Radis Tamworth provides personal care and support to older people, people living with a learning disability, including some with physical disabilities living in and around Tamworth. This service also provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

The provider was given seven working days’ notice of our inspection to arrange and seek people’s permission for us to telephone people on 12, 13 and 14 March 2018 and to visit some people in their home on 19 March. We visited the provider’s office on the 22 March and 11 April 2018. At the time of our inspection there were 128 people receiving this service.

There was a registered manager for the service. 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 personal have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in February 2017, we rated the service as requires improvement because systems were not in place to ensure people received their medicines when they needed these; the staff had not always taken action to ensure any safeguarding investigation could take place and people did not always receive their support at the time they expected and for the agreed length of time. People also had mixed views about how caring the staff were and decisions were made, that may not be in their best interests. People were not always confident that they would be listened to and improvements would be made and quality monitoring systems had not always been effective. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service provided to at least good.

At this inspection, we saw further improvements were still required. This was because people did not always receive their care at the right time and for the right length of time. The quality monitoring systems had not ensured that improvements were made in this area. Information was not always available in an accessible format. People were asked for their views about the service but the feedback had not been developed to ensure this was in a suitable format. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

People were protected from abuse because staff now understood what action to take if they were concerned someone was being abused or mistreated. Risks associated with people's care and living environment were effectively managed to promote their safety. People were helped to take their medicines and this was recorded. There were suitable numbers of staff employed and recruitment checks were carried out to ensure new staff were suitable to work with people.

Staff received training and support to enable them to fulfil their role and they were encouraged to develop their skills. People retained responsibility for their health care and staff supported them, where needed, to access healthcare services.

We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People made decisions about their care and staff knew how to respond

We inspected this service on 6, 7 and 8 February 2017. This was an announced inspection and we telephoned the provider three days’ prior to our inspection, in order to arrange home visits with people.

At our last inspection in November 2015, we identified concerns with how incidents and accidents were monitored to lower the risks and ensure that people were protected from further occurrences. Improvements were needed to ensure that the records were completed after medicines had been administered and care plans needed to include information about people’s preferences. On this inspection we found that further improvements were needed.

The service provides care and domiciliary support for older people and people with a learning disability who live in their own home in and around Tamworth. At the time of the inspection 160 people were receiving a service.

There was a registered manager in the service. 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.

Some people needed support to take their medicines. Where medicines were administered, systems were not in place to ensure people received them when needed.

People were not always protected from the risks of abuse. The staff knew how to recognise the signs of abuse and would report their concerns, although action had not always been taken to ensure any investigation could take place and protect people from potential future harm.

People did not always receive their support at the time they expected and for the agreed length of time. People had mixed views about how caring the staff were as some people felt rushed. This information was shared with commissioners of the service.

Where people needed support to help them make a decision, assessments had not been completed to ensure the right people helped them to make decisions in their best interests. People knew how to make a complaint or raise a concern if they needed to. People were not always confident that they would be listened to and improvements would be made. There were processes to monitor the quality of the service provided although these systems had not identified these concerns and action had not been taken to make improvements.

People received care and support from staff who were trained and knew how people liked things done. Where risks had been identified, staff knew how to provide support to keep people safe. Systems were in place to ensure that newly recruited staff were suitable to work with people who used the service.

Staff received supervision and had opportunities to develop their skills to meet people’s needs. New staff were supported through their induction and given opportunities to meet people before they provided any support. People received care that was individualised to their personal preferences and needs. The provider was flexible and responsive to changes for support times.

People were supported to express their views about the service within quality monitoring calls and through a survey. People were provided with information about how the provider had responded.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We completed an announced inspection at Radis Community Care (Tamworth) on 09 November 2015. At the last inspection on 20 September 2013, we found that the service was meeting the required standards in the areas that we inspected.

Radis Community Care (Tamworth) are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported approximately 144 people in their own homes.

There was a registered manager at the service. 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.

The provider had some systems in place to assess and monitor the quality of the service. However, some of these systems were not up to date and the concerns we raised had not been identified.

The provider had not notified us (CQC) of 2 incidents of alleged abuse as required.

The provider did not have a system in place to monitor incidents and accidents to lower the risks and ensure that people were protected from the risk of further occurrences.

People’s risks were assessed. Staff knew people’s needs and carried out support in a safe way whilst they ensured that people’s independence was promoted. However some improvements were needed that ensured people’s risks were updated as required.

Systems were in place to ensure that people received their medicines safely, but improvements were needed to ensure that the records were completed after medicines had been administered.

Some people’s preferences in care had been considered, but improvements were needed to ensure that all care plans contained people’s preferences and people’s needs were reviewed.

There were sufficient staff available to meet people’s assessed needs. The provider had an effective system in place to monitor the staffing levels against the needs of people who used the service.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs. Staff told us that they felt supported by the registered manager.

We found that people consented to their care and where they were unable to consent mental capacity assessments had been carried out in line with the Mental Capacity Act 2005.

We saw that staff treated people with compassion, dignity and respect. Staff listened to people and encouraged them to make decisions about their care.

People told us they knew how to complain and the provider had an effective system in place to investigate and respond to complaints.

Staff told us that the management were approachable and that they listened to them. Staff received supervision and spot checks on staff performance was carried out by senior staff.

People were encouraged to give feedback about the quality of service they received. Action plans were in place and acted on where concerns had been raised.

We spoke to two people about the service they received from Radis (Tamworth). One person told us "I don't know how we'd manage without them". He described the care workers as "brilliant"" and said they helped with whatever they needed. Another person told us the service was excellent, particularly over the previous year. He said the care workers were all very pleasant and did what was needed.

We found that Radis (Tamworth) had developed a plan to improve their services in the last six months. They were assessing people's needs and delivering personalised care. They worked with their staff to improve the support given to people when they took medicines. They were supporting their staff and had increased training opportunities. They monitored and reviewed their services to improve quality in all areas. Their record keeping and file management was good.

We visited this service as part of our scheduled programme. We had also received information from the local authority that some people were not receiving a safe, effective service. This was an unannounced visit and the service did not know we were visiting.

We spoke with people and relatives about the service they received. Most people were pleased with the support they received although some people said they would like to have more regular carers. People were particularly complimentary about their regular carers. Comments included, "Marvelous" and, "Staff very kind". Some people raised some concerns about the service when their regular care worker was not present. One person told us they cancelled the service when their regular care worker was away. They did not feel a new care worler would understand their relative's needs.

People were generally happy with the times of their calls and felt that care workers had sufficient time to provide the support they needed. People felt that staff provided their care in a manner that respected their privacy and dignity.

Everyone had a plan of care but these were centred around the tasks and provided little information about how people wanted their support to be provided. There was also limited information about how staff should support people with dementia care needs.

Most people said they were happy with the support they received to have their medication. However safeguarding issues had been raised in respect of medication administration and two people we spoke with identified issues about the support they received to have their medication.

The service had systems in place to review and monitor the service but over recent months some of these had lapsed due to staffing issues. The service had recently started to address such areas as telephone monitoring, spot checks and reviews.

When we inspected the Radis branch office in Tamworth we accompanied carers to see two people who used the service. We visited an Extra Care housing development where we spoke with 17 people. We spoke with seven people over the phone. We looked at records of comments made by a further eight people. We spoke with a warden for the Extra care housing development and with a community occupational therapist. We were present when two social services managers contacted the office to give feedback about the service.

The people we contacted were positive about the service. They told us the carers were kind and reliable. They mostly arrived on time and when they could not, the office would alert them. People said they got the service they needed, delivered in the way they wanted.

People had given informed consent to their care. Care plans were detailed and personalised. Care workers told us they were well supported by senior staff.

There had been a number of medication errors made by Radis staff earlier in 2013. We were satisfied that the managers had put strategies in place to reduce the risk of mistakes occurring in the future. The provider had systems in place to ensure the service met people’s needs.

In this report the name of a registered manager appears. They were not in post and not managing the regulatory activities at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of the inspection.