We carried out this announced inspection on 13 November 2018. Serenity Integrated Care 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 adults with physical disabilities.

At the time of our inspection the service was providing personal care to one person. Not everyone using the service 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. Where they do we also take into account any wider social care provided.

At our last inspection in May 2018 we were unable to rate the service. Breaches of regulations were found. This was because the service was not safely managing medicines or following safer recruitment processes. Following the last inspection, we asked the provider to complete an action plan to tell us what they would do to address these breaches.

At this inspection we found that the provider was now meeting regulations. We have rated them ‘good’. When services are rated ‘good’ we aim to return within 30 months to complete a further inspection. CQC monitors services and will return before this time if we have reason to think the rating of this service has changed.

The service had a registered manager. 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.

Staff were now recruited in line with safer recruitment standards. Staff rotas were planned in a way which allowed them to meet people’s needs safely.

Risks to people’s safety and wellbeing were assessed and mitigated through appropriate risk management plans. Where people had hoists, the provider took the right steps to ensure that this was done safely. People were safeguarded from abuse as care workers understood the possible signs of abuse and their responsibilities to report their concerns. People were screened for nutritional risks and suitable plans were in place to protect people from malnutrition.

Medicines were safely managed by staff who had the skills to do so. Care workers received suitable training and supervision to carry out their roles and the registered manager had checked that they were competent. Incidents were investigated in an open and honest way which promoted learning from when things had gone wrong.

People told us of the caring service that they received and care workers responded effectively to people’s needs. People’s care needs were assessed and there were detailed plans to meet people’s needs in a way which met their preferences. Care workers documented how they had met these and how they had worked to ensure that these were met and that people were safe and comfortable.

Care workers worked with health services to promote good health and to respond effectively to changes in a person’s health status and to avoid hospital admission wherever possible. The provider had a policy in place to ensure that they worked in line with the Mental Capacity Act (2005).

The provider was not routinely recording as part of their assessments when people required information supplied to them in accessible formats in line with the Accessible Information Standard (AIS). We have made a recommendation about this.

Managers had worked to improve and develop the service and were accessible. The registered manager carried out regular checks to ensure people were happy with their service and could contact the manager if they had a concern or complaint.

We carried out an announced inspection of ‘Serenity Integrated Care’ on 26 March 2018. This was the first inspection for this provider since they registered with the Care Quality Commission in May 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own houses. It provides a service to older adults, people with physical disabilities and complex health needs. At the time of our inspection the service had been providing care to one person for less than two months, and two other people receiving end of life care from the provider had recently died. This meant that although we were able to carry out an inspection we could not rate the quality of the service as we had insufficient evidence on which to do so.

The service had a registered manager who was also the company director. 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.

People we spoke with told us they were impressed by the caring nature of the organisation. Care was planned in a way which met people’s needs and care workers routinely stayed longer than required, particularly when people were unwell. People received the right support to eat and drink and this was monitored when there were concerns. There were measures in place to ensure people received good quality, dignified care at the end of their lives.

There were shortfalls in the way the service operated. Suitable tools were not in place for assessing people’s capacity to make decisions or documenting people’s consent to their care.

The provider did not carry out suitable pre-employment checks of care workers, and managers did not have the right systems in place to make sure that this was done.

Staff received suitable training to carry out their roles, but there was a lack of formal supervision and observation to ensure that staff continued to apply best practice in care.

People and their relatives and friends were invited to give feedback about the quality of their care.

Risks to people using the service were assessed, and prompt action was taken in response to concerns. People’s moving and handling risks were assessed and there were suitable numbers of staff made available to do this safely. The provider monitored when injuries and falls had occurred, but as only a small number of incidents had occurred we could not say whether these systems were effective. Medicines were not consistently managed safely, and managers were not checking this in a way which would detect errors.

People’s care packages were monitored and reviewed by managers; there were also formal review processes in place but it was too early for these to be applied.

We found breaches of regulations relating to the safe recruitment of care workers and medicines management. You can see what action we told the provider to take at the back of the full version of this report. We will continue to monitor the development of the service and aim to return to rate the quality of the service when we are able to do so.