About the service: Torch Healthcare Services Ltd is a small domiciliary care agency providing personal care to people in their own homes. Not everyone using the service receives the 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.

People’s experience of using this service:

People were not protected from harm because systems were not in place to keep them safe. People’s medicines were not managed safely as the service did not have safe systems in place. People were not being supported by staff who had gone through thorough recruitment checks.

People were not provided with effective care as staff had not been trained or had the support to carry out their roles. Despite the concerns people told us they thought their care workers were kind and caring.

People’s care plans did not provide the information required for staff to know the support needed. People had not always been able to be involved in the care planning process or have a review of their care.

The quality monitoring systems in place were inadequate and had not identified areas for improvement which meant the registered manager was not always aware of concerns. Action plans sent to us following our last inspection stated the action required would be completed by October 2018. The action had not been carried out.

The registered manager had not notified us of all incidents that required a notification to us by law.

Rating at last inspection: At our last comprehensive inspection which was published in August 2018 the service was rated as Requires Improvement. Following our inspection we asked the provider to complete an action plan to show what they would do by when to make the required improvements.

Why we inspected: This is a planned inspection based on the previous inspection rating.

Enforcement: We have found five repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, we have found one breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in 'special measures' will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of Inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as Inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspection is added to reports after any representations and appeals have been concluded.

This inspection took place on 14 and 19 June 2018 and was announced. This was the first inspection for this service since it was registered in March 2017. Torch Healthcare Services is a domiciliary care agency covering areas in and around Salisbury and Warminster. It provides personal care to people living in their own houses and flats in the community. It provides a service to people living with dementia, mental health, older people, learning disability, physical disability, sensory impairment and younger adults.

Not everyone using Torch Healthcare Services received 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.

There was a registered manager in post. 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. In January 2018 the provider had appointed a new manager who was also in the process of becoming registered. The new manager was working alongside the registered manager.

Medicines were not managed safely. People’s medicines administration records did not have the detail required to record what medicines had been administered. Staff had not been trained to administer medicines and their competence had not been assessed.

Staff were not recruited safely. The necessary pre-employment recruitment checks had not been completed. The service had not obtained a full employment history or checked gaps in employment. References from previous employers had not always been obtained.

Risks had not always been identified or assessed so that safety measures could be put in place. Where risk assessments had been completed, the service was not consistently working to safe practice they had identified.

There were not sufficient staff deployed to cover the care packages that had been agreed. The service recognised this and was in the process of handing back some contracts to the local authority.

Staff had not always been trained or supervised effectively. New staff had not had an induction to prepare them for their role. The registered manager had organised some online training which they were encouraging staff to complete.

Care plans were not detailed enough to guide staff to provide people with personalised care. Where people had specific health needs there was no guidance for staff to know what to do if the person became unwell.

Daily notes were not always written legibly. We were not able to read some entries in people’s daily notes. We showed them to the registered manager who also could not decipher some entries. Within the daily notes we saw staff had recorded incidents and accidents but there were no incident forms completed. Due to the lack of systems for recording incidents this did not enable the registered manager to investigate. This meant the registered manager had not taken the appropriate action following all incidents and accidents.

Quality monitoring systems had not been established at the service. Due to the lack of monitoring in all areas the registered manager did not have an overview of quality or safety. This meant the registered manager was not aware of the shortfalls so they could make sure improvement was made.

People had not been asked for their views as reviews were not consistent. There was no established system or process to gather people’s views using any other means such as surveys.

Staff we spoke with told us about the different types of abuse and the actions they would take to keep people safe. Safeguarding was discussed at team meetings and training was planned for all the staff to complete on safeguarding.

People were supported