This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The service provided care and support to older adults, people with disabilities and people living with dementia. At the time of our inspection 301 people were receiving care. The inspection took place on the 4 and 5 July 2018 and was announced.

At our last inspection on 15, 16 and 17 August 2017 we identified six breaches of the regulations around staffing, safe care and treatment, person centred care, safeguarding adults from abuse and good governance. At our current inspection improvements had been made however we still found breaches in safe care and treatment and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good and to bring them out of special measures.

The service had appointed a new registered manger since the last inspection. 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 service had recruited new staff which had improved staffing levels however verbal feedback we received highlighted there were still issues around timeliness of visits and missed calls. This meant people were missing mealtimes and their medicines.

The service had improved how they assessed risk by introducing a risk stratification tool which captured important information about people who presented with high risk and management reviewed this on a weekly basis. Risk assessments were now robust and provided information to staff to understand all the different risks people faced and how to mitigate against them. Staff were more vigilant to risks in people’s homes.

Staff received updated training in safeguarding and understood their responsibilities to report allegations of abuse to management and whistleblow if needed. The service also acted promptly upon receipt of allegations of abuse and worked with the local authority. Relatives felt confident their family member was safe with staff as they had observed improvements in how staff treated them and comments we received were positive about safety.

Medicines management had improved and the serviced had amended the medicine administration records (MAR) they used to a format that ensured staff could accurately record the medicines given and avoid errors. However, staff understanding of the different levels of support provided to people was not consistent.

Staff received a comprehensive training programme and service had appointed field supervisors to be leads in particular areas to support care staff.

Care plans had improved and were person centred.

The service followed the principles of the Mental Capacity Act 2005 and people confirmed they were encouraged to make their own decisions and maintain independence.

We received positive feedback in relation to how people were now being treated by staff from the service. Relatives stated that staff cared about their family member and showed respect and compassion. People were forming good relationships with staff and where there had been long standing care arrangements, these working relationships had just become stronger. Staff were responsive to people’s changing needs and moods and would raise concerns with the office straight away.

The service had completed work around inclusion in the community and had commenced a quarterly coffee morning with people who used the service. They had also introduced an LGBT inclusion and equality policy to include people who identified as LGBT whether it be staff or people who used the service.

The culture and atmosphere at branch level had improved and s

The inspection took place on 15, 16 and 17 August 2017 and was announced. The provider was given 24 hours' notice because the location provides a domiciliary care service for adults; we needed to be sure that someone would be in. Supreme Care Services provides personal care to people living in their own home. The service provides care and support for older adults, people with disabilities and people living with dementia. At the time of our inspection there were 181 people receiving care. This was the first inspection of the service since it was registered in April 2017.

There was a registered manager at the service at the time of our inspection. 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.

There were not sufficient numbers of staff deployed to meet people’s needs. There were high levels of calls to people’s homes that were missed or where staff arrived early or late or did not stay for the allocated amount of time. This meant that people missed meals and medicines.

People were not protected from risks to their health and wellbeing because risks had not always been identified and were not detailed enough to guide staff about how to manage specific risks. Not all staff were aware of the risks people faced and people’s relatives did not always feel their loved ones were safe and expressed concern about risk management.

Medicines were not managed properly. People reported that medicines were sometimes missed and there was not an effective monitoring system in place to check they were being administered safely.

The provider did not ensure that people were treated with dignity and respect. People and their relatives told us that this affected their wellbeing.

The service was not organised in a way that promoted safe and quality care through effective monitoring systems. People and their relatives were not confident with the management of the service and told us they were not always able to raise complaints and did not always feel their concerns were listened to.

The provider had not done all that was reasonably expected of them to promote good practice following a serious allegation of abuse. Staff were aware of the safeguarding adults procedure however, the policy did not contain relevant contact details for outside agencies. The provider could not be assured that staff were suitable to work in the caring profession as criminal record checks had not been obtained prior to staff starting work at the service.

People were not always supported to eat and drink enough when visits to people’s homes did not take place as planned for staff to support people with their meals. Relatives reported staff did not always prepare meals safely. People’s care plans did not always contain enough guidance with staff about nutrition.

The provider followed the latest guidance and legal developments about obtaining people’s consent to care. People or their relatives had signed care plans to indicate their involvement in care planning.

People’s relatives reported that staff were not adequately trained to work with people with dementia. Staff received the provider’s mandatory training and also completed the Care Certificate. Newly appointed staff were supported in their role by an induction period.

People were supported to access healthcare professionals when they became unwell.

We found six breaches of the regulations around staffing, respect and dignity, safe care and treatment, person-centred care, safeguarding adults from abuse and good governance. We made three recommendations in relation to complaints, training and meeting nutritional and hydration needs. Full information about CQC’s regulatory response to any concerns found during inspections i