Promedica24 UK Limited provides live in care staff to people living in their own homes throughout the country. Care staff are recruited in Poland and then come to the UK to live in people’s home and provide care for a period of usually seven weeks. Cassiobury House provides ‘living in’ carers to support people in their own homes. At the time of our inspection 76 people were receiving live in support in their own homes.

We inspected Cassiobury House on 3 May 2017. We then made telephone calls to people who used the service and staff on 8, 9 and 10 May 2017. The inspection was announced.

At our last inspection on 5 October 2016, the service was found not to be meeting the required standards in the areas we looked at. They were rated inadequate and placed in to special measures. The service was found to have several breaches of regulation relating to. Accidents and incidents were documented by staff but no follow up or risk assessments were completed to help keep people safe. There were no systems in place to monitor risks to people’s health and well- being. There were not sufficient staff resources to always cover staff when required. There were no systems in place that enabled staff to identify trends and patterns emerging to prevent risks and improve the service. The provider did not have effective governance in place and there were no systems to audit, monitor and drive improvement. There were no effective and accessible systems for identifying, receiving, handling and responding to complaints from people who used the service. Training did not cover all areas of people’s needs People were not always involved with reviews of their care and support. Not all people received personalised care and support that met their changing needs and took account of their preferences. Safeguarding incidents had not been reviewed to determine any action needed to keep people safe. The review of accidents and incidents was not robust. The provider had failed to notify the Care Quality Commission of incidents which had taken place, which under the terms of their registration they had a duty to report.

At this inspection we found that the provider had made the improvements required. However, there were some areas that required further improvement. These have been addressed in the report.

There was a manager in post who was not registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered manager had resigned and their last working day was 26 August 2016. There was a new manager in place who had made an application to CQC to register.

Accidents and incidents were recorded by staff and risk assessments were completed to help keep people safe. There were systems in place to monitor risks to people’s health and well- being. However, further improvements for the monitoring of these incidents to monitor emerging trends or patterns.

Care plans had been reviewed and updated since the last inspection. The plans were now person centred and contained guidance for staff. However, we found some examples where care records required further updating to ensure they were accurate. People told us that they felt safe in their homes. Staff had received training in how to safeguard people from abuse. Staff knew how to report concerns. There were now systems in place to ensure that agency resources were available to cover staff when required.

We found that capacity assessments did not always consider each separate decision as required.

The provider had effective governance in place, there were systems to audit, monitor and drive improvement.

People knew how to complain and there were effective and accessible systems for identifying, receiving,

Promedica24 UK Limited provides live in care staff to people living in their own homes throughout the country. Care staff are recruited in Poland and then come to the UK to live in people’s home and provide care for a period of usually seven weeks.

We inspected Cassiobury House on 5 October 2016. We then made telephone calls to people who use the service and staff on 6, 7, 10, 11 and 17 October 2016. The inspection was unannounced. At our last inspection on 02 March 2016, the service was found not to be meeting the required standards in the areas we looked at. The service was found to have breaches in regulation’s 9, 11, 12, 13, 16, 17 and 18. At this inspection we found that the provider had not made the improvements required. Cassiobury House provides ‘living in’ carers to support people in their own homes. At the time of our inspection 84 people were receiving live in support in their own homes.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement are made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

There was a manager in post who was not registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered manager had resigned and their last working day was 26 August 2016. There was a new manager in place who had made an application to CQC to register.

Accidents and incidents were recorded by staff but no follow up or risk assessments were completed to help keep people safe. There were no systems in place to monitor risks to people’s health and well- being.

People told us that they felt safe in their homes. Staff had received training in how to safeguard people from abuse. Staff knew how to report concerns. There were not sufficient staff resources to always cover staff when required.

There were no systems in place that enabled staff to identify trends and patterns emerging to prevent risks and improve the service. The provider did not have effective governance in place. There were no systems to audit, monitor and drive improvement.

People knew how to complain. However there were no effective and accessible systems for identifying, receiving, handling and responding to complaints from people who used the service.

Relatives and people were not always positive about the skills, experience and abilities of staff who worked in their homes. Staff received five days training in Poland, however the training did not cover all areas of people’s needs and we saw no evidence of additional training for staff to enable them to support people’s needs. Staff had received s