The inspection of Quality Home Care took place on 5 and 11 December 2018 with telephone calls being made to staff on 12 December 2018 and people who use the service on 17 and 18 December 2018. We previously inspected the service on 11, 18 and 19 September 2018. At that time the service was not meeting the regulations related to consent, good governance and fit and proper persons employed. The service was rated requires improvement.

Following the last inspection the registered provider told us the improvements they would make to comply with the regulations. On this inspection we checked and found some improvements had been made, however the registered provider was not meeting the regulations related to good governance.

Quality Homecare (Barnsley) Limited is a domiciliary care agency registered to provide personal care for people living in their own homes. Not everyone using Quality Home Care receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of the inspection the agency was supporting approximately 54 people.

There was a manager at the service who was registered with the Care Quality Commission (CQC.) A registered manager is a person who has registered with 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.

Staff employed by the service had been vetted to work with people that might be vulnerable, although one gap in employment had not been explored.

We found improvements had been made to the system in place to ensure sufficient time was left between visits, so people received their medicines in accordance with the prescription, although some gaps in governance still remained.

A system was in place to monitor, record and reduce the risks of very late or missed visits. Evidence was not always recorded about how inconsistencies in the electronic logging in and out system were followed up.

Most people told us there had been no recent missed calls and their visits were completed at the scheduled time.

Risks were assessed and measures put in place to reduce the risks. Staff competency checks, in respect of medicines, had been carried out in line with National Institute for Clinical Excellence (NICE) guidelines.

Care staff had a good understanding of what to do if they saw or suspected abuse during their visits and we saw concerns had been acted on when they arose.

We saw evidence people had given their consent to the care and support they were receiving. However some consent records were inconsistent and evidence of representatives’ legal authority was not always recorded.

Staff told us they felt supported and received supervision and training and we saw regular observations of practice were completed.

People and the relatives we spoke with told us they were treated with consideration and respect by care staff during their visits.

Care plans usually contained sufficient up to date and relevant information to provide direction for staff, although there were some inconsistencies. Staff we spoke with told us they were familiar with people's individual needs.

People told us they knew how to complain and no complaints had been made to the service since our last inspection.

The registered provider had put some measures in place to monitor and improve the quality and safety of the service, however they were not always consistently applied. Some evidence was available that issues arising from audits had been followed up, however this was not always recorded.

We found a continuing breach of regulation 17 (1) and (2)(a)(b) (c) (f) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because systems were not always operating effectively to assess, monitor

The inspection of Quality Home Care took place on 11 and 19 September 2018 with telephone calls being made to staff on 18 September 2018. We previously inspected the service on 13,14,16,28 February 2018. At that time the service was not meeting the regulations related to safe care and treatment, staff training, good governance and fit and proper person employed. The service was rated Inadequate.

Following the last inspection the registered provider told us the improvements they would make to comply with the regulations. On this inspection we checked and found some improvements had been made, however the registered provider was not meeting the regulations related to consent, good governance and fit and proper persons employed.

Quality Homecare (Barnsley) Limited is a domiciliary care agency registered to provide personal care for people living in their own homes. Not everyone using Quality Home Care receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of the inspection the agency was supporting approximately 61 people.

There was a manager at the service who was registered with the Care Quality Commission (CQC.) A registered manager is a person who has registered with 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.

At our last inspection a robust system of recruitment was not in place. At this inspection we found there was a continued risk that staff employed by the service had not been robustly vetted to work with people that might be vulnerable.

At our last inspection we found a system was not in place to ensure sufficient time was left between visits, so people received their medicines in accordance with the prescription to reduce the risk of accidental overdose. At this inspection we found some improvements had been made in this area, although we saw some minor issues remained.

Whist most risks were assessed and measures put in place to reduce the risks, we found one care plan in the office had not been updated to reflect current moving and positioning risks. Following our inspection the registered manager sent us an updated risk assessment they said had been left in the persons home, but not copied to the office.

A more effective system was in place to assess, monitor, record and reduce the risks associated with very late or missed visits in line with the registered provider’s policy, although evidence was not always recorded about follow up of gaps in the electronic logging in and out system.

Staff competency checks, in respect of medicines, had been carried out in line with National Institute for Clinical Excellence (NICE) guidelines.

There were mixed responses from people about visits being completed at the scheduled time.

Care staff had a good understanding of what to do if they saw or suspected abuse during their visits and we saw concerns had been acted on when they arose.

People were not always supported to have maximum choice and control of their lives because mental capacity assessments and best interest processes had not been completed in line with legislation. We saw evidence some people had given their consent to the care and support they were receiving.

Staff told us they felt supported and received supervision and training and we saw regular observations of practice were completed.

People and the relatives we spoke with told us they were treated with consideration and respect by care staff during their visits.

Care plans did not always contain sufficient up to date and relevant information to provide direction for staff. Staff we spoke with told us they were familiar with people's individual needs.

Complaints and concerns were acted upon.

Audits were not alway

The inspection of Quality Home Care took place on 13, 14 February 2018 with telephone calls being made to staff on 16, 19 and 28 February 2018 and a follow up visit on 20 March to view requested information that had not been received. We previously inspected the service on 12 July 2017. At that time the service was not meeting the regulations related to safe care and treatment, safeguarding service users form abuse, good governance and fit and proper person employed. The service was rated Inadequate.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions of safe, effective, caring, responsive and well led to at least good. The registered provider told us the improvements they would make to comply with the regulations. On this inspection we checked and found the necessary improvements had not been made.

Quality Homecare (Barnsley) Limited is a domiciliary care agency registered to provide personal care for people living in their own homes. Not everyone using Quality Home Care receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of the inspection the agency was supporting approximately 63 people.

There was a manager at the service who was registered with the Care Quality Commission (CQC.) A registered manager is a person who has registered with 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.

There were continuing issues with risk management at the service. Risk assessments did not always provide sufficient information to provide direction for staff, or information about how to reduce risks.

At our last inspection we found a system was not in place to ensure sufficient time was left between visits, so people received their medicines in accordance with the prescription to reduce the risk of accidental overdose. At this inspection we found no improvements had been made in this area and medicines errors caused by visits being too close together had not been recorded and acted on appropriately to prevent possible harm. We informed the local authority safeguarding team about our concerns.

An effective system was not in place to assess, monitor, record and reduce the risks associated with very late or missed visits in line with the registered provider’s policy. The registered manager did not accurately record or monitor incidents to reduce the risk of further missed or very late calls to people who were vulnerable.

Staff competency checks, in respect of medicines, had not been carried out in line with National Institute for Clinical Excellence (NICE) guidelines.

At our last inspection a robust system of recruitment was not in place. At this inspection we found there was a continued risk that staff employed by the service had not been appropriately vetted to work with people that might be vulnerable.

There were mixed responses from people about having a regular staff team that came at the scheduled time and stayed for the allocated time.

Care staff had an understanding of what to do if they saw or suspected abuse during their visits.

People were not supported to have maximum choice and control of their lives because mental capacity assessments and best interest processes had not been completed in line with legislation. We saw evidence some people had given their consent to the care and support they were receiving.

Most staff told us they felt supported and received some supervision and training, although only half of the staff training records were available to review. This meant we could not be assured all staff had been trained, supervised, appraised and had their competency checked in line with nationally recognised guidan

Quality Homecare (Barnsley) Limited is a domiciliary care agency registered to provide personal care for people living in their own homes.

At the time of the inspection the agency was supporting approximately 118 people. We spoke with 25 people who used the service or their relatives to obtain their views of the support provided. We visited six people in their own homes to speak with them. On five of those visits, relatives were in attendance and we also spoke with them.

At the time of this inspection the service employed 47 staff. We spoke with seven of those staff to obtain their views and experience of working for this agency.

We told the registered manager two days before our inspection that we would be visiting the service. We did this because the registered manager is sometimes out of the office and we needed to be sure they would be available.

There was a manager at the service who was registered with the Care Quality Commission (CQC.) A registered manager is a person who has registered with 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 agency was last inspected on 21 December 2016 and was not meeting the requirements of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Those regulations were safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and fit and proper persons employed. The registered provider sent us action plans stating the improvements they would make to comply with those regulations. On this inspection we checked and found the necessary improvements had not been made to comply with the breaches of regulation identified at the last inspection. Full information about CQC’s regulatory response to any concerns found during inspections is added to the reports after any representations and appeals have been concluded.

Care staff had a good understanding of what to do if they saw or suspected abuse during their visits. They were clear this must be reported to the registered manager of the service and were confident they would act on that information. However, the system and process in place for dealing with financial transactions was not robust enough to protect people and people were being charged for time that had not been completed by care staff.

Staff were familiar with people’s individual needs, but care plans and risk assessments did not always provide accurate and complete records in respect of each person. In some instances staff had not always carried out the action required to mitigate the recorded risk.

There were mixed responses from people about having a regular staff team that came at the scheduled time and stayed for the allocated time.

All the required recruitment information and documents were not available for staff. This meant there was a continued risk that staff employed by the service had not been appropriately vetted to work with people that might be vulnerable.

Staff received training and supervision, but did not always carry out their training in practice. In addition to this staff competency checks, in respect of medicines, had not been carried out as required by the National Institute for Clinical Excellence (NICE) guidelines.

The management of medicines required improvement so a consistent system was in place for the application of creams and that sufficient time was left between calls so people received their medicines in accordance with the prescription.

Most people told us they were treated with consideration and respect and that staff knew them well. But we found and were told of occasions when staff had not applied their training which compromised this. People’s records did not demonstrate that their preferred choice was being offered.

There was a mixed resp

Quality Homecare (Barnsley) Limited is a domiciliary care agency registered to provide personal care for people living in their own homes.

At the time of the inspection the agency was supporting approximately 127 people. We spoke with 11 of those people to obtain their views of the support provided. We also spoke with the relatives of two of those people. We visited six people in their own homes to speak with them. On four of those visits, relatives were in attendance and we also spoke with them.

At the time of this inspection the service employed 67 staff. We spoke with 10 of those staff to obtain their views and experience of working for this agency.

We told the registered manager two days before our inspection that we would be visiting the service. We did this because the registered manager is sometimes out of the office and we needed to be sure that they would be available.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

The service has a history of breaches in regulation since 7 July 2014. The agency was last inspected on 7 and 11 March 2016 and was not meeting the requirements of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Those regulations were safe care and treatment and good governance. We issued two warning notices. The registered provider sent us action plans stating the improvements they would make to comply with those regulations.

On this inspection we checked and found sufficient improvements had not been made to comply with the breaches of regulation identified at the last inspection, and a further breach in regulation was found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

All the required recruitment information and documents were not available for staff, which meant there was a risk people were not sufficiently protected, because the recruitment process was not sufficiently robust.

Care routines were reviewed to reflect the care delivered to people, but risks associated with the care routines continued not to be adequately assessed, monitored and recorded.

There were quality assurance systems in place to monitor the quality of the service provided. However, these continued to be ineffective in achieving sufficient improvement at the service to meet regulations.

Care staff had a good understanding of what to do if they saw or suspected abuse during their visits. They were clear that this must be reported to the registered manager of the service and were confident they would act on that information. However, the system and process in place for dealing with financial transactions were insufficient to protect people.

There were sufficient staff to provide a regular team of care staff. Staff received training, supervision and appraisal so that they had the right knowledge and skills they needed to carry out their role, so that people received effective care.

The conduct of staff did not always make people feel they were supported to have maximum choice and control of their lives.

Most people and relatives told us when they raised any issues with staff and managers, their concerns were listened to.

Safe systems and processes were in place for the management of medicines.

Most people told us they were treated with consideration and respect and the staff knew them well.

Staff were familiar with people’s individual needs and were able to describe how they maintained people’s privacy and dignity.

The overall rating for this service is ‘Inadequate’ and the service is therefore in

Quality Homecare (Barnsley) Limited is a domiciliary care agency registered to provide personal care for people living in their own homes.

At the time of the inspection the agency was supporting approximately 135 people, equating to approximately 2374 hours of care per week. We spoke with 12 of those people to obtain their views of the support provided. We also spoke with 13 relatives of people who received support from the agency. Prior to our inspection at the office base, we visited seven people in their own homes. On five of those visits, relatives were in attendance and we also spoke with them.

At the time of this inspection the service employed 64 staff. We spoke with12 of those staff to obtain their views and experience of working for this agency.

We told the provider two days before our inspection that we would be visiting the service. We did this because the registered manager is sometimes out of the office and we needed to be sure that they would be available. During our inspection we spoke with the registered manager, two members of staff responsible for training and supervision of staff, a care co-ordinator and a member of staff responsible for the oversight of quality assurance for the service.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

The service has a history of breaches of regulation since 7 July 2014. The agency was last inspected on 26 January 2015 and was not meeting the requirements of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Those regulations were receiving and acting on complaints and staffing. We issued two requirement notices. The registered provider sent us action plans stating the improvements they would make to comply with those regulations. On this inspection we checked to see if any improvements had been made with the breaches of regulation identified at the last inspection.

There were sufficient staff to provide a regular team of care staff and all the required recruitment information and documents were available for staff. Staff had received the majority of training so that staff had the right knowledge and skills they needed to carry out their role, so that people received effective care. Staff confirmed that following initial training they felt supported in their job role, but they had not received an annual appraisal as required and identified within the service’s own policies and procedures.

People and relatives told us when they raised any issues with staff and managers, their concerns were listened to, but the governance system regarding the recording of the outcome of complaints needed to improve.

Records of risks presented by people were not accurately identified and recorded and did not formalise any actions to be taken in regard to those risks and was therefore a breach of regulation.

The systems and processes in place for the management of topical of medicines was not safe and a breach of regulation.

Most people told us they were treated with consideration and respect and the staff knew them well.

Staff were familiar with people’s individual needs and were able to describe how they maintained people’s privacy and dignity.

Care staff had a good understanding of what to do if they saw or suspected abuse during their visits. They were clear that this must be reported to the manager of the service and were confident they would act on that information.

Staff sought people’s consent to care and treatment.

People were supported to have sufficient to eat, drink, maintain a balance diet and access healthcare professionals when necessary.

Care routines that had been rev

Quality Homecare (Barnsley) Limited is a domiciliary care agency registered to provide personal care for people living in their own homes.

At the time of the inspection the agency was supporting approximately 137 people, equating to approximately 1497 hours. As part of our inspection we telephoned 26 people to obtain their views of the support provided. Five of the telephone numbers supplied by the agency were incorrect. We were able to speak with seven of the people we telephoned and seven relatives. Prior to our inspection at the office base, we visited five people in their own homes. On four of those visits, relatives were in attendance and we also spoke with them.

At the time of this inspection the service employed 60 staff. We telephoned 12 staff to obtain their views and experience of working for this agency. Three of the telephone numbers provided by the agency were incorrect. We were able to speak with four staff.

We told the provider two days before our inspection that we would be visiting the service. We did this because the manager is sometimes out of the office and we needed to be sure that they would be available. During our inspection we spoke with the registered manager and a member of staff responsible for the oversight of quality assurance for the service.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

At our previous inspection on 7 July 2014 we had asked the registered provider to improve requirements relating to workers, assessing and monitoring of service provision and records. This was because there were breaches of those regulations, which may have placed people who used the service at risk of unsafe or inappropriate care. The registered provider sent us action plans stating the improvements they would make to comply with those regulations.

At this inspection we found the provider had made improvements in those areas.

There were mixed responses from people and their relatives about whether they were visited by a consistent team of staff. Some people told us they received care from staff that they knew well and they had a team of regular, reliable care staff that visited them. Others told us contrary to this. Likewise, some people told us their care staff were kind, caring and considerate, others had received occasional care that didn’t reflect those values. Our discussions with care staff demonstrated familiarity and knowledge of people’s individual needs, life history, their likes and dislikes and particular routines.

Care staff had a good understanding of what to do if they saw or suspected abuse during their visits. They were clear that this must be reported to the manager of the service and were confident they would act on that information. We saw this was a regular agenda item at staff meetings.

We found systems and processes in place for the safe recruitment of staff, with information and documents to support this.

We found safe systems and processes in place for the management of medicines.

Most people and relatives we spoke with told us they were confident staff had the knowledge, skills and experience they needed to carry out their roles and responsibilities. Staff confirmed they were trained prior to providing care and support to people who used the service and following initial training felt supported in their job role. We found there were some gaps in the training requirements of some staff.

We received no information that staff at the service had not followed the requirements of the Mental Capacity Act 2005 Code of practice, but staff’s understanding in this area needed to improve.

People who used the service had an assessment of their needs, a plan of care and risk assessments in place to identify any potential risks to people. We found these were not always signed and dated for accuracy and in case of challenge at a later date.

There were systems in place to monitor and improve the quality of the service provided. People who used the service and their relatives were asked for their opinion of the service via surveys. During this inspection we were able to see evidence of the information included in reports about the quality of service provided.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This corresponds to two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the time of this inspection, records showed there were 113 people who were supported by the service. We telephoned fourteen people that used the service, or their representatives to ask them about their experiences of Quality Homecare (Barnsley) Limited. We were able to speak with eleven people, or their representatives.

We also telephoned ten care staff employed by Quality Homecare (Barnsley) Limited to ask them about their experiences of working for the agency. We were able to speak with four staff. We also spoke with two staff in person at the agencies office.

In addition to speaking with people who used the service and/or their representatives, staff and the registered manager, we also reviewed a range of relevant documentation.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Care plans and risk assessments were available in people’s homes for staff to follow, but these did not always reflect fully the care that people needed.

People were protected from the risk of infection because appropriate guidance had been followed. When we spoke with people who used the service and their representatives they all said staff wore their gloves and aprons when providing personal care and they had not seen staff wear jewellery, only wedding rings. Comments included, “oh, they’re good with their hygiene”.

In the main, people were given their medicines when they needed them, but better monitoring of this is needed to ensure where there are gaps in medication records, these are investigated by the registered provider.

The recruitment process was not sufficiently robust, with all the recruitment documents in place before staff commenced work, which meant the registered manager could not be assured staff were safe to work with vulnerable people.

People’s care plans were not always accurate, which means people may be placed at risk of receiving unsafe or inappropriate care.

Is the service effective?

Staff had regular rotas that they followed to enable continuity of care and ensure they knew people well.

Is the service caring?

There was a mixed response from people and their relatives about the care provided. Comments included, “they could try and encourage [relative] to have a wash and offer more nutritional food in a more appetising way, rather than just taking the easy option”, “I’m not right struck. Everything’s late, which means meals are late and they don’t stay their time”, “my mum looks forward to them coming. The relationship with them is comfortable and they have a laugh. They look like honest, trustworthy people and they respect my mum” and “the staff are grand lasses. They have a joke with us and chat if they’ve time. It’s brilliant care. I’ve got a care plan that’s updated. I’ve no issues there and my husband signs it. Staff arrive on time, unless they’re busy and then they’ll phone up and say they’re going to be late.”

Is the service responsive?

We could not be assured the service was responsive in listening to people and staff’s concerns/complaints, as we found details of comments in the complaint file that did not always evidence the complaint had been investigated, so that an audit trail of the actions taken could be confirmed.

Is the service well-led?

The manager of the service was registered with the CQC which is a requirement of the home’s registration.

When we spoke with people and their relatives, some people and relatives said they did not want to be identified to the service, for fear of any repercussions. There were also some staff that identified some concerns, but did not want identifying to the service. This does not indicate an open, transparent culture exists for those people and relatives using the service, to ensure learning and improvements to the service provided.

The service had quality checking systems in place, but these were not being followed and what was taking place was not being effective in identifying, assessing and managing risks to assure the service that a quality service was being provided and any risks minimised with appropriate action plans.

If you want to see the evidence supporting our summary please read the full report.

At the time of our inspection, Quality Homecare provided support to approximately 125 people. We spoke via telephone with 14 people who were using the service and eight relatives of people using the service to obtain their views. We spoke with a total of nine members of staff which included seven support staff.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People told us, “They follow my wishes”, “They always ask before doing anything” and “They always ask if I want anything else doing.”

People experienced care, treatment and support that met their needs and protected their rights. People told us, “I’m very happy with them, long may it continue”, “I’m quite happy with them” and “They’re really good”

Where people were assisted and/ or prompted with their medication, people told us “I’ve always had it (medication) when I should” and “I’ve never had any problems.” Staff were appropriately trained and appropriate policies and procedures were in place.

There were enough qualified, skilled and experienced staff to meet people’s needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We talked to five people who used the service including two relatives by telephone during our inspection visit. People told us peoples privacy and dignity was respected, they were happy with the personal care they received and liked all the staff that looked after them. The people we talked to also confirmed they had been involved in the planning of their care.They confirmed that members of staff generally came at the agreed time and stayed and looked after them for the agreed period of time. Some comments captured included, “yes, I’m happy with my care”, “[staff] are nice and friendly” and “I’m quite satisfied [with my care]”.

We talked to two relatives of people who used the service who explained how they were happy with their family member’s care. Some comments captured included, “quite happy at this time (with overall care)”, “couldn’t manage without them (staff)” and “I can’t praise them (staff) enough…absolutely marvellous!”