This inspection took place 5 December 2018 and was announced.

Prelle Healthcare is a domiciliary care agency. It provides personal care for people living in their own homes. At the time of the inspection the service was supporting 24 people for around 115 hours per week. 12 out of the 24 people were receiving the regulated activity, personal care. The service is registered to provide services to younger adults or older people living with dementia, learning disability and/or autistic spectrum disorder, mental health needs, physical disabilities or sensory impairment.

The 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 the service demonstrated to us that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Our last inspection at Prelle Healthcare took place on 30 May 2018. The service was rated Inadequate overall. We found the service was in breach of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. There were breaches in Regulation 12: safe care and treatment, Regulation 17: good governance, Regulation 18: staffing, Regulation 19: fit and proper persons employed. We also found the service was in breach of the Health and Social Care Act 2008, Section 33, failure to comply with conditions of registration and Care Quality Commission (Registration) Regulations 2009, Regulation 14, notice of absence.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we found sufficient improvements had been made to meet the requirements of regulations. However, further improvements are expected and we have made three recommendations to the provider.

There was a manager at the service who was registered with the CQC. 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.

During the inspection we received very positive feedback from people who used the service. They said the service was well-run and the management team were approachable and friendly. Since the previous inspection the provider had introduced new systems to evaluate and improve the quality and safety of the services provided. Through our checks of the provider’s audits we saw the provider could question poor practice, respond to areas of risk and make improvements to the service. However, as many of the quality assurances systems were relatively new or in development, they needed to be tested over time.

People who used the service told us they felt safe. We found there were sufficient numbers of staff to meet people’s needs and it was evident that staff had been safely recruited. There had been two recorded safeguarding concerns since we last inspected, in each case the service had notified the safeguarding authority and taken all appropriate action mitigate the potential risk of harm. We have made a recommendation about notifying the CQC of certain incidents.

Systems were in place to manage medicines in a safe way. We saw records were kept when medicines support was provided. However, when medicines support was not required, such as when people were staying in hospital, this was not always appropriately recorded in people’s administration record so that gaps were clearly explained

This inspection took place on 30 May 2018 and was announced.

This was the first inspection of the service.

Prelle Healthcare is a domiciliary care agency. It provides personal care for people living in their own homes. At the time of the inspection the service was supporting 23 people for around 160 hours per week. When the service registered with the Care Quality Commission (CQC) they told us they would be providing services to younger adults or older people living with dementia, learning disability and/or autistic spectrum disorder, mental health needs, physical disabilities or sensory impairment. However, the registered provider was currently providing a service to older people with physical or sensory impairment or living with dementia.

There was a manager at the service who was registered with CQC. 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.

The leadership and management of the service lacked understanding about meeting their responsibilities as a registered provider and manager. For example, the registered provider was operating in breach of their conditions of registration. This was because the registered provider was operating from a location address that was different to the address they had registered. They had not notified us of this, so the inspection was carried out at a different address than that identified on this inspection report. In addition, the provider had not notified CQC, as required by law, of any incidents which may potentially affect the safety and wellbeing of people using the service.

The registered provider did not have effective governance systems in place to continually assess, monitor and review the service so that required improvements could be identified and acted upon, including mitigating risks to people who used the service.

Despite concerns about the registered providers knowledge and effective governance systems most people told us they received good care and support.

We have made recommendations about care records so that staff had the information about how to best support the person and to reduce or eliminate the risks associated with their care and support. This included risks associated with the health, safety or wellbeing of the person.

The registered provider did not have effective recruitment processes in place. When staff were recruited, the system in place had not ensured all the relevant information and documents required were obtained before the staff member began working with people.

There was an insufficient number of staff to provide people with safe care and treatment and protect them from harm. The registered provider acknowledged the current staff team was insufficient to enable people to receive calls at regular times. This meant the registered provider was carrying out some of those calls to ensure calls were covered, but this had meant some of their other responsibilities as a registered provider had not been established or effective in practice.

Currently, the service was relying on training staff had received in previous roles so that they had the skills, knowledge and experience to deliver effective care and support. This meant that staff may not be aware of best practice or current guidance in care. Regular supervision for those staff was not established for the service to assure themselves staff were delivering effective care and support in accordance with their own vision and values and policies and procedures.

People who used the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, care records did not always contain information about people who had the legal authority t