We carried out an unannounced comprehensive inspection of Westhome Care Services Limited on 21, 23, 26, 29 and 30 November 2018. At the last comprehensive inspection of the service on 24 and 27 July 2017, 24 August 2017 and 29 September 2017 breaches of legal requirements were found in relation to the person-centred care, safe care and treatment of people and the governance of the service. At this inspection the service had made the required improvements and was meeting the legal requirements.

Following the last comprehensive inspection, we asked the service to complete an action plan detailing what they would do and by when to improve the key questions of safe, caring, responsive and well-led to at least good. We saw people’s needs had been assessed regularly and these were detailed in care plans. Infection control procedures were now in place at the service and the service had a policy for staff around this. The governance of the service had improved and we saw evidence of a new governance frame work which included regular audits and documented actions taken if any issues were highlighted.

Westhome Care Services Limited is a domiciliary care agency. It provides personal care and support to people living in their own homes. It provides a service to a range of people including those living with mental health needs, dementia and physical disabilities. At the time of inspection there were 97 people using the service and 84 were receiving the regulated activity of personal care.

There was a registered manager in post who had been registered with the Care Quality Commission (CQC) to provide the regulated activity since March 2016. A registered manager is a person who has registered with the 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. The registered manager submitted notifications to the Commission but we found two incidents that had not been notified to the CQC.

There was a new governance framework in place to monitor the quality and safety of the care provided to people. At the time of inspection this framework had not been fully imbedded and not all audits had been completed.

People told us that they felt safe with the care provided by staff and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Care files contained detailed risk assessments which were personalised, these included steps to mitigate risks around infection control, environmental risks and people’s risk of having a fall. Staff had received training and attended supervision sessions around safeguarding vulnerable adults.

Medicines were managed safely. Staff had received training around medicine’s management and had regular checks of their competencies.

Staff were safely recruited and they were provided with all the necessary induction training required for their role. The registered manager continued to provide on-going training for staff and monitored when refresher training was required. The registered manager had previous experience in a training role and delivered face to face training with all staff in a designated training room at the service’s main office. Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. There was an infection control policy in place and staff had received training in this.

Staffing levels reflected the needs of people using the service and visits were appropriately scheduled to meet people’s needs. Staff received regular supervision and appraisals.

The service had carried out an extensive service user quality project to ensure that the service was performing to a high standard. This included collating feedback and survey information. People and their relatives told us that they felt staff w

This was an unannounced inspection which we carried out on 24 July, 27 July, 24 August and 29 September 2017. We last inspected Westhome care Services in July 2016 where we found breaches had been complied with but further improvements were required.

At this inspection we found some improvements had been made but other improvements were required specifically around record keeping, infection control and monitoring systems to ensure people received safe, reliable and effective care.

Westhome Care Services is a domiciliary care agency providing care and support to people in their own home. The agency provides 24 hour personal care and support to some people with complex support needs. It is registered to deliver personal care. At the time of inspection approximately 86 people were being supported.

A registered manager was in place. 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 did not always receive safe care and support. Several people told us their visits were sometimes late or missed. People and their relatives told us they did not feel protected with the infection control measures followed by the care workers. Staff had received training about safeguarding and knew how to respond to any allegation of abuse. Appropriate vetting procedures were carried out for all staff before they began working with people. However, we have made a recommendation the provider promote equal opportunities and follows best practice with regard to recruitment. Risk assessments were in place that accurately identified current risks to the person.

Staff told us communication was sometimes effective to ensure any changes in people’s care and support needs were met. However, people who used the service and relatives told us communication with the main office needed to be improved.

People told us staff were kind and caring. Most staff knew people’s care and support needs, however systems were not all in place to ensure staff delivered appropriate care that met people's needs. Records did not all reflect the care provided by staff.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe way. Staff helped ensure people who used the service had food and drink to meet their needs.

Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

Staff received opportunities for training to meet peoples’ care needs. A system was in place for staff to receive supervision and appraisal. Processes were in place to manage and respond to complaints and concerns. People were aware of how to make a complaint should they need to. People told us the management team and staff were approachable. They told us they were asked their views about the service they received.

Improvements had been made to the quality assurance system but more improvements were needed to ensure it was robust. The audits used to assess the quality of the service provided were not effective as they had not identified the issues that we found during the inspection.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This related to safe care and treatment, person-centred care and good governance. You can see what action we told the provider to take at the back of the ful

We inspected Westhome Care Services Limited on 16 March, 12 and 13 April, 26 April 2016, the inspection was announced with a short notice period of 24 hours given to the registered provider.

We previously carried out an announced comprehensive inspection of the service on 18, 23 and 25 September 2015. Breaches of legal requirements were found. After this comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulations 9, 13, 16, 17, 18 and 19.

We undertook this inspection to check that they had followed their plan and that they now met legal requirements. During this inspection we found that the registered provider had implemented these actions and that some improvements had been made.

Westhome Care Services Limited is a domiciliary care service registered to provide the regulated activity of personal care. At the time of our inspection they were providing personal care and support to 71 people who lived in their own homes.

The registered manager had been registered with us since 3 March 2016. 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.

Consent to care and treatment was not always sought in line with the Mental Capacity Act 2005 and the Code of Practice. The service did not explore the conditions attached to lasting power of attorneys to ensure that they acted in accordance with decisions made lawfully, and in the best interests of people who used the service. We have made a recommendation about this.

Staff were aware of the actions they should take to report safeguarding incidents. Following investigations remedial actions were not always risk assessed and adequate controls were not always put in place to effectively protect people from the risk associated with potential abuse or neglect reoccurring.

Staff were not provided with the appropriate information or systems to enable them to safely administer medication within a community setting. This included medication that was administered only ‘when required’.

There was an effective recruitment process in place for care staff. This included safe and appropriate checks being carried out to verify that staff were suitable to deliver care to vulnerable people. All care staff had received an induction. People told us that they felt that staff had the necessary skills and knowledge to carry out their roles and deliver effective care and support. Training requirements and completion had much improved since our last inspection. Staff had undertaken specific training in relation to particular health conditions to enhance the delivery of care to people. Staff received regular supervision and an annual appraisal to support and develop them in their role.

Risk assessments were carried out following assessment of people's needs to ensure safe delivery of care and support. People had their nutritional needs assessed and where appropriate were supported to have sufficient to eat and drink. This took into account people's assessed needs, preferences, likes and dislikes.

Positive and caring relationships were developed with people who used the service. The service had a stable staff team who were mostly allocated permanent rotas which promoted continuity of care. This meant that staff were able to build relationships with people who used the service.

From our observations we saw staff spoke with people over the telephone using a manner that was gentle and compassionate. We observed that staff were respectful in their manner and responded promptly to queries. People we spoke with, and their relatives, spoke positively about the service at the time of this inspection.

Some people who used the service told us that they w

This inspection took place on 18, 23 and 25 September 2015 and was announced. We last inspected the service on 13 August 2013. We found they were meeting all the legal requirements we inspected against.

Westhome Care Services Limited provides personal care for people living in their own homes. At the time of the inspection they were supporting 131 people (some of whom were living with dementia) living across Sunderland and South Tyneside.

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.

Medicine administration records were not always completed. This meant that it was not always possible to see whether medicines had been administered. People’s care plans did not list their medicines. It was not always clear from the plans what kind of support they needed with their medicines. There was no guidance for staff to follow when supporting people with ‘when required’ medicines.

Risks to people’s health were not always fully assessed. Some care plans referred to people’s particular health needs but did not set out how they should be mitigated. Where risks were identified for staff to monitor, there was no evidence that this was being done. We did not see any evidence of initial moving and handling assessments being completed.

There was no safeguarding policy in place. It was not clear how people were made aware of how to report possible concerns. Staff were trained in safeguarding and had a good working knowledge of possible types of abuse and how to respond. Safeguarding incidents were investigated and action plans were created but it was not always clear that remedial action had been taken.

The recruitment policy specified that staff had to obtain a Disclosure and Barring Service (DBS) check and provide two references before beginning work. We saw that staff started before these were in place. When staff started in post prior to receipt of satisfactory employment checks, they were always supervised or risk assessed.

People told us that there were enough staff employed to support them. There was not always continuity of staff and they were sometimes late. People said that when appointments were missed or staff were running late communication from the service was poor. Staff told us that they had enough time to support people.

Staff received mandatory training in areas such as moving and handling, emergency first aid, infection control and safeguarding. We saw that some staff were overdue mandatory training or had never completed it. Staff did not receive training in specialist areas of care, such as pressure care or skin integrity.

The service had a policy of annual appraisals and supervisions of staff every four months. We saw that staff did not always receive them. Where supervisions had taken place and staff had raised an issue remedial action was not always taken. Staff told us that they felt confident to raise issues with management.

People said they felt supported with their food and nutrition. Where people had specialist dietary requirements these were recorded, but we saw that they were not always acted on.

There was no evidence that capacity assessments had taken place or any formal record of decisions being made in people’s best interest.

Some people’s care plans showed that they were receiving support in specialist areas from external professionals such as occupational therapists. However, some people with the same support needs had not been referred to such professionals.

People told us that not all staff were caring. They told us that they were often supported by staff they had not met before, which made them feel that staff did not know them or how to support them. People said that when appointments were missed or staff were running late communication from the service was poor.

Care plans were not always written in a person-centred way. It was not always clear from care plans what level of support people needed or had requested. Not all care plans contained information about people’s background or personal preferences.

The service had a complaints policy, but this only related to written complaints. There were no records to show that investigations of complaints occurred or remedial action taken. Where people told us that they had raised concerns with the service this had not been recorded.

Audits of care plans relied on people, some of whom were living with dementia, filling in a questionnaire to tell the service that their support needs had changed. People were supposed to be sent a questionnaire twice a year, but we saw that some people’s audit questionnaires were overdue.

We were told that staff meetings took place but that the last one was held in June 2014. It was not clear how the service sought feedback from staff who had not received supervisions or appraisals, or how any feedback given was used to improve the service.

The registered manager did not always understand their responsibilities to make notifications to the CQC. We saw that we had not been told about some relevant matters.

You can see what action we told the provider to take at the back of the full version of the report.

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.