Smart Homecare Aylsham 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 adults, people living with dementia, sensory or physical impairments. At the time of our inspection, 17 people were using the service.

There was a registered manager in post who was also the provider. 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. For the purposes of this report they have been referred to as the provider.

We had previously inspected the service on 24 July 2018. We found that the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider was in breach of seven of the regulations including person-centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing and fit and proper persons employed. The overall rating for the service was inadequate and the service was placed in special measures.

During this inspection, we found that the provider was in breach of seven regulations. You can see what action we told the provider to take at the back of the full version of this report. During the inspection we mainly dealt with the administrator, this was because the provider was out of the office due to prior engagements. The administrator jointly oversaw the day to day running of the service along with the provider.

The provider had failed to comply with a number of the regulations as required under the HSCA 2008 (Regulated Activities) Regulations 2014. In addition, the provider had failed to sustain improvements where breaches of regulations had been identified during the previous inspection.

The provider was still in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because people’s medicines were not managed in a safe way and there were no risk assessments in place for people who were being supported with taking their medicines. There were also no care plans and risk assessments in place for people who were living with diabetes.

Individual risks relating to people’s health and wellbeing had not been adequately planned for and risk assessments failed to detail how staff could mitigate known risks. Risks relating to infection prevention and control had not been identified or planned for.

Not all accidents and incidents had been recorded, therefore no reviews of these had taken place to safeguard against future occurrences.

Processes for recruiting staff had not improved and the provider remained in breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Appropriate background checks had not been completed to ensure staff were of good character and employment histories for staff were not complete.

At our previous inspection we found the provider was in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because a safeguarding incident had not been reported to the local safeguarding authority. We found the provider was no longer in breach of this regulation because they were reporting incidents to the local authority. However, we had not been notified of this incident and this meant the provider was in breach of Regulation 18 of the Care Quality Commission (Registration Regulations) 2009.

Training provisions for staff were not adequate and the training did not equip staff with the knowledge required to carry out their role effectively. Staff did not receive yearly appraisals and supervisions were not formalised meetings. This meant the provider remained in breach of Regulation

Smart Homecare Aylsham 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 adults, people living with dementia, sensory or physical impairments. At the time of our inspection, 17 people were using the service.

There was a registered manager in post who was also the provider. 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. For the purposes of this report they have been referred to as the provider.

This is the first time we have inspected this service since it was registered in August 2016. At this inspection we found a number of concerns and found that the provider was in breach of seven regulations 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 this report.

The provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not managed safely and staff had not received the correct training to handle and administer people’s medicines.

Individual risks relating to people’s health and wellbeing had not been identified or planned for. Risks within people’s environments had not been considered, therefore, there were no plans in place in case of an emergency.

Accidents and incidents were not accurately recorded.

People were at risk of infection. Staff had not received training in infection, prevention and control. Risks relating to infection had not been identified and planned for.

People were not adequately safeguarded from abuse. Staff had not received training in safeguarding and a safeguarding incident had not been reported to the safeguarding team. This meant that the provider was in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A further breach was found of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not safe. The appropriate background checks had not been carried out on prospective staff and the interview process was not formalised.

Assessments of people’s care needs were not holistic and lacked detail. These assessments were used as people’s care plans rather than as a separate document.

Staff were not adequately trained. Most staff had not completed the training set by the provider. There was no formal induction programme for staff and supervision of staff did not take place. This meant that the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not act within the principles of the Mental Capacity Act 2005 (MCA). People’s capacity was not assessed where there were concerns about a person’s ability to make a decision. Therefore, it was unclear if decisions were being made in people’s best interests. Staff had not received training in the MCA. Therefore, it was found that the provider was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff did not always work collaboratively with other agencies or professionals to provide effective care for people.

People’s nutritional needs were not managed in a safe way. There was a lack of care planning in place for people who were nutritionally at risk.

There were no care plans or risk assessments in place for people’s individual care and support needs. The assessment document used to inform staff of people’s needs was not sufficiently detailed and lacked information about people’s co