The inspection took place on 15 and 19 October 2018 and was announced. We spoke with staff and people using the service up until 1 November 2018. The service had previously been inspected on 15 August 2016 and rated good. Prior to that inspection the service had been inspected in May 2014 and was not compliant with the management of medicines or the regulation requiring supporting workers.

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 the inspection they were supporting 27 people although the registered manager was unclear with us as to how many of these people were provided with a regulated activity of ‘personal care’.

There was a registered manager who had been registered since 2014. 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.

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Recent staff recruitment had not been robust. Staff employment history had not been explored, and there was only one reference in one candidate’s file and this did not match any employer listed on their application form. From the records we reviewed, one person had commenced providing care before their Disclosure and Barring Service check had been returned.

People told us they felt safe whilst staff were providing care. However, we found elements of the service which were not safe. For example, we could not always gain a response to the registered providers telephone line. People’s relatives and professionals also reported to us, they had the same issue. This meant it was not possible for people to contact the office for an immediate response. We raised our concerns with the registered manager to ensure they instigated an effective system to ensure people were able to contact the service by telephone.

Rotas we were provided with at inspection were inaccurate as they had the same care worker listed to visit people at the same time. People had told us on a few occasions, calls had been missed which might have been as a result of the way the rotas were designed. We advised the registered manager or these concerns, as they were unaware any calls had been missed.

Risk assessments were not in place for all identified risks such as to manage the risk of falls. Risk reduction plans to mitigate all identified risks needed to contain all the information required to guide staff. Most people at the service had low level needs, however, it was important to ensure all risks were recorded and reduced.

The service mostly reminded people to take their medicines by way of a prompt. However, the recording of the administration of medicines was not in line with current best practice. We also found not all staff had their training to administer medicines refreshed or their competency checked by a person assessed as competent to do so. The registered manager agreed to rectify this immediately and had put a system in place shortly after the inspection had finished.

We found training for staff was not all up to date, although some had been undertaken following the announcement of the inspection. Supervision and appraisal records did not follow nationally recognised best practice in terms of quality. The registered manager had not kept up to date with nationally recognised best practice guidance in the provision of community based domiciliary care services.

The majority of people supported had the capacity to consent to their care and treatment. However, the registered manager and staff did not have a good understanding about the Mental Capacity Act 2005. The registered manager had not understood, they needed to formally assess people’s capacity

The inspection of Vista Home Care Services Ltd took place on 15 August 2016 and was announced. We previously inspected the service on 12 May 2014, at that time we found the registered provider was not meeting the regulations relating to the safe management of medicines and supporting workers. The registered person sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Vista Home Care Services Ltd provides care and support to people living in their own homes in the Dewsbury and Batley area of Kirklees. On the days of our inspection 15 people were receiving support with personal care.

The registered provider is also the registered manager for the service. 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 told us they felt safe; staff had received safeguarding training and were aware of their responsibility to report any concerns to their manager. Care plans contained risk assessments which were relevant to people’s individual needs. The registered person had a robust system in place to vet potential employees. All staff were trained and assessed as competent by the registered person, to administer people’s medicines.

New employees were supported in their role and there was a programme of on-going refresher training for existing staff. Staff received regular supervision to ensure they had the skills and competence to meet people’s needs.

Staff had received training in the Mental Capacity Act and were understood people’s rights to make decisions about their lives.

Staff were caring and kind. People’s privacy and dignity was respected and care plans reflected the need to encourage people to retain their level of independence.

People had care plans in place which noted the tasks they required support with. Staff told us these were reflective of people’s needs and were updated at least annually.

The registered person had a system in place to monitor the performance of the service. Staff were monitored at regular intervals and audits were completed of people’s daily records. The registered provider asked people and staff for feedback, this information had been reviewed and fed back to staff.

This was a scheduled inspection led by one inspector. We carried out the inspection with our five questions in mind. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with the manager, speaking with relatives of people who use the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with four relatives of people who used the service. They all said they felt their relative was safe.

People were at risk of medicines not being administered appropriately.

Is the service effective?

When speaking with staff it was clear they cared for the people they supported.

Mandatory training for staff was not up to date. Staff had not received supervision during 2014.

Is the service caring?

Prior to the service accepting a new service user, the manager visited the individual to assess what their needs were.

One relative of a person who used the service told us, “Really good staff. They are excellent.”

Is the service responsive?

We spoke with four relatives of people who used the service. They all said they knew how to complain. We saw the service had received two complaints since January2014 which had been fully investigated.

Is the service well-led?

The registered care provider also manages the service on a daily basis.

Only two of the four staff we spoke with had any knowledge of whistleblowing procedures.

The service has a quality assurance system, although not all audits were formally recorded.

Four staff we spoke with all told us they felt supported by their manager.