This comprehensive inspection carried out by one inspector, commenced on 1 November 2018 and ended on 5 November 2018.

At the last inspection in August 2017, the service was rated Requires Improvement and the provider was in breach of three regulations. These related to unsafe recruitment practices, staff training and support and governance; these affected the key questions of Safe, Effective and Well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We checked to see that the action plan had been completed and found progress had been made in some areas, including staff recruitment. However, there continued to be concerns with staff training and a lack of governance systems. This is the second consecutive time the service has been rated requires improvement.

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 older and younger adults.

Not everyone using Quality Home Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection, five people were receiving a regulated activity.

There was a registered manager in post. 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.

Systems to recruit staff safely had been improved and relevant pre-employment checks were in place. We found the registered manager and provider were now compliant in this area of the regulation. However, staff training and governance, areas they were required to improve during the last inspection, had not been sufficiently improved and they continued to be in breach of the regulations in these areas.

Some small improvements had been made to how the service was run, such as ensuring staff received supervision and an appraisal. Although some training for staff was now planned, assurances that staff had the necessary skills and abilities to carry out their roles effectively could not be provided. There was no evidence new staff had received a thorough induction to equip them with the skills and knowledge for the role.

There continued to be a lack of systems to assess, monitor and improve the quality and safety of the service. This had led to shortfalls in the management and recording of medicines, risks not always being assessed and recorded, and a lack of documentation of how the Mental Capacity Act 2005 (MCA) had been followed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not always support this practice.

Medicines were not always managed and recorded in line with the provider’s policy and best practice guidelines were not always followed by staff, which led to some shortfalls. The provider could not provide evidence that staff had received appropriate training in medicines management and staff’s competency had not been assessed in this area. We have made a recommendation regarding the safe management of medicines.

Staff were aware of how to recognise and respond to safeguarding concerns. Staff knew people well and could tell us how they would recognise a deterioration in people’s health and how they would respond to certain risks. Staff supported people to access appropriate healthcare and supported them to maintain a diet of their choosing.

Overall, people’s care plans contained appropr

Quality Home Care is a domiciliary care agency that supports people to live in their own homes. The office is situated in a central area of the town. On the day of the inspection visit there were six people using the service who received personal care. This was the first inspection of this service.

The service did not have a registered manager in post, they had resigned in January 2017 and the provider had been managing the service since then. 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.

We found there was no clear governance system in place to monitor how the service was operating and drive any improvements needed. For example, there was no auditing programme and shortfalls identified during the inspection had not been identified by the provider.

The provider could not demonstrate that staff had been supported to receive necessary training relevant to their role before they started providing care to people. This meant people could be supported by staff who did not have the right skills and knowledge to meet their needs.

The provider had not carried out all of the required pre-employment checks on staff before they commenced work which meant people were exposed to an avoidable risk.

Sufficient numbers of staff were employed to meet the needs of people who used the service. People told us they received consistent care from a regular care worker who arrived on time and supported them in a caring and unrushed manner.

Procedures were in place to guide staff on the safe administration of medicines. The records we checked showed people had received their medicines as prescribed. We found improvements were needed with the recording of the administration of topical medicines. We have made a

recommendation about the management of this.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and consent was sought for care support.

People told us they felt safe and staff understood their responsibilities to protect people from the risk of abuse. Risks to people's health and safety were assessed and appropriately managed.

People were supported to eat and drink to promote their wellbeing, and staff supported their healthcare needs where needed.

There were positive and caring relationships between people and staff because staff took the time to get to know the people they supported. People and their relatives were involved in the planning and reviewing of their care. Feedback we received from people and their relatives about the care staff was positive and complimentary. People told us they were treated with respect and individuality by staff who were kind and caring.

Feedback systems were in place where the views of people and relatives were sought. People were given information on how to raise a complaint should they choose to do so. There had been no recorded complaints about the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staffing, fit and proper persons employed and good governance. You can see what action we told the provider to take at the back of the full version of the report.