The inspection took place on 02 October 2017 and was unannounced.

UK International Nursing Agency Limited Dom Care is registered to provide accommodation for up to seven people who may require nursing and /or personal care. It is also registered to provide care to people living in their own homes. On the day of this inspection there were two people accommodated at the care home and one person in receipt of the regulated activity ‘personal care’ who lived in the community.

The home 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.

When we inspected this service in January 2015 we found that the provider had failed to ensure there were enough skilled and experienced staff available to meet people’s needs, staff lacked knowledge and understanding of safeguarding matters and the Mental Capacity Act 2005, incidents of concern had not been reported to the Care Quality Commission as required under regulation and people’s medicines had not been managed safely. The provider had not appointed a registered manager, the provider’s recruitment procedures were not robust and restraint had been used without ensuring the appropriate authorisations and procedures had been followed. The provider’s quality monitoring systems had not been effective in identifying these shortfalls and people’s feedback was not acted upon.

Subsequent to the comprehensive inspection we undertook two further focused inspections to assess the progress that had been made towards meeting the regulations and providing people with a safe and effective service. We found that improvements had been made with some further improvement required in areas relating to the effectiveness of the care provided and how well the service was managed.

At this comprehensive inspection we found that people were not always supported to lead an active and fulfilled life.

People were safe using the service. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from the registered manager which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

We observed that the staff team were kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. We noted that where any issues were raised with the management team they were responded to appropriately and in a timely manner.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We carried out an unannounced comprehensive inspection of UK International Nursing Agency Dom Care on 22 and 30 January 2015 at which breaches regulations 9, 17, 13, 11, 18, 15, and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. The provider told us that they would not be taking on any new people to use the service until they met requirements.

We undertook a focused inspection of UK International Nursing Agency Dom Care on 16 July 2015 and found improvements had been made, however there were continued breaches of regulations 09, 17, and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not enough staff available to provide safe care to people and management systems continued to be ineffective. We issued warning notices in relation to Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the focused inspection, the provider wrote to us on 15 September 2015 to tell us how they would meet the legal requirements. We undertook a further focused inspection on the 03 February 2016 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 these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for UK International Nursing Agency Dom Care on our website at www.cqc.org.uk.

UK International Nursing Agency Limited Dom Care provides accommodation for up to seven people who require nursing and /or personal care. It also provides care to people living in their own homes. This inspection focused on the residential home. At this inspection we found improvements had been made, however we also found further improvements were required in areas relating to the effectiveness of the care provided and how well the service was managed.

There were sufficient numbers of staff available to safely support people’s needs. A system was in place to effectively monitor and review incidents to keep people safe.

Staff received training relevant to their job roles and were supported through regular supervisions and appraisals to carry out their responsibilities and meet people`s needs effectively. People whose liberty had been deprived to keep them safe, had not consistently had the conditions of their authorisation met.

People were involved in the planning of their care, and care plans individually addressed the support needs people required based upon their individual needs and preferences.

There was a registered manager in post at this inspection. People’s care records were not accurately maintained to ensure a contemporaneous note was recorded for people’s daily care.

We carried out an unannounced comprehensive inspection of UK International Nursing Agency Dom Care on 22 and 30 January 2015 at which breaches of regulations 9, 10, 11, 13, 15, 18, 20, 21, 22 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were found. These correspond to regulations 9, 17, 13, 11, 18, 15, and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This was because there were not enough staff available to provide safe care to people. Staff had not undergone robust pre-employment checks before commencing work. Staff were not knowledgeable about signs of abuse or how to report this and not all staff had received training or development relevant to their role. People’s medicines were also not managed safely. When assessing people’s capacity to make decisions, staff had not acted in accordance with the Mental Capacity Act 2005. Care plans and risk assessments had not been developed or reviewed for areas of identified need. Notifications that were required to be sent to the Care Quality Commission had not been sent. In addition management systems were not robust.

Following the comprehensive inspection, the provider wrote to us on 15 May 2015 to tell us how they would meet the legal requirements. We undertook a focused inspection on the 16 July 2015 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 these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for UK International Nursing Agency Dom Care on our website at www.cqc.org.uk.

UK International Nursing Agency Limited Dom Care is a domiciliary agency providing personal care to people in their own homes. It is also provides accommodation for up to seven people who require nursing and /or personal care.

There continued to be insufficient numbers of staff available to safely support people’s needs.

People’s medicines were stored and managed safely. However safe practises were not always observed when completing controlled medicines records.

Staff were now recruited through a robust procedure. However not all staff were provided with regular professional development to ensure their knowledge was up to date.

Management systems continued to be ineffective.

There was not 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 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service.

Staff followed the requirements of the Mental Capacity Act 2005 for people who lacked capacity to make particular decisions.

Incidents that required reporting to the Care Quality Commission had been made as required.

At this inspection we found the service to be in breach of Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take and what action we are taking at the back of the full version of the report.

People we spoke with were complimentary about the care and service provided. They felt well supported. One person remarked, "The care workers are excellent. I have no problems with the service; it's first class."

A relative said that the care worker had helped the person to cook their own meals, and had ensured that the meals were balanced and nutritious. The same relative said, "I am very happy with the service. I have no complaints. This is an excellent service. The staff are excellent and very efficient."

The relatives we spoke with said that they had been involved in the decisions about the care package on behalf of the person using the service. They said that the person's wishes and preferences had been respected. They said that the agency had always consulted them if there were changes in the person's care needs.

We sent postal surveys to people who use the service and to their main carers (a relative or friend). Everyone who completed the survey responded very positively and said that they were very satisfied with the care provided by the agency. One person said, “Our care worker is very caring, punctual, helpful and professional”.

This unannounced inspection took place on 22 and 30 January 2015 in response to concerns that had been raised to us. At our last inspection on 16 January 2014 we found the service was meeting the requirements. Since our last inspection the service has registered to provide accommodation in addition to personal care in the community.

UK International Nursing Agency Limited provides accommodation and nursing care for up to 7 people who have nursing needs or are living with dementia. There were 2 people living at the home when we visited with a further 4 people supported in the community with personal care needs.

There was not 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 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection there had been no applications made to the local authority in relation to people who lived at the service. The manager and staff were not familiar with their role in relation to MCA and DoLS.

People’s safety was being compromised in a number of areas.

There were insufficient numbers of staff available to safely support people’s needs.

Incidents that required reporting to the Care Quality Commission had not been made.

Peoples medicines were not stored or managed safely, however staff had received appropriate training

Staff were not clear on how to identify and report any concerns relating to a person’s safety and welfare. The manager had not responded to all appropriately. Restraint had historically been used to control a person without ensuring the appropriate authorisations and procedures had been followed.

Staff did not follow the requirements of the Mental Capacity Act 2005 for people who lacked capacity to make particular decisions.

Staff were not recruited through a robust procedure and were not provided with regular professional development to ensure their knowledge was up to date.

Staff knew people well and provided support in a timely manner. There was sufficient food and drink available and people were assisted to eat and drink in a calm and sensitive way.

People had access to a range of health care professionals, such as chiropodist, mental health team and a doctor. People saw a doctor regularly and people were referred when there were concerns with their health.

There was not an effective system of regular auditing, review and action to ensure people received a quality service that kept them safe.

People’s feedback including staff had been sought; however it was not always acted upon.

We found the requirements of the standards were not being met. On the 30 January 2015 in response to our concerns we asked the provider to impose a voluntary suspension of new people using the service.

We have referred our findings to the local authority safeguarding and commissioning teams.