The inspection took place on 14 and 15 March 2018. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults. We gave the provider 48 hours’ notice. This was to ensure that someone would be available in the office as it is a domiciliary care service. Phone calls to people, relatives and staff took place at the same time and following this office visit, up to 23 March 2018. At the time of our inspection there were approximately 177 people being supported with their personal care needs who had a range of support needs such as dementia, physical disability and older people who needed assistance.

There was a registered manager in post at the time of our inspection. 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.

This was the service’s first published inspection since it was registered at this address. At this inspection we identified 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.

Systems in place to monitor the quality of the service were not always effective at identifying and rectifying concerns or changes.

Staff did not always have enough training or knowledge to know how to support people with some specific health conditions.

Guidance was not always available for staff to follow in relations to people’s specific conditions, such as diabetes, epilepsy, stoma and catheter care. There was also a lack of information about how to support people with behaviours that challenge.

There was mixed feedback about staffing and the punctuality of calls.

People’s medicines were not always managed safely as there were not always instructions available for staff to follow.

The principles of the Mental Capacity Act 2005 (MCA) were not always followed as mental capacity assessments were of varying quality and had not always been reviewed as appropriate. People told us they were asked for their consent prior to being supported.

Care plans and risk assessments were not always updated when necessary and reviews had not always identified omissions.

Lessons were learned as action plans were put in place following feedback from an external consultant about what improvements were required. However action had not always been completed or embedded.

People were supported to have food and drink where necessary. We have made a recommendation about how staff record the support they provide.

People told us they felt safe. People were protected from avoidable harm by staff who understood their responsibilities and had been recruited safely.

Infection control measures were in place as people told us staff took appropriate measures.

People were supported to access other health professionals where necessary, or their relatives were kept updated.

The service checked whether they could support someone prior to the care starting by reviewing information provided to them.

People felt they were treated with dignity and respect. People were involved in decisions about their care and were encouraged to be as independent as possible.

People knew how to complain and felt able to raised concerns. Concerns had been responded to.

The service had made preparations for end of life support, although they did not currently support any one who was nearing the end of their life.

People, relatives and staff found the registered manager and providers to be approachable.

The provider had made us aware that they knew of some of the concerns and were in the process of developing and implementing a new care plan and some technological adva