The inspection of the office location took place on 10 February 2017. On 28 February 2017 we visited people in their own homes to receive face to face feedback on the service they received On 16 March 2017 we contacted people and relatives for feedback about the service they received. Wilnash Care Limited provides personal care and support to people living in their own homes. There were 32 people being supported by the service at the time of our inspection.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

When we last inspected the service on 5 August 2016 we found breaches of regulations 9, 10, 12, 16, 17 & 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to manage people’s medicines safely, there was insufficient care planning in place to ensure people’s individual needs were being met, people’s dignity was not always respected or maintained, the staff team were not provided with support or supervision to ensure they were able to meet people’s specific health needs. The provider’s governance and monitoring systems had failed to identify and address concerns about the lack of training for staff to meet people’s specific health conditions. We took action using our regulatory powers and urgently imposed a restriction to ensure Wilnash Care Limited took no further admissions, and sought urgent assurances to ensure people were kept safe. We also placed the service in Special Measures and kept the service under review along with referring our findings to the local authorities safeguarding and commissioning teams.

Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements and therefore improved the quality of the service provided at Wilnash Care Limited.

At this inspection we found that the service had significantly improved. People told us they received care and support that met their individual needs. People were involved in the development, planning and review of their care.

Staff knew people well and treated them with dignity and respect. Care plans were personalised and contained detailed information about people’s support needs and risk assessments were detailed and specific providing staff with all relevant information to ensure risks were both identified and mitigated where possible. Staff knew how to recognise and respond to any allegations of abuse. Medicines were managed safely.

People were supported by sufficient numbers of staff and these were recruited through a robust process which helped ensure staff were suited for the roles they performed. Staff were inducted and received on-going training and support. Staff had individual supervisions, team meetings and regular contact with office staff to share good practice and discuss any concerns.

People were supported to make their own decisions, and to retain where possible everyday living skills and abilities and their choices were respected. Their views were obtained through a variety of communication feedback methods and people’s views were taken into account.

The service demonstrated they had systems and processes in place to monitor and improve the service to achieve a consistently good standard of care and support for everyone who used the service. There was a call monitoring system in place and spot checks were carried which ensured visits to people were provided at the agreed times.

This inspection took place on the 5, 8, 9 and 16 of August 2016 and was announced. The provider was given 48 hours’ notice of the inspection because we needed to ensure that somebody would be available to meet us in their offices.

Wilnash Care Ltd is a domiciliary care service providing care and support to 36 people in their own homes. At the time of our inspection there were 32 people using the service.

The service had not had a registered manager in post for two years prior to our inspection. 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 were left at risk of receiving care and support that was unsafe and did not meet their needs. There were not enough staff deployed by the service to meet people’s needs. Calls requiring two care workers were routinely attended by a single member of staff, which left people at risk of not being moved correctly. There was insufficient monitoring of call times to identify patterns or trends that may have impacted on the quality of care that people received. People’s medicines were not managed or accounted for correctly and changes to medicines were not identified and included in people’s care plans. Risk assessments were not detailed enough to adequately capture risks to people or control measures to minimise these.

Some staff did not have valid employment references on their files. Existing staff did not receive regular supervision nor appraisal of their performance, training or development needs. While staff had received an induction and some training, this was not regularly refreshed or updated, and there was no system in place to monitor this or plan a schedule to train staff in the future. Not all staff understood the correct way to safeguard people or what constituted a safeguarding incident. There was no training provided to help staff to understand the Mental Capacity Act (2005) and people’s care plans did not include any information in relation to their capacity to make and understand decisions about their care and support. While there was some evidence of consent in place, relatives had sometimes consented on people’s behalf without an assessment of the person’s capacity to make their own decisions or a decision made in the person’s best interest that the relative should give consent.

The service did not adequately identify people’s needs in relation to nutrition and hydration. There was limited information available in people’s care plans to help staff understand the foods and drinks that were appropriate for them. There was some evidence that support was being sought from external healthcare professionals as necessary.

People told us that staff were kind and caring, and staff had developed positive relationships with people. However there was not always enough information in people’s care plans to provide staff with adequate knowledge of the person. Some people felt treated with dignity and respect, but others told us this was not always observed. People’s care plans did not fully reflect the extent of people’s needs, and were not always reviewed if the person’s needs changed. There was limited evidence of involvement from people or relatives in reviews of people’s needs.

The provider’s complaints policy was out of date and included incorrect information about how to make a complaint. The service did not record or monitor all complaints and the response to complaints was inadequate.

There was no registered manager in post and no application to register a manager had been made since the previous one had left two years previously. While people, relatives and staff were positive about the support provided by the manager of the service, there was inadequate governance and oversigh

We carried out a follow up compliance inspection visit to this service on 23 April 2013. We reviewed records and care plans for people who used the service. We looked at staff files, recruitment and training records and spoke to staff who worked in the service.

We looked at quality monitoring data and the system for managing and recording complaints. We reviewed the providers safeguarding policy and arrangements for processing any safeguarding concerns or alerts.

We reviewed staff support systems and spoke to staff about their roles and responsibilities within the organisation.

We talked to office based staff about how the provider had implemented systems and processes to ensure sustained compliance with the regulations, we also made observations during our visit about how staff interacted with each other and how they went about their business in a clearly defined role.

Staff also told us that things were working much better and everybody was clear now about their roles and responsibilities and there was a robust structure from which they could rebuild the business. The managers told us they spent more time 'managing the service in a proactive way' as opposed to the way the service had previously been managed by reacting to and dealing with incidents as they occurred. We found evidence to show that the service was structured to deliver good quality care and support in a planned way. The service was meeting all the standards we reviewed during our visit.

People who used this service told us they were generally happy with the standard of care they received, although they said communication could be better because they were not always told about changes to the times of their visits, or if a new care worker would be attending.

We also found some concerns about the way in which visits had been allocated to the care staff.

The rotas indicated that multiple visits had often been allocated to a care worker within the same short time interval: for example, records showed that one care worker had been scheduled to attend three people between 12.30pm and 1pm. This meant that people’s visit times had had to be moved, and they had not always been notified of the changes.

On several occasions, people who use the service had cancelled visits because they could not be provided at the times stated in the care plan. This meant that people had not always received the care that they had been assessed as needing.

Other people who use this service said that the staff were very nice and helped as much as they could. One person said that the staff went out of their way to assist them.

The inspection team was made up of two inspectors. We set out to answer our five questions; 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 our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

We saw evidence that risk assessments had been undertaken to help minimise the risk to people living in their own homes. The agency had a complaints policy and procedure in place, which was user friendly. A copy of the complaints procedure was available to people who used the service.

Is the service effective?

We found that people had an assessment of their needs carried out and staff had ensured that the identified needs had been met. Each person had a care package agreed by the individual, their relatives, the service and social services where appropriate. We saw evidence in people’s daily records how people had been cared for and supported during the home visits.

We looked at a sample of the agency’s call monitoring system and we were able to see that the majority of home visits were made within the agreed time.

Is the service caring?

We spoke with some people who used the service on 26 June 2014, 27 June 2014 and 1 July 2014. People we spoke with confirmed that staff were caring and very supportive. One person we spoke with said when speaking of staff “They are splendid.” Another person said “The carers are brilliant.”

Is the service responsive?

We found that the care plans had been reviewed regularly and any changes in people’s care needs had been reflected so that up to date information was available to staff. This ensured that people’s needs were met appropriately.

We noted that although staff had regularly supervision, the agency did not held regular staff meetings to ensure that information regarding changes which affected the agency and the people who used the service were cascaded to all staff.

Is the service well-led?

People expressed their satisfaction with the service they received.

The agency has a registered manager but we were told on the day of our inspection that the registered manager was inactive. The deputy manager had assumed the responsibilities which were held by the registered manager. The staff members we spoke with told us that they felt supported by the management team and that they were able to discuss any concerns they may have.

We looked at the agency’s financial accounts and we found that the agency was financially viable and had additional funds in place to deal with unexpected emergencies.

We looked at the agency’s statement of purpose and we found that it had not been updated with their current address. We also found that the statement of purpose did not provide clear information on how and where people who use the service can escalate a complaint.

We have asked the provider to tell us how they will become compliant with the regulation which relates to the statement of purpose.