This inspection site visit took place on 31 May 2018, along with calls to people and relatives, calls to staff took place on 6 June 2018. The inspection was announced. We gave the service 48 hours’ notice of the inspection visit because we needed to make sure someone was in.

At our last inspection we found improvements were needed to staffing and how risks were assessed and people were supported in line with their preferences. We also found improvements were needed to staff training and the systems in place to monitor the quality of the service. At this inspection we found the provider had made some of the required improvements but more were needed to ensure there were sufficient staff in place to provide support.

Priority Care (Shropshire) Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults, younger disabled adults and children. At the time of our inspection there were 32 people using the service.

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

People did not always receive support from consistent staff. There were not always sufficient staff to meet people’s needs at the time they wanted.

People were safeguarded from abuse. People had plans in place which supported them to reduce the risks to their safety. People received support from staff to administer their medicines safely. People were protected from the risk of infection. The registered manager had systems in place to learn when things went wrong.

People’s needs were assessed; and care plans were in place to guide staff. People were supported to have maximum choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice. People were supported to maintain a healthy diet. People were supported to access health professionals when required.

People were supported by caring staff that protected their privacy and dignity. People had support to make decisions and choices about their care and maintain their independence.

People’s preferences were understood by staff and recorded in their care plans. People understood how to make a complaint and felt their concerns would be addressed. Staff understood how to provide people with care at the end of their life and the registered manager had a system in place to assess people’s needs.

The systems in place to monitor the quality of the service were not consistent in identifying concerns. Improvements were needed in how the registered manager and provider used information to drive improvements. A registered manager was in post; and people, relatives and staff felt they were approachable.

This inspection took place on 16 and 17 January 2017 and was announced. Priority Care (Shropshire) Limited provides community support and personal care to older people, people living with dementia, people with mental health concerns, and people with sensory impairments, in their own homes. At the time of the inspection, 59 people were receiving a service from the provider. This was the first comprehensive inspection of the service following registration.

There was not a registered manager in post at the time of the inspection. 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 2008 and associated Regulations about how the service is run. A manager was in post and the provider told us they would ensure a registered manager was in place by April 2017.

People did not always feel staff supported them to manage risks safely. Some people told us staff were not able to safely use transfer equipment provided. There were insufficient staff to meet people’s needs at the times they required it, people said staff were late delivering their care and support. There were systems in place to ensure staff were recruited safely. Staff took appropriate action to safeguard people from harm. Staff could explain how they identified the signs of abuse and reported incidents.

Most staff had the knowledge to support people effectively however some people told us staff sometimes did not know how to support them correctly, for example with the use of continence aids. People told us staff always sought their consent to care and treatment and staff could explain how to apply the principles of the Mental Capacity Act. People received support from staff to maintain a healthy diet and they told us staff enabled them to choose what they had to eat and drink. People received support to monitor their health and access health professionals when they needed to.

People had support from kind and caring staff. People told us the staff were kind and polite. People were supported to make decisions about all aspects of their care and support and staff enabled them to choose things for themselves. People were supported in a way which maintained their independence. Staff encouraged people to do things for themselves where they were able. Staff supported people in a way which maintained their privacy and dignity when providing care and support.

People were not supported at the times they preferred. People told us staff were often late which meant they had to wait for their care and support. People told us that staff understood their preferences for how care and support was delivered. People knew how to complain and there were systems in place to ensure complaints were appropriately investigated and responded to.

People had opportunities to provide feedback about the quality of the service, but this did not always lead to improvements. People told us they had seen no improvements to the times of their calls despite giving feedback to the management team. People’s care records were not always reflective of up to date information and were not always reviewed. The provider had systems in place to check people’s needs had been met; however this was not always effective. People did not always feel they could approach the management team. Staff felt they were supported by the management team and the manager had system in place to support staff.