The service is a domiciliary care agency. It provides personal care to people living in their own homes, flats and specialist housing. It provides a service to older adults and younger disabled adults. There were 154 people using the service at the time of this inspection.

This inspection took place on 20 July 2018. We gave two days’ notice to the provider to ensure someone was available to assist us with the inspection.

We last inspected the service in December 2016 and found the provider was meeting the fundamental standards. We rated the service ‘Good’ overall. At this inspection we found standards had deteriorated and we rated the service ‘Requires improvement’ in each key question and overall.

A registered manager was 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.

Although staff numbers were sufficient, people did not always receive care at the agreed times and people raised concerns about lateness and staff rushing and finishing too early. The provider had an electronic system to monitor staff timekeeping but the provider told us this was unreliable at the time of our inspection.

The provider communicated poorly with people when staff were going to be late and also when people would receive a different care worker than usual.

People felt the provider did not always respond well to concerns they raised and did not always resolve issues they raised, such as those relating to timekeeping. People were unhappy with the replacement care workers when their usual care workers were on leave. They found the replacement care workers did not understand their needs and often experienced issues with timekeeping with them.

The provider did not always assess risks to people’s care in line with best practice as part of doing all they could to reduce the risks. This meant written guidance for staff in reducing risks, such as those relating to medicines management, self-harm and aggression towards staff were lacking for some people.

Care plans did not always contain details of how people wanted to receive their care and what was important in relation to their care. However, care plans contained other information about people’s needs and preferences to guide staff.

The provider had not always followed the Mental Capacity Act (2005) in caring for people. They had not always ensured they carried out assessments in a decision-specific way to ensure proper and fair assessments of capacity.

The registered manager required more robust oversight of the service. The provider’s governance systems were lacking as they had not identified and resolved the issues we found during our inspection. This was a breach of regulation. You can see the action we asked the provider to take at the back of our full-length report.

Besides the lack of medicines risk assessments and management plans staff administered medicines safely to people.

The provider had systems to safeguarding people from abuse and improper treatment. The provider checked staff were suitable to work with people through recruitment checks.

Staff received the support to understand their role. The provider trained new staff with a suitable induction and an annual training programme and staff received regular supervision.

The provider consulted people as part of assessing their needs and reviewed any professional reports.

Staff were caring and understood the people they cared for. People liked their usual care workers but were less positive about replacement staff who covered when their usual care workers were on leave. Staff treated people with respect and maintained their privacy and dignity and supported people to maintain their independence.

Trinity Care Services Limited provides personal care and support to people in their own homes. At the time of our visit there were 105 people using the service.

This inspection took place on 6 and 13 December 2016. Both visits were announced. We gave 24 hour’s notice of the first visit to make sure the registered manager and other senior staff were available at their office to talk with us. The purpose of the inspection was to carry out a full comprehensive review of the service and to follow-up on the two requirement actions and one enforcement action made at the previous inspection in August 2015.

The service had 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.

People using the service told us they were treated in a respectful and caring manner by regular staff members who knew them well and supported them safely and effectively.

Staff members had been safely recruited and had received an induction to the service. Staff we spoke with were confident that they provided a good service to people. They had access to training and supervision and said they felt supported by the service.

Staff understood how to help protect people from the risk of abuse. The agency had procedures in place to report any safeguarding concerns to the local authority.

At this inspection improvements had been made to help ensure people and staff were protected from potential risk of harm as the service had identified and assessed any risks to them and reviewed these on a regular basis. We saw people had assessments which were individual to the person and their environment.

We also found the service had made improvements to make sure people were receiving their medicines as prescribed.

Staff had received training in the MCA (Mental Capacity Act) and understood the importance of gaining people’s consent before assisting them.

The service completed assessments of people’s needs and these were used to inform the care plan for each person. New care plan summaries had been introduced and work was on-going to make these more individualised reflecting the person and what was important to them.

People and their relatives felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues.

The registered manager was aware of how many people were using the service and that their care and support needs were being met. The agency monitored the quality of the service and made changes to improve the service provided when required.

We inspected Trinity Care Service on 21 August 2015. The inspection was announced 48 hours in advance because we needed to ensure the registered manager was available.

Trinity Care Service provides personal care to adults in their own home. At the time of our visit the registered manager told us there were 24 people using the service. Information sent to us by the service later indicated there were 25 and then 27 people using the service at the time of our visit. However, information received from local authorities which commission the service indicates that there were at least 70 people using the service who were receiving personal care at the time of our inspection.

The service had a registered manager. 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.

We previously inspected Trinity Care Service in July 2014. We found the provider was not meeting all the legal requirements and regulations we inspected. People were not adequately protected against abuse because staff did not have good knowledge about how to identify abuse and report any concerns. The procedures in place to manage medicines were not consistently applied by all staff and the systems in place to assess and monitor the quality of care were ineffective.

During our inspection in August 2015 we found that there were arrangements in place to protect people from abuse which staff were aware of. Staff had received safeguarding training and had good knowledge about how to identify abuse and report any concerns.

We found that care was not always planned and delivered to ensure people were protected against foreseeable harm. People had risk assessments but they did not identify obvious risks or give staff sufficient information on how to manage the risks identified. There were not appropriate arrangements in place to ensure people received their medicines safely.

Staff arrived on time and stayed for the time allocated. People were cared for by a sufficient number of suitable staff to keep them safe and meet their needs. Staff were recruited using an effective procedure which was consistently applied. Staff controlled the risk and spread of infection by following the service’s infection control policy.

Care plans provided information to staff about how to meet people’s individual needs. However, the information was not always sufficiently detailed to enable staff to safely support people they did not know well.

Staff had the skills and experience to deliver care effectively. Staff worked with a variety of healthcare professionals to support people to maintain good health.

Staff understood the relevant requirements of the Mental Capacity Act (MCA) 2005 and how it applied to people in their care.

People were given choice and felt in control of the care they received. Staff were kind, caring and treated people with respect. People were satisfied with the quality of care they received. People were supported to express their views and give feedback on the care they received. The provider listened to and learned from people’s experiences to improve the service.

Staff understood their roles and responsibilities. People felt able to contact the service’s office to make a complaint and discuss their care. There were systems in place to assess and monitor the quality of care people received. However, we were concerned the registered manager did not know the number of people using the service, that staff were giving people medicines or that inadequate risk assessments were being conducted.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the arrangements in place for people to receive their medicines safely, how the provider protected people from avoidable harm and how the service was managed. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was announced 48 hours in advance. Trinity Care Services provides personal care to adults in their home. At the time of our inspection there were 39 people using the service receiving personal care. The service had a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law, as does the provider.

People using the service told us they felt safe. They knew who to contact at the service if they had any concerns about their safety or wished to make a complaint. We were concerned the provider and registered manager did not have suitable arrangements in place to ensure that people were protected against the risk of abuse. Although care workers had received training in safeguarding adults, the provider and registered manager did not ensure care workers understood their training and how to apply it in practice. The care workers we spoke with did not know how to recognise abuse or the action to take if they suspected a person using the service was at risk of harm.

People told us that no mistakes had been made with their medicines. However, we found the procedures in place to manage medicines were not consistently applied by all staff. Some of the entries in people’s medicine records were illegible. We also found there were gaps in some people’s medicine records. This meant that people were at risk of receiving care or treatment that was inappropriate or unsafe.

People’s needs were assessed before they began to use the service and re-assessed regularly thereafter. Care workers were aware of people’s needs because they had access to people’s care plans in their homes and because they usually worked with the same people. This meant that people received consistent care from care workers who knew their needs and understood how they preferred their care to be delivered.

People were satisfied with the quality of care they received and told us the care they received met their needs. Care workers and office staff worked well with other services and healthcare professionals such as district nurses and physiotherapists to maintain people’s health. People were supported to have good nutrition because staff knew what constituted a balanced diet and told us their meals were prepared in the way they preferred.

People felt their care workers had the skills and knowledge required to deliver their care. Care workers told us they were adequately supported by the service to care for people effectively. We saw confirmation that care workers received appropriate training, regular supervision and professional development. Care workers had been recruited using a thorough recruitment process and appropriate checks were carried out before they were allowed to work with people using the service. This minimised the risk of people being cared for by care workers who were unsuitable for the role.

People were involved in their care planning. Care plans had information on how people wanted to be supported and detailed how their care should be delivered. People told us the service provided care and support that met their individual needs. People with particular health needs were cared for by care workers who had received training specifically to meet their particular health needs. We saw that where people had life threatening illnesses their care workers had received training in palliative care.

People told us their care workers were caring and that they were treated with kindness and respect. Care workers ensured people’s dignity was respected at all times when they received personal care and asked for their permission before supporting them. People told us the care workers helped them to remain independent. The service responded quickly when notified there had been a change in a person’s needs or preferences. People were supported by the service to express their views which were taken into account in developing the service.

People felt the service was well organised and managed. This was also the view of care workers who told us they were supported by the registered manager and office staff, to carry out their role effectively. However, we found that the systems in place to monitor the quality of care provided were ineffective. We were concerned that care workers did not adequately complete people’s care records and they were not returned to the service’s office regularly for review. This had not been identified by the service’s internal audit system. Similarly, gaps in people’s medical records had not been highlighted by the service’s internal audit.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People we spoke with told us they felt in control of how their care was delivered. One person told us, “They always ask my permission before they do anything.” Another person told us, “they do things the way I ask them to.”

We found that people’s needs were assessed before care was delivered and people were involved in their care planning. People’s care was planned and delivered to meet their individual needs and to ensure their welfare and safety. People knew the details of their care plan and were satisfied with the way care was delivered.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with told us they felt safe. We found that staff received regular training in safeguarding vulnerable adults and had good knowledge about safeguarding people who use the service from abuse.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We found the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We saw some satisfaction surveys that had been completed recently by people using the service and/or their representatives and they were all happy with the care being provided by the agency.

People who use the service were given appropriate information and support regarding their care and support. Their care records showed that their needs had been assessed by the agency’s staff and care plans drawn up accordingly. The manager confirmed that people’s needs were re-assessed when there were changes. We saw records that people needs were being reviewed on a regular basis in conjunction with the placing authority.