This comprehensive inspection took place on 12 and 16 October 2018. Positive Care Link is a domiciliary care service. It provides personal care to people living in their own homes. Not everyone using the service receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care' and help with tasks related to personal hygiene and eating. At the time of our visit, 10 people were using the service.

At the last inspection on 12 January 2018, we found that the service did not meet the regulations we inspected. We found a continued breach in safe care and treatment. We found that the provider did not have safe management of medicines systems in place. In addition, risks for people were not always appropriately assessed and plans were not in place to mitigate them. We issued a warning notice for this breach. We also found a continued breach in good governance because the provider did not maintain complete and contemporaneous records for people. We found a new breach in relation to staffing, because training for staff did not support them to carry out the duties. We issued a requirement notice for these breaches.

At this inspection we followed up on the warning notice and the requirement notices to ensure action had been taken to resolve our concerns. We found that the provider and registered manager had taken action to address some of the concerns from our previous inspection. However, we found that sufficient action had not been taken to resolve all of the concerns.

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.

Medicines were managed safely. There were records and processes in place that demonstrated people’s medicines was managed appropriately. However, we found that medicine administration recording was not always accurate.

The registered manager had systems in place that monitored the quality of the service. But we found these were not always effective because these did not find the concerns we found with some aspects of the service.

Pre-employment checks were carried out and returned before newly employed staff worked at the service. There were enough staff available to meet people’s needs safely and effectively. However, when we checked the care worker tracker system there were errors in the recording of visit times which meant the systems could not identify a missed or late visit.

The registered manager had made improvements in the identification of risks for people. Each person had a risk assessment that was associated with their health or care needs. A risk management plan was in place to guide staff to manage and mitigate risks.

The registered provider had a safeguarding policy in place. Staff understood abuse and how to manage an allegation of abuse and protect people from harm.

Each person had an assessment of their care and support needs. Staff had reviewed and updated people’s care records since our last inspection. People’s care records held information on their individual needs, likes and dislikes. Staff had access to this guidance to enable them to support people.

People had meals prepared for them if this was required. Meals provided met people’s personal choices, preferences and nutritional needs.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff completed training in MCA which helped them the identify when people lacked the mental capacity to make decisions for themselves. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the servi

Our last comprehensive inspection of this service took place on 25 October 2016 where we found breaches of regulations in regards to risk management and good governance. We rated the service “Requires improvement”. At this inspection we found the service remained “Requires improvement”. Following our last inspection, we asked the provider to complete an action plan to show what they would do in order to meet regulations.

This inspection was announced and took place on 12 January 2018 to check that the provider had followed their plan and to confirm they now met legal requirements. At this inspection we found the provider had failed to make necessary improvements.

Positive Care Link is a domiciliary care service providing personal care and support to adults. Whilst we have taken into account any wider social care and support provided to people in their homes and in the community, the Care Quality Commission (CQC) carried out this inspection only in relation to the regulated activity of ‘personal care’.

At the time of our visit the service was supporting 42 people. Of these people, 14 were receiving support and assistance with personal care tasks.

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.

People's care and support needs were assessed by local authority social workers before a timetable of tasks was created and an appropriate package of care provided.

The provider did not consistently provide staff with information about people’s life histories, individual preferences, communication methods, likes and dislikes, cultural and emotional needs. This information can be useful for staff when meeting people for the first time and ensures that individualised support is appropriate and person-centred.

The registered manager demonstrated a poor understanding of the risk assessment process. Risks to people's health, well-being and safety were not being clearly identified during the assessment process and therefore appropriate plans to manage and minimise risks were not always in place.

Most people told us they felt safe with staff. Staff received safeguarding training and were able to explain what they would do and who they would contact if they had any concerns about people's safety.

Staff were not always following the provider’s medicines policies and procedures when supporting people to manage their medicines. Information we reviewed provided insufficient detail as to what medicines had been prompted, at what time and whether people had been observed taking their medicines.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff respected people's decisions and gained people's consent before they provided personal care. People using the service and their relatives told us staff were kind and caring and mindful of privacy and dignity issues.

People were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, district nurses and social workers.

People were supported with meal preparation where this task formed part of their care plan. However, care records did not provide any specific information regarding dietary requirements where people were at risk of choking due to their illness or disabilities.

There were measures in place to ensure that staff were recruited safely and were suitable for their roles and once in post, staff received a programme of ongoing training and supervision.

People's feedback was sought through spot check visits and telephone reviews and there was a process in place for ensuring that complaints were investigated and responded to appropriately.

We found that the provider was in con

We carried out a comprehensive inspection of this service on 19 July 2015 where several breaches of legal requirements were found. Following this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to person-centred care, safe care and treatment, safeguarding, medicines, staffing and governance.

We undertook this comprehensive inspection on 25 and 26 October 2016 to check that the provider had followed their plan and to confirm they now met legal requirements. The inspection was carried out by one inspector and was unannounced.

Positive Care Link is a domiciliary care service providing personal care and support to adults and children in their own homes.

At the time of our visit the service was supporting 37 people. Of these people, 15 were receiving support and assistance with personal care tasks.

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’s care and support needs were assessed by local authority social workers before a timetable of tasks was created and an appropriate package of care provided. Life histories, individual preferences, communication methods, likes and dislikes did not form part of people’s care plans. This information can be useful for staff when meeting people for the first time and ensures that individualised support is appropriate and person-centred.

Risks to people’s health, well-being and safety were not being clearly identified during the assessment process and therefore appropriate plans to manage and minimise risks were not always in place. Senior staff responsible for the completion of these assessments demonstrated a poor understanding of the risk assessment process.

People told us they felt safe with staff, who had received safeguarding training and understood how to protect people from abuse. The provider had up to date safeguarding policies and procedures in place. Staff were able to explain what they would do and who they would contact if they had any concerns about people’s safety.

Not all staff were involved in supporting people with their medicines, but where they were responsible for prompting people’s medicines, staff were required to complete training in medicines administration and record this task in people’s daily logs. However, when completed daily logs were returned to the office they were destroyed. This information must be retained in line with the Data Protection Act 1998 and for the purpose of monitoring and quality checks.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff respected people’s decisions and gained people’s consent before they provided personal care. People using the service and their relatives told us staff were kind and caring and mindful of privacy and dignity issues.

People were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, district nurses and social workers. Staff told us they notified office staff and people’s relatives if they had concerns about people’s health and we saw evidence of this in the correspondence section of people’s care records.

People were supported with meal preparation where this task formed part of their care plan. However, care records did not provide any specific information regarding dietary requirements where people had been diagnosed with diabetes or where health care professionals had requested staff to support people with healthy eating plans.

There were measures in place to ensure that staff were recruited safely and were suitable for their roles and once in post, staff received a programme of ongoing training and supervision.

People’s

The inspection took place on 19 June 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care service where office staff may be out of the office providing care; we needed to be sure that someone would be in.

Positive Care Link is a domiciliary care agency that provides personal care to older people, people with mental health issues, people with ongoing health needs and those with physical disabilities. There were 15 people receiving personal care from the service at the time of our inspection.

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.

We found that people were not protected from the risk of potential harm because staff could not identify different types of abuse and the manager was not aware to whom she needed to report allegations of abuse. Robust risk assessments were not in place to guide staff about how to manage risks to people. People were at risk of not living the way they chose because the manager had not embedded the principles of the Mental Capacity Act 2005 into the service.

Medicines were not well managed because staff were not given detailed guidance about how to administer them or what to do if something went wrong.

The provider could not be assured that staff were fit for work because criminal record checks were not obtained in a timely manner and staff were not supported by a robust induction programme.

People were supported to get enough to eat and drink and people had access to healthcare professionals.

Staff were compassionate and caring towards people using the service and did not rush care tasks. They took the time to talk to people and obtain consent for day-to-day tasks.

More could have been done to communicate with people who were not able to tell people about their preferences. Communication methods and life histories were not included in care plans to tell care staff how to support the individual. People were not fully involved in their care planning although we found that the service responded to people’s preferences to deliver care at different times.

People felt they could give feedback about the service, however the formal method of recording concerns was not fit for monitoring purposes. Audits and spot checks were in place to gather people’s views but these did not always drive forward improvements in service delivery.

We have made one recommendation in relation to monitoring complaints.

We found six breaches of regulations relating to staffing, medicine management, safe care and treatment, safeguarding service users from abuse, person-centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

At the time of our inspection the agency was providing support to 20 people living in their own homes. We spoke with seven people and or their relatives on the telephone to gather their feedback on the service provided to them. We spoke with the registered manager and one other management staff member based in the office and made calls to five care staff members working for the agency.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff employed to work at the service had been selected for their suitability, skills and experience, so they could meet the needs of the people receiving care. The provider had an infection control policy in place and staff were provided with protective equipment. People told us that the staff always used disposable gloves and aprons.

Is the service effective?

People told us that they were happy with the care they received. Staff told us they got to know people well and they understood people’s care and support needs. One person told us, "staff do a good job it’s all working well.”

Is the service caring?

The feedback people gave us about the staff was positive, with one person saying, “they are very good and caring.” Relatives we spoke with told us staff were caring towards their family member and said staff were caring and kind. People were supported by kind and attentive staff.

Is the service responsive?

We saw people had signed their care plans giving consent to the care provided.

People’s needs had been assessed and reviewed every six months. Records confirmed people’s preferences, history and diverse needs had been recorded and care and support had been provided, which met their wishes. People told us they knew how to make a complaint. Relatives knew how to contact the provider if they needed help or advice. One person said about the care assistance “they are attentive and make sure I am ok.”

Is the service well-led?

The manager had systems in place to monitor the quality of the service provided. Staff told us they were supported in their job, which helped to ensure people who used the service received a good standard of care and support. They felt they could raise issues or concerns with their managers and these would be acted upon. One staff member said, ”we report any problems to our manager.” Staff said they had team meetings, supervision and appraisal.

At the time of the inspection the provider was providing care for 15 people in their own homes. We spoke with one person who used the service, one relative, two staff and the registered manager.

There was evidence people were provided with information on their care and their views and experiences were taken into account in the way the service was provided.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider had a safeguarding policy in place and staff were aware of their responsibilities.

There were sufficient skilled and experienced staff to safely meet the needs of people who use the service. In the staff files we looked at we saw evidence staff had received appropriate training.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

As part of our inspection we spoke with the registered manager, senior staff and with four care workers at the time of our visit to the office and over the telephone. We also spoke over the telephone with one person who received a service from this agency and one relative of a person who used the service. Other people who used the service were either unavailable or did not wish to speak with us.

We asked people to tell us what it was like to receive services. People who spoke with us felt that care workers treated them with dignity and respect. They also told us that care staff respected their decisions in relation to day-to-day tasks.

People who spoke with us agreed that the care staff met their individual or their relative's needs. They commented about care workers being friendly and the agency was providing a good quality of care. People told us there was a high level of stability and were regularly attended by care workers they knew. They also said it was very rare the agency sent them a care worker they did not know.

One relative said: “I don't know what I would do without them” and "Mum gets on well with her carers". Another person commented: “I cannot speak highly enough about all of my care workers".

People who use the service and their relatives agreed they had been involved in the setting up of the care and were consulted by the agency about how it should be provided.

People told us there was a good communication between them and the agency's head office and that senior staff resolved any issues quickly and efficiently.