This inspection took place on 27 and 28 June 2018 and was announced. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. The service’s last comprehensive inspection was on 12 and 17 July 2017, where we found the service to be in breach of regulations in relation to safe care and treatment and good governance. We served the provider with Warning Notices where we specified actions that the provider was required to take. At our focused inspection on 9 November 2017, we found that the provider was still in breach in regard to safe care and treatment and good governance.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions Safe and Well-led to at least good. At the inspection on 27 and 28 June 2018, we found that the provider had made improvements.

Turkish Cypriot Community Association is a domiciliary care service that provides personal care to older people living in their own houses and flats in the community. Not everyone using Turkish Cypriot Community Association 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 inspection, the service was providing personal care to 87 people with physical disabilities and older people in their own homes.

The service had a registered manager. 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 and their relatives told us staff were reliable and felt safe with them. Staff were provided with information on risks to people’s healthcare needs and how to minimise those risks to ensure their and people’s safety. The provider employed suitable and sufficient numbers of staff to meet people’s needs safely. People were supported with their medicines needs by staff who were trained in medication administration. Staff followed appropriate infection control procedures to prevent cross contamination and avoid risk of spread of infection. The provider maintained appropriate accidents and incidents records and shared learning outcomes with the staff team to minimise future occurrences.

The provider assessed people’s needs at the time of referral and informed staff on how to provide individualised care. Staff were provided with sufficient induction, regular training and supervision to meet people’s needs effectively. People were happy with the nutrition and hydration support. The provider supported people where requested to access healthcare services to maintain good health. People told us staff asked them before supporting them and staff knew people’s right to choose and encouraged them make decisions.

People and their relatives told us staff were caring and treated them with dignity and respect. Staff were trained in equality and diversity, and treated people as individuals. People were supported to remain independent and their confidentiality was maintained. The provider delivered a cultural specific service and ensured staff were matched with people with similar language and cultural backgrounds. People were supported by the same staff team that ensured continuity of care.

Staff knew people’s likes, dislikes and background history. People told us they received personalised care. The provider had updated people’s care plans to make them more person-centred. People and their relatives knew how to raise concerns. People were supported with end of life care needs but these were not always clearly reflected in their care

We carried out an announced comprehensive inspection of this service on 12 and 17 July 2017, at which time we found breaches of two Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the provider not consistently assessing the risks associated with people's health, care and mobility needs, and not mitigating any such risks. The provider did not thoroughly investigate incidents, take actions in a timely manner to remedy the situation or gain any learning from the incidents to prevent further occurrences and ensure improvements were made. The provider did not regularly conduct audits of records and information related to people using the service, the management of the service and staff recruitment. We found the provider was also in breach of Care Quality Commission (Registration) Regulations 2009 by failing to notify us of safeguarding and police incidents. We served the provider with Warning Notices where we specified actions that the provider was required to take by a set date.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 9 November 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Turkish Cypriot Community Association’ on our website at www.cqc.org.uk.

Turkish Cypriot Community Association is a domiciliary care service run by Turkish Cypriot Community Association. At the time of inspection the service was providing personal care to 103 people with learning disabilities, dementia or mental health issues in their own homes. Most of the people who used the service and the staff spoke Turkish.

At our focused inspection on 9 November 2017, we found that the provider had not followed their plan based on our Warning Notices which was to be completed by 31 October 2017. We found that the provider had not addressed the breaches of the Regulations 12 and Regulation17.

The provider had not reviewed and updated risk assessments and care plans for all people using their service. The risks assessments that were updated did not consistently provide information on mitigating factors to ensure people received safe care. People’s care plans and consent to care forms were still not being signed. People’s daily care logs and medicine administration records were now routinely brought in the office. However, there were no records of audits of people’s daily care logs.

Staff recruitment checks were now carried out in line with the provider’s recruitment policy. The provider had improved systems around responding to accidents and incidents, safeguarding and health and care professional records.

Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

The inspection took place on 12 and 17July 2017. This was an announced inspection. We gave the provider 48 hours notice of the inspection as this is a domiciliary care agency and we wanted to ensure the manager was available in the office to meet with us. This service was last inspected on 11 and 17 May 2016 when we found the provider was in breach of four regulations, in relation to need for consent, safe care and treatment, good governance and staff supervision.

Turkish Cypriot Community Association is a domiciliary care service run by Turkish Cypriot Community Association. At the time of inspection, the service was providing personal care to 105 people with learning disabilities, dementia or mental health issues in their own homes. Most of the people who used the service and the staff spoke Turkish.

The service had a registered manager 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 made improvements since the last inspection but these were not sufficient in providing safe care and treatment and good governance.

The registered provider failed to notify us about two incidents and did not raise safeguarding alert with the local authority on one occasion. Risks associated to people’s care were not reviewed following accidents and incidents, and actions agreed were not followed through. Accidents and incidents records were not reviewed by the management. Environmental risk assessments were completed, however risks assessments related to people’s health conditions were not carried out. Risk assessments and care plans did not give sufficient information and instructions to staff on how to provide safe and personalised care. Medicines administration records (MAR) for people who were prompted with medicines management were not always completed. Care plans were not personalised and lacked information on people’s likes and dislikes.

The data management and monitoring systems to assess the quality and safety of care delivery was ineffective. The registered provider was not auditing systems related to care delivery including daily care logs, MAR, care plans and risk assessments. Some staff references lacked additional paperwork to confirm they had been verified. People’s mental capacity assessment records required supplementary information regarding their power of attorney.

People and their relatives told us they were happy with the service and found staff caring and kind. People were satisfied with staff’s punctuality and found the service reliable and trustworthy, and were happy to recommend the service. The service provided continuity of care and that enabled positive relationships between staff and people using the service. Staff were matched to people with similar cultural backgrounds. People told us staff treated them with and dignity and respect. People were provided with companionship services as and when required.

Staff told us they felt supported by the management and their suggestions were taken on board. Staff received regular supervision and annual appraisal. Induction and training records confirmed staff received mandatory and additional training to do their job effectively. Staff had a good understanding of their role in identifying signs of abuse and reporting any concerns of poor care, neglect and abuse. Staff sought people’s permission before providing care and gave them choices.

People’s nutrition and hydration needs were met. The service worked with health and care professionals in improving people’s physical health.

The service sought formal feedback on the quality of care delivery from people and their relatives via annual feedback survey forms and called people quarterly to find out if there were any concerns.

We found the registere

The inspection took place on 11 and 17 May 2016. This was an announced inspection. We gave the provider 48 hours notice of the inspection as this is a domiciliary care agency and we wanted to ensure the registered manager was available in the office to meet us. We last inspected the provider on 01 November 2013. This was an announced inspection. At this inspection, we found the provider to be compliant.

Turkish Cypriot Community Association is a domiciliary care service run by Turkish Cypriot Homecare. The service provides personal care to over 120 people with learning disabilities, dementia, mental health, older people and younger adults in their own homes. Most of the people who use the service and the staff speak in Turkish language. On the day of inspection 120 people were receiving services.

The service had a registered manager who has been registered with the Care Quality Commission. 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 and relatives told us they found staff caring, compassionate and helpful. People and relatives told us that staff listened to them and their health and care needs were met. Staff were able to demonstrate their understanding of the needs and preferences of the people they cared for, for example we observed staff caring for people in a way that maintained their privacy and dignity.

Care plans and risk assessments did not support the safe handling and management of some people's medicines. We checked medicines administration records and found that clear and accurate records were not being kept of medicines administered by staff. There were incomplete care delivery records. Care plans were detailed and recorded individual needs, likes and dislikes. Risk assessments were comprehensive and individualised. However, not all care plans and risk assessments were regularly updated and reviewed.

There were safeguarding policies and procedures in place. Staff were able to demonstrate their role in raising concerns. Staff had a good understanding of the safeguarding procedure and the role of external agencies.

There were inconsistencies in staff receiving appropriate and necessary support and supervision; we evidenced some records of staff supervision. Staff told us they attended induction training and additional training. We evidenced staff training records.

Staff files had records of application forms, interview assessment notes, criminal record checks and reference checks.

The service lacked effective systems and process to assess, monitor and improve the quality and safety of service provided although we saw some evidence of monitoring checks of the quality and safety of the service.

We found that the registered provider was not meeting legal requirements and there were a number of breaches 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 the report.

All the people who used the service and their relatives who we spoke with were positive about the service. They told us that staff were “caring” and “respectful”. People who used the service indicated that they were satisfied with their care. One person told us that they were "very happy [with the service]" and that staff were "always on time". People told us staff were never in a hurry and always completed the tasks. Another person told us that staff "listened" to what they said. This indicated that people were listened to and their needs were met.

Care plans and risk assessments were completed and regularly reviewed. We noted that people who used the service and their representatives were involved in the review of care plans.

People felt that staff listened to them. A person told us staff were “trustworthy”. We noted that staff knew how to make sure that people were protected from abuse. We noted that there was an effective recruitment system in place. The provider stated that a refresher adult safeguarding training was planned for staff.

There was a system in place to monitor the quality of the service. This ensured that people’s views about the quality of the service were sought. However, the provider may wish to note that quality assurance work undertaken in July 2013 had not been fully completed.

People told us that they were "very happy" with their carers. They told us staff treated them with "lots of respects". People felt that their needs were met because staff were “very helpful” and they had risk assessments and care plans.

We noted the staff were aware of and responded to people’s cultural, language and spiritual needs. These meant people’s individual needs were met.

People had information about how to make complaints. This enabled them to report to the manager when they were not happy about their care.

We noted that the agency had enough staff available to provide the care that people needed. People told us that staff turned up on time and completed tasks. This ensured that people received care and support that met their needs.

People who use the service told us that they were very happy with the service. They told us that they benefitted from being able to communicate their needs in their own language and that their cultural and religious needs were being met. People gave us comments such as, “I’m absolutely delighted with the service. They are very good.” And, “I wouldn’t have any other agency coming into the house. They always come on time and the carers do whatever they can to help you.”