This inspection took place on 04 September 2018, the inspection was announced.

This service 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 and younger adults with a physical disability. The service was also available to provide personal care for children, however there were no children being provided with personal care when we inspected.

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. There were 23 people receiving support with their personal care when we inspected.

At the last inspection on 20 December 2017 we rated the service Requires Improvement overall and rated the Effective domain Inadequate. The provider had failed to provide care and treatment with the consent of the relevant person. The provider had failed to establish and operate effective complaint systems. The provider had not ensured that leadership and quality assurance systems were effective to make sure people were safe and they received a good service. The provider had failed to operate effective recruitment procedures. The provider had failed to provide training and support for staff relating to people's needs. The provider had not ensured that people received appropriate care that met their needs and reflected their preferences. The provider had failed to manage care and treatment in a safe way and failed to ensure that medicines were suitably managed. We also recommended that the provider made it clear to people and their relatives the emergency contact arrangements relating to the service if they took a holiday. We imposed a condition on the provider's registration.

The provider submitted an action plan on 06 March 2018. This showed they had met two regulations by 01 March 2018. The provider planned to meet the remainder of the Regulations by 31 March 2018.

At this inspection we found the provider had met some of their actions. However, there continued to be four breaches. The service has been rated Requires Improvement overall. This is the second consecutive time the service has been rated Requires Improvement.

People told us they received safe, effective, caring, responsive and well led care. They had nothing but positive feedback about the service they received.

The provider had made some improvements to their recruitment processes. However, further improvements were required. Two of the four staff files we viewed showed gaps in employment history that had not been explored which meant the provider had not always followed effective recruitment procedures to check that potential staff employed had the skills and experience needed to carry out their roles.

At the last inspection staff had not attended training relevant to people's needs. At this inspection training had improved. However, some staff had not received basic training before providing care and support to people in their homes. Medicines training had not yet been completed by some staff; these staff were administering medicines to people. This is an area for improvement.

Staff told us they received regular supervision meetings and regular spot checks to ensure that they were putting their training into practice. They felt they had good support from the provider.

Although some improvements had been made to risk assessment processes since the last inspection. People’s care records did not always evidence that the provider had assessed risks to people's safety. One person’s care file detailed that they were cared for in bed. There was no risk assessment for staff to detail how staff should safely manoeuvre the person when providing personal care, there was no information about what equipment was in place.

People are supported to have maximum choice and control of their lives and st

The inspection took place on 20 December 2017. The inspection was announced.

Tiger Lily 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 older adults, people living with dementia and younger adults with a physical disability. The service was also available to provide personal care for children, however there were no children being provided with personal care when we inspected.

Not everyone using Tiger Lily Care 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 the time of our inspection they were supporting 16 people who received support with personal care tasks.

The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA 2005) that included the steps staff should take to comply with legal requirements. Staff had a limited understanding of the MCA 2005 to enable them to protect people’s rights. Care plans and documentation did not evidence that the MCA 2005 had been followed.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. People had opportunities to feedback about the service they received in an informal manner. However they were not given the opportunity to provide feedback anonymously.

People were supported and helped to maintain their health and to access health services. Timely action had not always been taken when people’s health changed.

Risks to people’s safety and welfare were not always managed to make sure they were protected from harm.

Staff had not attended training relevant to people’s needs. Supervisions for staff required improvement.

Medicines practice was not always safe. Staff had not received medicines training and had not had their competency assessed. Medicines had not always been recorded adequately.

People's care plans did not always make it clear how staff should meet their care and support needs. Essential information about people such as their life history, likes, dislikes and preferences were not included. Care plans did not always reflect each person's current need or specific healthcare needs.

People did not always know who to complain to if they needed to. The complaints procedure was available in the office and in some people’s care files in their homes. The complaints procedure did not give people all the information they needed to take their complaint further if they needed to.

People were not always clear how to contact the provider out of hours. We made a recommendation about this.

People were protected from abuse or the risk of abuse. The provider and staff were aware of their roles and responsibilities in relation to safeguarding people.

Some people received support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

There were suitable numbers of staff on shift to meet people’s needs. The provider worked with people providing care and support on a regular basis. People received consistent support from staff they knew well.

People’s information was treated confidentially. People’s paper records were stored securely in locked filing cabinets.

People and relatives told us that staff were kind and caring. Staff treated people with dignity and respect.

Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

People and their relatives told us the service was well run.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Acti