Following the last inspection in October 2017 when the service was rated as Requires Improvement overall, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well Led to at least good.

At the last inspection we found an insufficient level of leadership at the home, there were concerns with the culture of the staff team. Accidents and incidents were not always processed or in a safe way. Peoples medicines were not stored safely. People were not always protected from harming themselves. Staff did not always understand what harm could look like. Staff security checks were not complete and training was not up to date. People’s confidential information was not protected and there was no complaints process in place. The provider was not completing meaningful and effective audits and responding to the issues found.

We inspected the service again in October 2018 and we found improvements had been made. The overall rating for this service is now ‘Good’.

When we inspected the service on 30, 31 October and 1 November 2018. This inspection was announced.

Precious Homes Treow house is a domiciliary care agency and a supported living service. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger adults who have a learning disability. The service was supporting eight people with the regulated activity of personal care. The service was supporting others but they were not receiving assistance with the regulated activity.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of this inspection eight people were in receipt of the regulated activity of personal care.

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 kept safe as staff understood what harm looked like and they knew what to do about it if they had any concerns. Staff also understood what constituted discrimination, but staff did not know what they could do about it, if a person experienced discrimination.

There were safe processes in place to respond to accidents and incidents to promote people’s safety. People had detailed risk assessments and care plans in place. However, there was no evidence to confirm if staff routinely looked at these documents.

There were sufficient numbers of staff who said they responded to people’s needs in a timely way and they did not feel under pressure to rush people. People received their medicines safely and medicines were also stored safely. Staff told us that they followed good hygiene practices when they supported people with personal care and food preparation.

A person’s health need was not responded to or identified appropriately andstaff did not receive competency checks when they were supporting people alone. The management checks on new staff were not kept available in the service and were not reviewed to check these had been robust checks.

There were plans in place which staff followed when people were at risk of choking or of being an unhealthy weight.

Consent to care was sought according to the principles of the Mental Capacity Act 2005. However, there were some short falls with how people were supported to spend their money, when they did not have capacity to do so. Also, the service did not evidence who exactly they would share people’s sensitive information with if they needed to do this.

The provider? and staff valued and cared for the people they supp

The inspection took place on 4 and 5 October 2017. Precious Homes Bedfordshire provides assistance for people who require support with daily tasks and personal care in their own homes in supported living accommodation. This is when people have their own tenancy and are supported by staff on site to live as independent lives as possible. The service also supported two people who lived outside of Treow House the supported living scheme. The service was supporting about 19 people when we visited the service, but not all of these people were in receipt of the regulated activity of personal care. During the inspection we focused on the care of three people who were in receipt of personal care.

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.

We found two breaches 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.

There was a lack of systems for the management of the service to ensure they consistently and robustly responded to accidents and incidents involving people who used the service in a safe way. Concerns by the local authority had been raised about this and the management of the service had not responded in a timely way to resolve this issue.

The service was not always storing people’s medicines in a safe way. Staff recruitment checks were not fully completed and in a robust way before staff started working at the service.

Staff knew how to identify abuse, and report it to the registered manager. However, not all staff knew of the outside agencies they could also report their concerns to.

The risks which people faced were identified in their risk assessments. However, the plans in place to mitigate these risks were not always detailed enough to advise staff about what action they must take, in certain situations.

Staff did not receive a full induction to their work before they started working independently in people’s homes. The competency of staff was not being monitored effectively enough to check if staff were competent in their work. Not all staff had training in key areas before they started working independently.

People were supported by staff to make choices with their daily care needs. The service assessed if people had capacity to make certain decisions. However, there were no records that showed that people had fully given their consent to share their care information with other agencies.

People told us that staff were kind to them and they were happy to be around the staff who supported them. People’s confidential information was not always treated in a respectful and safe way.

People’s care assessments were centred on them as individuals but they were not always up to date. Staff were not accessing this information in a meaningful way in order to understand the needs of the people they were supporting. People had regular reviews and were involved in this process.

With the exception of medicine audits, the provider and the registered manager were not completing audits to assess the quality of the care provided, and putting plans in place to make timely improvements. Some quality audits were not effective and were not being checked by the manager. There was a lack of systems in place to ensure the service was monitored in a meaningful way. Despite concerns raised by the local authority about the culture of the service, timely action had not been taken to ensure these were addressed, resolved, and did not occur again.