We undertook an announced inspection of Sihara Care on 11 July 2017.

Sihara Care is a domiciliary care agency registered to provide personal care to people in their own homes. The service focuses on providing reablement services to adults with physical and mental health problems. At the time of the inspection, the service was providing care to 27 people.

Since the previous inspection, the registered manager moved to another role within the service. At the time of the inspection on 11 July 2017, a manager had been appointed and commenced their role on 10 July 2017. The provider explained that the new manager would make an application to register with the Care Quality Commission (CQC) in due course. 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 last comprehensive inspection we carried out in August 2016 found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection in July 2017, we found that the service had taken appropriate action to improve on the breaches of regulation we previously identified.

People and their relatives informed us that they were satisfied with the care and services provided by the service. People told us they felt safe around care staff and were treated with respect and dignity. Relatives of people who used the service said they were confident that people were safe around care staff and raised no concerns in respect of this.

The inspection in August 2016 found that risk assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. During the inspection in July 2017, we found that the service had made improvements to risk assessments. Risk assessments detailed potential risks to people, the warning signs and information for staff on how to support people appropriately.

Systems and processes were in place to help protect people from the risk of harm. The inspection in August 2016 found that the majority of staff were unable to describe the safeguarding and whistleblowing process. During the inspection in July 2017, we saw documented evidence to confirm that care staff had received refresher safeguarding and whistleblowing training. Staff we spoke with during this inspection knew how to recognise and report any concerns or allegations of abuse.

During the inspection in August 2016, we found the service was not completing Medication Administration Records (MARs) when administering medicines to people and people were therefore at risk of not receiving their medicines safely. We found a breach of regulation in respect of this. During the inspection in July 2017, we found that the service had taken appropriate action in respect of this. Staff had received training on the administration of medicines and the service introduced MARs when administering and prompting people with their medicines and these were being completed by care staff.

During the inspection in August 2016, we found that some of the training provided to care staff was not effective as it was evident that there were deficiencies in their knowledge and we found a breach of regulations in respect of this. During the inspection in July 2017, we found that the service had taken appropriate action to improve this. We saw documented evidence that staff had received refresher training. Further, care staff we spoke with were able to demonstrate that they had an understanding of the areas covered during their training. Staff also received supervisions and appraisals. The provider confirmed that they would ensure these were carried out consistently for all staff.

Care staff we spoke with told us that they felt sup

We carried out an announced comprehensive inspection of this service on 16 August 2016 at which there were breaches of legal regulations. For two of those breaches we issued the service with a warning notice. These were in relation to the assessment of risks to the health and safety of people using the service not being carried out appropriately. We found that risks were not being identified for people and their specific needs which meant risks were not being managed effectively. There was also a breach in relation to the service not having effective systems and processes in place to assess and monitor the quality and safety of the services provided, to mitigate risks to the health, safety and welfare of people using the service, and to ensure that records relating to service users were accurate and complete.

We undertook a focused inspection on the 15 November 2016 to check whether the service had met the warning notice and to confirm that they now met legal requirements. We inspected the safe and well led domain only at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Sihara Care' on our website at www.cqc.org.uk'.

Sihara Care is a domiciliary care agency registered to provide personal care to people in their own homes. The service focuses on providing reablement services to adults with physical and mental health problems. At the time of the inspection, the service was providing care to 15 people.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At this focused inspection on 15 November 2016, the service demonstrated that they had taken sufficient action to comply with the warning notice and that the legal requirements had been met.

We found that risk assessments included more detail and reflected potential risks to people. We saw evidence that the service had implemented new format moving and handling risk assessments and medication administration assessments.

We also found that the service now had systems in place to assess and monitor the quality and safety of the services provided, to mitigate risks to the health, safety and welfare of people using the service, and to ensure that records relating to service users were accurate and complete.

However, we need to be sure that the service is able to demonstrate that they are able to consistently meet both Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will therefore look at these Regulations again at the next comprehensive inspection we carry out.

We undertook an announced inspection of Sihara Care on 16 August 2016.

Sihara Care is a domiciliary care agency registered to provide personal care to people in their own homes. The service focuses on providing reablement services to adults with physical and mental health problems. At the time of the inspection, the service was providing care to 29 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

Sihara Care was previously registered with the CQC at a different address. In May 2016 they moved to their current address. This was the first inspection of the service since their change of address.

The majority of people who used the service told us that they felt safe around care workers. People told us that they were treated with respect and dignity when being cared for by care workers.

Individual risk assessments were completed for people. However, the assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. This could result in people receiving unsafe care and we found a breach of regulations in respect of this.

There were processes in place to help ensure people were protected from the risk of abuse. Despite receiving safeguarding training, the majority of staff we spoke with were unable to describe the process for identifying and reporting concerns and were unable able to give example of types of abuse that may occur.

There were some arrangements to manage medicines safely and appropriately. Records showed care workers had received medicines training and medicines policies and procedures were in place. However, we found the service was not completing Medication Administration Records (MARs) when administering medicines to people. People were therefore at risk of not receiving their medicines safely and we found a breach of regulation in respect of this.

Care workers we spoke with told us that they felt supported by the registered manager. They told us that management were approachable and they raised no concerns in respect of this. However we found that care workers lacked knowledge of certain areas of care. Some of the training provided to care workers was not effective as there were deficiencies in their knowledge. Staff received supervisions but we noted that this was not consistent for all care workers. Staff had not received an appraisal in the last year. We found that there was a breach of regulations in respect of this.

People using the service told us that they experienced consistency in the care they received and generally had regular care staff.

Appropriate checks were carried out when staff were recruited.

Care plans lacked information about people’s mental health and their levels of mental capacity to make decisions and provide consent to their care. There was no information in people’s care plans which showed how people who had limited capacity or were not able to verbally communicate were supported to make decisions and how their consent was gained. We found a breach of regulation in respect of this.

The registered manager explained that the service aimed to provide good quality care and promoting high standards where people’s rights were paramount. We saw that the aims and objectives of the service as detailed in the service user guide reflected this ethos. The registered manager told us that the focus of the service was on providing care that has positive outcomes for them and providing top quality services.

There was limited information in care support plans about the support that people required from care staff. The information included in people’s care