Proactive Medicare provides personal care to people living in their own houses and flats and specialist housing. This service is a domiciliary care agency and primarily provides a service to older people. The domiciliary care agency office is near to all major bus and train routes.

The inspection was carried out between the 18 September 2018 and 24 September 2018. At the time of the inspection, there were 14 people using the service.

At our last inspection in April 2017 we rated the service as ‘Requires Improvement.’ Breaches of the legal requirements were found in relation to Regulations 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). At this inspection, we found not all improvements had been made and the overall rating of the service remained ‘Requires Improvement’. This is the second time the service has been rated as ‘Requires Improvement’.

The service had a registered manager in post and they were formally registered with us in August 2018. 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.

Our key findings across all the areas we inspected were as follows:

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service. The current arrangements had not identified the issues we found during our inspection. Had these arrangements been more effective, it is envisaged that the shortfalls identified would have been addressed sooner. The incidence of ‘missed’ and ‘late’ calls at the service were not being monitored. Audits relating to medicines were not effective as they had not picked up where there were gaps or anomalies. Neither were these analysed month on month, together with people’s support plans to ensure consistency and to monitor trends for future learning.

Improvements were required to the registered provider’s recruitment practices to ensure these were robust and safe. This remained outstanding from our previous inspection to the service in April 2017. Medication practices and procedures required strengthening to ensure these were in line with good practice procedures and guidance. Not all people had received their prescribed medication because of the morning and lunchtime call times were too close together. Where concerns had been raised and the registered manager notified relating to staff’s poor practice, this had not been considered or raised as a safeguarding concern with the Local Authority or Care Quality Commission; and internal investigation arrangements were not as robust as they should be.

People told us they were safe and had no concerns about their safety and wellbeing. Risks to people were identified and managed to prevent people from receiving unsafe care and support. The domiciliary care service was appropriately staffed to meet the needs of people using the service. People were protected by the service’s arrangements for the prevention and control of infection.

Newly employed staff received an induction to carry out their roles and responsibilities effectively. Staff received mandatory training to meet people’s needs, though a review was required to determine the appropriateness of too many training courses completed in one day and the potential impact this may have on staff and people using the service. Suitable arrangements were in place for staff to receive supervision at regular intervals and staff confirmed they were supported by the registered manager. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported by staff as needed with meal preparation and the provision of drinks. People receive

Proactive Medicare Limited provides personal care and support to people in their own homes.

The inspection was completed on 21 April 2017 and 28 April 2017 and was announced. At the time of the inspection there were five people who used the service.

There was a registered manager in post who was also the provider. 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.

Quality assurance checks were not in place to enable the provider to assess and monitor the service in line with regulatory requirements or to improve the quality and safety of the service. The provider’s arrangements were not as robust as they should be as they had not recognised the issues we identified during our inspection.

Proper recruitment checks had not been completed on all staff before they commenced working at the service and processes had not been operated in line with the provider’s own policy and procedures. Suitable arrangements were not in place to ensure that newly employed staff received suitable training opportunities, a robust induction and formal supervision and ‘spot visit’ checks. Minor improvements were required in relation to medicines management.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered and risk assessments had not been developed for all areas of identified risk.

People told us that they were kept safe. Staffing levels were suitable to meet people’s needs. People told us that there had been no missed or late calls and only a few occasions where staff were late. People’s healthcare needs were managed well and they received appropriate nutrition and hydration each day according to their needs.

People spoke positively about the way staff treated them and reported that they received appropriate care and support. Staff demonstrated a good knowledge and understanding of the people they cared for and supported. People told us that their personal care and support was provided in a way which maintained their privacy and dignity. We found that people’s care plans reflected current information to guide staff on the most appropriate care people required to meet their needs.

You can see what actions we told the provider to take at the back of the full version of the report.