ensured that people were supported by staff who had been assessed as suitable. The inspection rating awarded previously was not conspicuously displayed on their website. We also found that the systems used to assess, monitor and improve the quality and safety of the services provided to people and the managements of risks to people was not effective.

At this inspection we found that improvements had been made to the provider’s safeguarding, complaints and recruitment processes and they had taken effective action to display their latest ratings. However the registered provider had failed to make sufficient improvement to assess, monitor and improve the quality and safety of the service. The registered provider did not have a clear and concise staff rota system so they could monitor if people were receiving their calls as planned. They did not provide detailed guidance for staff about the risk associated with people’s conditions. Systems in place did not always ensure the registered provider responded appropriately to requests for information from the commission.

People told us they felt the service kept them safe and felt confident in the abilities of the staff who supported them. The registered provider had taken action to ensure concerns about people being at risk of abuse would be raised with the appropriate authorities and in line with good practice.

People were supported by staff who involved other health professionals when their conditions changed so that people were supported by the most suitable health care professional to meet their needs.

Staff were knowledgeable about how to protect people from the risks associated with their specific conditions but this detail was not always reflected in people’s care plans for use by staff who were less familiar with people’s needs.

People told us they were happy with how staff supported them with medication; however records were not always sufficiently completed to demonstrate that people had received their medication as prescribed.

People were happy to use the service and felt supported by consistent staff who had the skills and knowledge to meet their individual care needs. The registered provider had taken action to ensure people were supported by staff who were suitable to do so.

People were supported to express how they wanted their care to be provided and were supported in line with the Mental Capacity Act 2005. Staff knew people’s individual preferences and how to maintain their privacy and dignity when providing personal care.

People and staff told us they felt comfortable to complain if something was not right and they were confident that their concerns would be taken seriously. The registered provider had taken action to improve how people’s complaints were handled.

People expressed confidence in how the service was run and leadership. Most pe

The inspection took place on 9 and 13 June 2016 and was announced. We conducted this inspection in response to information of concern we had received about the service. When we last inspected this service in July 2015 we found it compliant with all the regulations we looked at. However we did identify that some aspects of the service required improving including how people were protected against the risks associated with their conditions, how the registered manager monitored the quality of the service and the recording of people’s medicines. At our latest inspection we noted these areas still required improving.

We were advised that the service provided personal care to about 270 people in their own homes. There was a registered manager at this location. 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.

Recruitment processes were not robust and failed to provide assurance that people were supported by staff who were suitable and adequately skilled to meet their needs. We saw evidence that some staff had started providing care to people before suitable checks had been completed. Staff we spoke with were knowledgeable about how to meet the care needs of the people they supported although records did not identify all the staff competencies, the training staff had undertaken or when further training would be required. You can see what action we have asked the provider to take at the back of the report.

The registered manager had failed to keep up to date with changes in legislation and they were not aware of the requirements to display and promote the ratings awarded at their last inspection or when to submit statutory notifications to the Commission. They had delegated much of the daily management to senior members of staff but had not established adequate reporting processes so they could monitor if the service was meeting people’s needs. The systems in place that they used to monitor the service were ineffective and they were unable to confidently or accurately identify how many people used the service, if people ever received late or missed calls, if the care they received was meeting their needs and what action was taken when there were concerns. They were unable to confirm how many staff were employed. You can see what action we have asked the provider to take at the back of the report.

Staff knew how to recognise the signs of abuse however the registered manager had not always notified the appropriate authorities as required and in line with good practice. You can see what action we have asked the provider to take at the back of the report.

Care plans identified people’s specific conditions and how staff were to support them to keep them well but they did not provide details about how staff were to manage the specific risks associated with people’s conditions. There were processes and information in place to help staff safely manage peoples medication in line with how it had been prescribed.

There were systems to obtain people’s views of the service and we saw that the comments were acted on. Senior staff conducted spot checks and observations of how staff supported people.

We saw that complaints were investigated and responded to however there was no consistent approach. The provider had failed to respond appropriately to concerns that had been raised by the authority who commissions some care on behalf of people using the service. The registered manager did not have a robust system to monitor information collected for trends to identify how the service people received could be improved. You can see what action we have asked the provider to take at the back of the report.

People were generally supported by the same staff which had h

The inspection took place on 2 July 2015 and was announced. At our last inspection in May 2014 we found that some care plans had not been updated and quality checks were not effective. The provider sent us an action plan to tell us the improvements they were going to make to ensure the service would comply with the regulations.

The service provided domiciliary care to 128 people in their own homes and there was a registered manager in place. 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 not always kept safe. Staff knew how to recognise signs of abuse and who to raise concerns with. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions however some of these needed to be personalised to reflect people’s specific conditions. It was not possible to identify if people had taken the medications they needed to stay well because records of administration had not been maintained accurately.

People were supported by the number of staff identified as necessary in their care plans to keep them safe. There were recruitment and induction processes in place however further checks required had not been completed to ensure some members of staff were suitable to support the people who used the service

Staff had the skills and knowledge to ensure people were supported in line with their care needs and best practice. Staff had regular supervisions in order to review how to meet people’s care needs and provide support to staff.

The registered manager and staff we spoke with were knowledgeable of and acted in line with the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing personal care.

When necessary, people were supported to eat and drink and access other health care professionals in order to maintain their health.

People had positive relationships with the staff who supported them and spoke about them with affection. The provider sought out and respected people’s views about the care they received. Staff promoted and upheld people’s privacy and dignity.

The provider was responsive to people’s needs and changing views. People were supported by staff that they said they liked and care was delivered in line with their wishes. People could raise concerns however the provider did not always manage complaints in line with their own policy.

People were confident in how the service was led and the registered manager’s abilities. The provider had established processes for monitoring and improving the quality of the care people received although these were not always effective in identifying how the service could be improved.

What people told us and what we found

On the day of our inspection, we found that 79 people were receiving care from this agency. We subsequently spoke to nine people who received services and their relatives, five members of staff and the manager of the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We spoke to several people who received services. People told us they felt safe. Comments included, “Yes I feel safe, I trust my carer’s” and “The carer's are excellent, no worries with them.”

We saw that the agency had an appropriate safeguarding policy and procedures in place. We noted that this policy had been reviewed in January 2014 and was detailed and ‘fit for purpose’.

People’s health and welfare needs were being met because staff who supported them had the appropriate skills and experience. Disclosure and barring checks (formerly checks undertaken by the Criminal Record Bureau - CRB), pre-employment enquiries and personal references had been obtained to ensure that staff were of good character and suitable to work with vulnerable people. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults. We spoke to staff and they demonstrated that they understood their role in safeguarding the people they supported and knew what action to take should it be necessary to do so.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) legislation. We found that no-one being supported by this agency was subject to a restriction by this legislation. We spoke to the manager and staff about the Deprivation of Liberty Safeguards (DOLS) and found that they had a current policy in place in relation to this legislation and understood their responsibilities.

We concluded that people were safe and being supported by trained and caring staff. However, errors with care plans and lateness of calls meant that not everyone was receiving safe and appropriate care at all times. We have asked the provider to tell us how they will make improvements and meet the requirements of the law.

Is the service effective?

Care staff had the appropriate skills and knowledge to provide safe, effective and appropriate care and support. Care staff told us that they were well trained, competent and able to meet the needs of the people who used the service. Training records showed that the majority of staff had received appropriate training in a number of relevant topics, including: manual handling, medication and infection control.

People told us that they were happy with the care they received and the care staff who supported them. Comments included “ Staff are very good when they get here, but they arrive late regularly” and “The staff are very good, we have no complaints.”

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. However we found that some care plans did not always reflect changes in people’s health needs. Some care plans had not been updated or revised since their initial assessment.

We checked people’s daily records and saw several examples of care staff arriving late at calls. We spoke to the management team about this and were told that some people were quite flexible about the times they received care and support. However, care plans had not been updated, signed or endorsed to show that new or flexible calling times had been agreed with the person receiving care.

We concluded that although significant improvements have been made since our last inspection of this agency, Passion 4 Care did not always provide a safe and effective service. We have asked the provider to tell us how they will make improvements and meet the requirements of the law.

Is the service caring?

People we spoke with and visited told us they were supported by kind and attentive staff. Comments included, “I really like my carers, they are wonderful and will do anything I ask” and “The staff are very kind and caring.”

We spoke to relatives of people who received services from Passion 4 Care. They were complimentary about the standards of care being provided and the competence of staff delivering care and support. Comments included, “My relative is very happy with the service she receives and gets on really well with the carers.”

Is the service responsive?

There were good arrangements for making sure that people could express their views about the service. We saw records which showed that people had been consulted about a wide range of issues including safety, care and support and timeliness of calls. We found that the service had a comprehensive complaints policy. This meant that people had regular opportunities to discuss and influence matters that were important to them.

Customer satisfaction survey (questionnaires) showed that a high percentage of those that responded indicated that they were happy with the service they received and felt safe with care staff. However, several people had concerns about time keeping and the lateness of calls.

We noted that Passion 4 Care did not have an effective system for recording, analysing and trying to understand why care staff had difficulties arriving at calls on time. In the absence of accurate records and analysis, the agency was unable to address the issues of timeliness effectively and make improvements to the service being delivered.

We found that care staff had regular meetings with the management at this care agency and were able to discuss their training and development needs, welfare and any concerns they might have about the people they were caring for.

We concluded that people who received care and support from this care agency were involved in the delivery of their care and listened to in a way that responded to their needs and concerns. However concerns regarding late calls had not been responded to effectively. We have asked the provider to tell us how they will make improvements and meet the requirements of the law.

Is the service well-led?

It was clear from our recent inspection of this agency that significant improvements had been made since our last inspections in June 2013 and February 2014. However we found that the provider did not have an effective system to assess and monitor the quality of service that people received. We also found that some care plans had not been adequately reviewed and concerns regarding the timeliness of calls to people’s homes had not improved.

We concluded that although improvements had been made at this agency, leadership was not always effective and consistent.