At our last comprehensive inspection on 1 February 2017 we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for good governance. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-led to at least good.

During this inspection, the service demonstrated to us that improvements had been made and that it was no longer in breach of this regulation. However, further improvements were still needed and we have made a recommendation that the provider continues with the improvements relating to their quality assurance processes.

This inspection took place on 13 March 2018 and was announced.

This service is a domiciliary care agency. It provides personal care to 33 people living in their own houses and flats in the community. It provides a service to older adults, younger adults and people who are living with a physical disability.

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.

Individual risks relating to people’s health and wellbeing were not fully documented. Risk assessments did not contain sufficient guidance for staff about how risks can be managed and mitigated. Where risks had been identified, guidance provided in the risk assessments did not demonstrate how people were affected individually by the risk. However, staff knew people’s individual risks and how to minimise known risks.

Environmental risks in people’s homes were assessed and documented. This included guidance about what to do in the event of a fire and how to manage incidents with the water and gas supply to people’s homes.

Staff knew their responsibilities in relation to keeping people safe. Staff knew how and who to report concerns of abuse too. Staff had also attended training in safeguarding.

There were enough staff to meet people’s care needs and people received their visits on time.

Safe practices were in place for the recruitment of staff. Appropriate references and a clearance from the Disclosure and Barring Service were obtained before staff started working at the service.

People’s medicines were managed in a safe way and people’s medicines administration record charts showed that people were given their medicines as prescribed. Staff received training in the management of people’s medicines and their knowledge and practice in this area was regularly assessed.

Assessments of people’s care needs took place before they started to use the service and people’s care needs were reviewed on a regular basis.

Staff received training relevant to their role and received regular supervision from the management team. An induction programme was in place for new staff where they would shadow more experienced members of staff.

People were supported to maintain a healthy nutritional intake and staff were aware of people’s individual needs relating to their food and fluid intake.

Referrals to other healthcare professionals were made in a timely manner where there were concerns about a person’s health or wellbeing.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff understood the principles of the MCA and had received training in this subject.

Staff treated people in a kind and caring way. People were cared for in a way that maintained their dignity and staff were respectful of their privacy. Confidential documents about people’s care were stored in a safe way.

People and their relatives were involved in the planning of their care. P

The inspection took place on the 1 February 2017. We contacted the service before we visited to announce the inspection. This was because the service provides a domiciliary care service to people in their own homes. We wanted to ensure that we could access the service’s office and speak with the manager and staff.

Patina’s Home Care provides personal care to around 30 people who live in their own homes, in Great Yarmouth and the surrounding areas. With domiciliary care services the Care Quality Commission (CQC) only regulates personal care. This was the service’s first inspection.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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. For the purpose of this report the registered manager will be referred to as the manager. The service also had a daily manager and senior care staff.

The service was not producing complete and clear records of people’s care needs and their associated risks. Staff were generally knowledgeable of people’s needs but these had not been obtained and recorded in people’s risk assessments. People did not have robust plans in place to guide staff about how to manage people’s needs and what action they should take, if there were concerns.

The service was also not recording when they made contact with health and social care professionals to seek their involvement when a person’s needs had changed.

The service did not have robust auditing systems in place to monitor the quality of people’s risks assessments, their care plans and reviews. The service had not identified there were issues with their assessment and review processes. Some audits and quality monitoring systems were not effective.

These issues all constituted a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People received care visits from a group of regular carer staff at their own agreed times. People did not have missed care visits. When necessary, staff stayed longer with people than their allotted times in order to ensure their needs were met.

Staff and the manager were motivated to provide good care to people. Staff understood the importance of responding to concerns about people’s health. There was a training system in place and staff spoke positively about the training and the induction they received. Staff had a thorough induction to the service and their role.

The manager and staff demonstrated they understood how to protect people from the risk of abuse. Staff were aware of this potential issue and knew what to do if they had concerns. People felt involved in the planning of their care.

People benefited from staff who felt supported and valued by the management team. Staff found the manager approachable and supportive. The manager and staff had confidence in the service they were providing.

Staff understood the importance of promoting and protecting people’s dignity, privacy and independence. People and their relatives gave many positive examples of the caring and supportive approach of staff. People told us they were treated with dignity and in a caring and kind way. People and staff told us that they formed positive relationships with one another.

Staff had received training in the Mental Capacity Act 2005 (MCA) and demonstrated they understood the importance of gaining people’s consent before assisting them.

The manager and staff supported people in a practical way to avoid social isolation. People felt comfortable speaking with the manager and raising any issues they may have had. There was a complaints process in place for the manager to respond to complaints.

The manag