Precious Care Services Ltd provides domestic services and personal care to older people; people with learning disabilities or autistic spectrum; physical disabilities; people living with dementia and people who misuse drugs and alcohol. The service was providing a regulated activity to 16 people who were using the service at the time of our visit.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

At our previous inspection on 14, 15 and 17 November 2016 we found a number of breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach in the Care Quality Commission (Registration) Regulations 2009. The provider was given an overall rating of ‘inadequate’ which placed them into special measures. We took enforcement action against the provider due to the concerns found.

We asked the provider to take action to make improvements in the areas of person-centred care; meeting nutritional and hydration needs; fit and proper persons employed; staffing and notifications of other incidents. After our visit we asked the provider to complete an action plan with a date when they would be compliant. The provider submitted the action plan by the required timescale and informed us improvements would be made by 31 January 2017.

During this inspection we found the provider had made significant improvements to reduce the risk of harm to people. However, further improvements were required in the service’s quality assurance systems to ensure any shortfalls would be promptly identified and addressed.

People were overwhelmingly positive about the caring attitude of staff. We heard comments such as, “They (staff) engage in a positive and affectionate way. You can tell they’re caring rather than just coming to do a job and leave.” Staff had a good understanding of people’s care and support needs; people and their relatives were involved in making decisions about their care and staff knew people’s individual communication skills, abilities and preferences.

People and their relatives said they felt safe from abuse; staff were aware of their responsibilities to keep people safe, medicine competency assessments still had not been completed for staff. Recruitment procedures were not thoroughly checked for accuracy. Staff job application forms contained missing information. We have recommended the service seek current guidance on the completion of medicine competency assessments in a timely manner.

Staff had received relevant training and supervision; people’s nutritional needs were met and people or those who represented them had signed to give consent to the care and support delivered.

Assessment of care needs were completed and updated to ensure care and support delivered reflected the care people said they wanted. Care plans were personalised and detailed people’s preferences for care. People and their relatives said the service was responsive to their needs.

People felt the service was well managed and provided them with safe, caring and effective care. The registered manager had undertaken relevant training and changed their work practice to ensure the service was managed effectively. However, further improvements were required with the thoroughness of audits and the completion of reports. We recommend the service seeks good practice on how to complete audits of recruitment records and ensure information submitted to the CQC is fully completed.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection th

11a Station Road provides domestic services and personal care to older people; people with learning disabilities or autistic spectrum; physical disabilities; people living with dementia and people who misuse drugs and alcohol. The service was providing a regulated activity to 13 people who were using the service at the time of our visit.

The service has a 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our visit we became aware people may be at risk of harm. We found a number of unsafe care practices that placed people at risk of harm. The registered manager failed to report an allegation of suspected abuse. We found there was no procedure in place to mitigate the impact. There were no risk management plans in place for people who had identified risks; where people had unexplainable injuries the service did not take appropriate action; some staff did not undertake safeguarding refresher training and new staff did not receive the relevant training at all. The provider carried out unsafe recruitment practices. This meant people were at risk of abuse, harm and inappropriate care.

People and their relatives said they felt safe. They told us staff arrived on time and the care received was not rushed.

Staff did not receive appropriate induction, supervision and training. Staff had no understanding of the Mental Capacity Act 2005 (MCA) and how it related to their work practice, as they had not undertaken the relevant training. The MCA protects people who lack capacity to make specific decisions and gives statutory principles what should be applied in order to support them. The service did not act in accordance with the requirements of the MCA. We have made a

recommendation for the service to seek guidance on undertaking mental capacity assessments based upon the MCA.

People’s nutritional needs were not always met. Where people had medical conditions that affected their nutrition care records did not show how staff should support them. This meant people’s nutritional needs were not effectively being met.

‘Baseline initial assessment of needs’ which contained information such as people's care and support needs, medical histories, family and social histories and preferences, were either partially completed or not evident in personal care records. This had the potential of people receiving care and support they did not want. There were no arrangements in place to ensure people’s individual care needs were regularly reviewed and kept up to date. This meant the service did not ensure the care and support delivered to people was still relevant. We have made a recommendation for the service to seek guidance on how to record outcomes of complaints received.

People felt the service was responsive to their needs.

The registered manager demonstrated a lack of understanding of fundamental standards and their regulatory responsibilities. They failed to notify us of safeguarding incidents that had occurred in line with the required regulation and submit information requested by us within a set timeframe. There were no effective systems and processes in place to assess and monitor the quality of the services provided. This meant people’s welfare and safety was placed at risk because the service was not effectively managed.

People felt staff were caring, treated them with respect and in a dignified manner. Staff had developed good working relationships with people and understood their needs. The service promoted and encouraged people to be independent.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken