Community Care Worker Limited

About the service

Community Care Worker is a domiciliary care agency providing the regulated activity of personal care to people living in their own home. The service provides support to older persons and people living with dementia. The service can also support people with physical disabilities, learning disabilities, autism and/or mental health needs. At the time of our inspection there were 48 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

The processes in place to keep people safe had improved since the last inspection. Risks to people’s safety were being considered and the majority of concerns found at the last inspection had been addressed. For example, there was now a process in place to monitor people’s skin integrity.

Improvements had been made to call times and we received no reports of missed calls. Some people reported call times were not always exact. However, we found the majority of the calls deemed late, were within the thresholds set by the local authority. People received more consistent staff support and staff now worked within specific geographical areas which they told us was much better. Processes were in place to ensure medicine errors were investigated and lessons were learnt when things went wrong.

People were supported by sufficient staff who had been recruited following receipt of satisfactory references and Disclosure and Barring Service (DBS) checks. We discussed the recruitment records with the provider and recommended any preliminary recruitment activities were also recorded to ensure there was a complete timeline of events. For example, telephone conversations. Staff were knowledgeable on infection control and had access to personal protective equipment (PPE).

Staff told us they received regular training, but staff were completing a lot of training in one day. Although the provider gave further assurances regarding how training was managed, we recommended the provider took steps to ensure all learning was recorded and it was clear when staff had been assessed as competent.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s care needs were assessed. People were supported with mealtimes and referred to health services, if needed.

The provider had improved the governance of the service and involved other agencies in driving improvements. The staff team engaged well with people, although a number of people told us there was an occasional language barrier, especially with new staff but all staff were polite. The provider engaged with people to gather their feedback. However not all persons felt they have been contacted. We recommended the provider engage with everyone to ensure their feedback can be gathered and acted upon as necessary.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the last inspection staff told us they had received training in learning disabilities and autism but did not feel confident. At the time of this inspection, the location did not support anyone with a learning disability or an autistic person. We will revisit this area on our next inspection to ensure the service is meeting the principles of Right Support, Right Care, Right Culture.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 20 September 2022).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 24 September 2021. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Care Worker on our website at www.cqc.org.uk.

Recommendations

We have recommended the provider ensures their training records and recruitment records are reviewed to ensure all relevant information is being recorded. We have also recommended all people who use the service are engaged in the quality monitoring process to ensure their feedback is gathered and actions can be taken as needed.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Community Care Worker Limited is a domiciliary care service that provides personal care to people living in their own homes. At the time of our inspection, the service was providing personal care support to 76 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

This was a targeted inspection that considered the safe administration and recording of medicines. Based on our inspection of medicines management we found people did not always receive their medicines as they were prescribed. People did not always receive their medicines in line with safe practice guidance. People did not always receive their time specific medicines at the correct time. People did not always have accurate guidance in their medicines records to support staff to administer their medicines safely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was inadequate (published 29 September 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the management of medicines. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Care Worker Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a continued breach in relation to the safe management of medicines at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Community Care Worker Limited is a domiciliary care service that provides personal care to people living in their own homes. At the time of our inspection, the service was providing personal care support to 101 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People did not always receive safe care. People were placed at risk because staff did not always stay for the full call duration and risks associated with their care were not always identified and planned for. People’s medicines were not managed safely. People were not always protected against the risk of infection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Although records showed staff had received training, this had not given them the skills or knowledge needed and this was reflected by what people, relatives and staff told us. Staff did not always feel confident in their role and did not always demonstrate they had learnt from their training. People’s care plans did not include all the information staff needed to be able to support them safely or in the way they wanted.

There was a continued lack of provider oversight of the service to ensure it was being managed safely and in line with current good practice. Quality systems had not identified concerns, errors and contradictory information in care records. An open culture was not embedded at the service and people and their relatives did not always feel well treated and listened to.

Lessons were able to be learnt through incidents which had happened, although further improvement was needed to ensure this was reflected across the whole service.

The provider had worked with other health professionals to deliver people’s care however, the recording of these contacts needed improvement.

Throughout our inspection we received mixed feedback from people, relatives and staff. When people had regular care staff, they considered the service they received to be good. Some people felt some staff are excellent, however some people gave us negative feedback about staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 28 September 2021).

At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 July 2021. Breaches of legal requirements were found. We imposed conditions onto the provider’s registration following that inspection to require them to send us monthly report of actions.

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Care Worker Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding people, safe care and treatment, management of medicines, staff training, consent and the oversight of the quality and safety of care to people.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Community Care Worker Limited is a domiciliary care service that provides personal care to people living in their own homes. At the time of our inspection the service was providing personal care support to approximately 180 people. This number could only be approximated as the provider was unclear about how many people they supported with personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service

People were not always kept safe as safeguarding concerns were not always acted upon or reported to the local safeguarding authority. There were not enough staff available to cover all calls so some people experienced missed calls. People had been left at risk as a result of some missed calls. Medicines were not always managed safely. The provider had not followed government guidance about the COVID-19 testing for staff.

There was ineffective oversight of the quality and safety of people’s care and support. Quality assurance systems were not effective at identifying concerns and acting upon these. The provider had poor oversight of staff roles and responsibilities. People, relatives and staff had concerns about poor communication with the office. The provider had not always worked in partnership with other organisations. Notifications were not always submitted as necessary.

Staff did not always have enough training to feel confident in their role. One staff member was sent out to administer medicine without training which put people at risk. People did not always have access to other health professionals when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, some people’s capacity assessments could be more robust.

Staff were following guidance about personal protective equipment and wearing these whilst in calls. People were supported to access food and fluids when this was needed as part of their care. The previous inspection rating was being displayed as necessary.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 9 April 2021).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, alleged poor moving and handling, missed visits and lack of consistency of staff. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we decided to look at effective also.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Care Worker Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the oversight of the quality and safety of care to people, safeguarding people, staffing levels and the training for staff, safe care and treatment and the management of medicines at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Community Care Worker Limited is a domiciliary care service supporting people with personal care in their

own homes. The service was supporting 112 people at the time of our inspection. Younger and older people

had support needs such as physical and sensory impairments, learning disabilities, dementia or mental

health needs.

Not everyone who used the service received personal care. CQC only inspects where people

receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also

consider any wider social care provided.

People’s experience of using this service and what we found

People’s needs were assessed, planned and reviewed to ensure they received support that met their changing needs. Staff managed people’s risk assessments and care plans to ensure people received person-centred support.

There were a range of audits in place that the registered manager undertook. However, these did not always identify where ‘as required’ medication protocols were not in place. Other medicines were managed safely.

All accidents and incidents and medicines errors were recorded and reviewed by the registered manager, where trends and a root cause analysis were undertaken.

The registered manager had an effective system to ensure that staff received appropriate training. Staff worked in partnership with professionals from health and social care organisations to meet people’s needs. People’s files and care plans contained evidence of safeguarding referrals.

Effective systems were in place to ensure staff were recruited safely at the service. People told us that staff wore PPE (personal protective equipment) when coming into their homes.

There were effective management systems in place, with a clear staffing structure. The service had formed good working relationships with social workers and the local authority.

Rating at last inspection and update:

The rating at the last inspection was requires improvement (report was published on 20 February 2020). You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Community Care Worker Limited on our website at www.cqc.org.uk.

Why we inspected

We received concerns in relation to people's care and how the service was promoting people's

safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the safe key question.

The ratings from the previous comprehensive inspection for those key questions not looked at on this

occasion were used in calculating the overall rating at this inspection. The overall rating for the service has

changed to good. We did not inspect effective, caring and responsive due to us wanting to limit ourselves and spend the least amount of time at the premises.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Community Care Worker Limited is a domiciliary care service supporting people with personal care in their own homes. The service was supporting 58 people at the time of our inspection. Younger and older people had support needs such as physical and sensory impairments, learning disabilities, dementia or mental health needs. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Systems to monitor the and improve the quality of care had improved, however, these were still not fully effective at identifying all concerns and had not fully embedded into custom and practice.

Medicines management required improvement to ensure people’s medicines were always safely managed. Risks to people were not always assessed and planned for, although improvements were made following our feedback. Lessons were learned when things went wrong, although systems required strengthening to ensure all issues were identified. Staff were recruited safely, although checks could be more robust.

People were protected from the risk of abuse by staff who understood their responsibilities and knew to report concerns; appropriate referrals had been made. People were protected from cross infection as staff used appropriate personal protective equipment. People were supported by enough staff.

People had access to other health professionals when necessary. People’s health conditions were recorded in their plans. Staff received training to be effective in their role and felt supported. People were appropriately supported with their food and drinks. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Documentation required strengthening to ensure it was clear why people were not signing their own consent to their care and support.

People were supported by a kind and caring staff team. People’s dignity was maintained, and they were supported to remain as independent as possible. People’s protected characteristics were taken into account and people were involved in decisions about their care.

No one was being supported with end of life care, but action was being taken to ensure the service was able to effectively support people should the time come. People had personalised care plans in place and were supported in a way they liked. People felt confident and well supported by their regular staff. People were supported to communicate in a way that suited them. People and relatives felt able to raise concerns and these were investigated and responded to.

The previous rating was being displayed and notifications were submitted as required. People were asked their opinion about the service and people had given positive feedback. Staff had their competency checked and the service was on a learning and improvement journey with the support of an external consultant. Staff felt supported by management. The provider and care manager were aware of their responsibilities regarding duty of candour. The service worked in partnership with other organisations and there were future plans to expand this.

Rating at last inspection

The last rating for this service was requires improvement overall, with inadequate in well-led (9 July 2019). There was previously a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to poor oversight of the service and a failure to improve enough following previous inspections. At this inspection we found the service was no longer in breach.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Community Care Worker Limited is a domiciliary care service that was providing personal care to 56 people living in their own homes at the time of the inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. People had a range of support needs such as people living with dementia or those who needed support with their mental health, older and younger adults, people with a learning disability and a physical and/or sensory impairment.

People’s experience of using this service

People had experienced less-than-good care over a period of five consecutive inspections. Systems were not embedded or were not always effective at identifying omissions and monitoring trends. Staff training was not monitored effectively. Some improvements had been made and further were planned however, this had not yet resulted in people consistently receiving good care.

Staff recruitment had improved so they were recruited safely, however we found not all double up calls were attended by two staff at the same time according to rotas. People were not always protected from infection control risks. Risks assessments were inconsistent; some were in place and detailed, whereas other were not. The management of medicines were not always safe as some creams were being applied that were not prescribed and some guidance was missing for staff.

There was mixed feedback about staff training and some staff felt it could be improved. People were supported to access other health professionals, but improvements were needed to the information available to staff about people’s specific health conditions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Following our feedback, improvements were made to the service checking on people’s legal right to make decisions on other people’s behalf. People were supported with their diet and nutrition.

There had been some instances of staff discussing inappropriate topics when in people’s homes. People were not always involved in decisions about their care. However, people overall felt treated with dignity and respect. People told us they were supported to remain independent and had their privacy maintained.

There was mixed feedback about people’s preferences being understood by staff as the staff team could change so people did not always have regular staff. There was mixed feedback about the response to feedback. No one was receiving support for end of life care, however how people would be supported had been considered by the registered manager.

The service worked in partnership with other organisations. People and staff were engaged in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 December 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections. At this inspection not enough improvement had been made or sustained and the provider was still in breach of a regulation.

Why we inspected

The inspection was prompted due to concerns received about poor quality care. We have found evidence that the provider needs to make improvements. Please see the full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified a breach in relation to the provider failing to make sufficient improvements to achieve an overall good rating and systems not always being effective at identifying areas for improvement. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. This is because the provider has failed to achieve an overall good rating in five consecutive inspections. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to older adults and younger adults who have a physical or learning disability. At the time of the inspection there were 20 people receiving a service of personal care within their own homes.

Not everyone using Community Care Worker 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.

There was a registered manager at the service who is also the provider. 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.

There was a lack of structure and organisation within the service, which impacted on the monitoring of some people’s care and led to breaches in regulations. Improvements at the service had not been acted on in a timely manner to ensure regulations were met and lessons had not been learnt when things went wrong.

Staff felt the registered manager was not always approachable and did not always listen to them when they raised concerns.

Records were not stored securely and improvements were needed to ensure records were accurate and accessible in the absence of the registered person.

The provider was not meeting the conditions of their registration because they were storing documents at an unregistered address.

The provider had not made the necessary improvements since the last inspection to ensure staff were consistently recruited safely.

Improvements were needed to ensure actions in place as a result of complaints were recorded in care records for staff to follow.

Staff were aware of their responsibilities to protect people from the risk of harm. Staff knew people’s risks and supported them to remain as independent as possible whilst protecting their safety.

There were enough staff available to meet people’s needs in a timely way. Medicines were managed safely and infection control measures were in place to protect people from the potential risk of cross infection.

People’s cultural and diverse needs were planned for to enable a fully individualised care provision that met people’s preferences.

The provider was following the principles of the Mental Capacity Act 2005. This meant that people were receiving care that was in their best interests. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s care was reviewed. However, this information had not always been included in people’s records to ensure they received care that met their changing needs.

Staff received training to carry out their role effectively.

People were supported to eat and drink sufficient amounts and nutritional risks were assessed and monitored.

People’s health was monitored and health professionals input was sought where needed.

People were supported by kind and caring staff who ensured people’s dignity was maintained and their right to privacy was upheld.

People’s choices were promoted and respected by staff in a way that promoted people’s individual communication needs.

People received care from a consistent staff group which met their individual needs and preferences.

People and relatives felt able to approach the registered manager.

Feedback about the quality of care had been gained from people and checks on staff performance had been completed to ensure people were receiving the care required.

We found there was a breach in regulation 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. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this inspection, we identified Regulatory Breaches. You can see what action we told the provider to take at the back of the full version of the report.

The service is registered to provide personal care to people in their own homes. At the time of our inspection eight people were in receipt of personal care from the service.

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 and associated Regulations about how the service is run.

Safe recruitment systems were not in place to ensure that staff were suitable to work at the service.

Incidents of potential abuse and neglect were not always reported to the local safeguarding team in accordance with local and national guidance.

Action was not always taken in response to safety incidents to reduce the risk of further incidents occurring. Health and medical advice was not always sought in response to significant safety incidents.

People did not always receive their care at the agreed time as travel time between calls was not always accurately planned for.

The systems used to assess and monitor the quality of care were not always effective in identifying improvements needed.

People received their medicines as prescribed. However, improvements were needed to the way that medicines administration was recorded.

People’s ability to consent to their care was assessed and consent to care was gained. Staff knew how to meet the requirements of the Mental Capacity Act 2005 in the event that a person could no longer make decisions about their care.

Staff were trained to provide care and support and staff were supported by the registered manager to carry out their roles.

People were involved in the assessment, planning and review of their care and staff supported people in accordance with their care preferences. This included the support they received to eat and drink.

Staff promoted people’s privacy and dignity and people told us they were treated with kindness and respect.

Complaints were managed effectively to improve people’s care experiences.

People’s feedback about their care was regular sought to help assess the quality of care.

The registered manager and provider displayed their last inspection rating as required.

As a result of our last inspections, this provider was placed into special measures by CQC. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Community Care Worker Limited are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported four people in their own homes.

There was a registered manager at the service who was also the provider. 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’s risks had been planned for and staff knew how to support people safely. We found that some improvements were needed to ensure that all records contained up to date information about people’s risks.

Systems had been put in place to ensure that medicines were administered and managed safely. However, some further improvements were needed to ensure that there was detailed guidance for staff to follow when administering topical creams.

Improvements had been made to the systems in place to assess and monitor the quality of the service. However, some improvements were needed to ensure these were consistently effective and the monitoring of the service was sustained.

People were protected from the risk of abuse because staff understood their responsibilities and actions required to safeguard people from the risk of harm.

There were enough suitably trained staff available to meet people’s assessed needs. The provider had safe recruitment procedures in place and we found that required checks had been carried out on all staff to ensure that staff were suitable and of good character to provide care to people who used the service.

People had been asked to provide feedback about the quality of service they received. Where people had given feedback this had been recorded and acted upon by the registered manager.

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 .

Community Care Worker Limited are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported five people in their own homes.

There was a registered manager at the service who was also the provider. 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’s risks had not always been planned or managed to keep people safe. Records gave inconsistent accounts of people’s risks and how staff needed to support people to reduce their risks.

Effective systems were not in place to ensure that medicines were administered and managed safely.

Improvements had been made to the systems in place to assess and monitor the quality of the service. However, these were not effective and the concerns we raised at the inspection had not been identified by the registered manager. Risks had not always been mitigated to ensure people were receiving safe care.

People and their relatives were involved in the planning of their care and some improvements had been made to show people’s preferences in how they received their care.

Reviews of people’s care needs had been carried out. However, further improvements were needed to ensure that people’s changing needs were updated.

People were protected from the risk of abuse because staff understood their responsibilities and actions required to safeguard people from the risk of harm.

There were enough suitably trained staff available to meet people’s assessed needs. Staff had received training to help them carry out their role effectively.

The provider had safe recruitment procedures in place and we found that required checks had been carried out on all staff to ensure that staff were suitable and of good character to provide care to people who used the service.

We found that people had consented to their care and where they were unable to consent there had been mental capacity assessments carried out to ensure that decisions were made in their best interests. Staff and the provider understood their responsibilities under the Mental Capacity Act 2005.

People were supported to access other health professionals to maintain their health and wellbeing.

People told us that staff treated them in a caring way and showed dignity and respect when they provided support. Choices were promoted and people were able to choose how they received their care in a way that met their preferences.

Improvements had been made to the way the provider handled and responded to complaints that had been made by people who used the service and their relatives.

People had been asked to provide feedback about the quality of service they received. Where people had given feedback this had been recorded and acted upon by the registered manager.

We identified 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.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009. 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 .

Community Care Worker Limited are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported 14 people in their own homes.

There was a registered manager at the service who was also the provider. 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 not protected from the risk of harm because staff did not understand their responsibilities and actions required to safeguard people from the risk of abuse.

People’s risks had not been assessed or monitored effectively to keep people safe. Staff did not give consistent accounts of people’s risks and how these needed to be managed to keep them safe.

The provider did not have a system in place to monitor incidents and accidents to lower risks and ensure that people were protected from the risk of further occurrences.

There were not enough staff available to meet people’s assessed needs. The provider did not have an effective system in place to monitor the staffing levels against the needs of people who used the service.

The provider had unsafe recruitment procedures and we found that the required checks had not been carried out on all staff to ensure that staff were suitable and of good character to provide care to people who used the service.

Systems were not in place to ensure that medicines were managed safely and in a way that they had been prescribed.

Staff had received some training before they provided care but we found that they had not received training in important areas such as; The Mental Capacity Act 2005 and staff had limited knowledge about safeguarding people from harm and how to support people who displayed behaviour that challenged.

We found that people had not consented to their care and where they were unable to consent there had been no mental capacity assessments carried out to ensure that decisions were made in their best interests. Staff and the provider did not understand their responsibilities under the Mental Capacity Act 2005.

We found that there was no evidence that other health and social care professionals were contacted when people’s health and wellbeing had deteriorated.

People and their relatives had not been involved in the planning of their care. We found that people’s preferences in care had not been considered or acted upon to ensure people received the care they wanted at a time they wanted it.

The provider did not have an effective system in place to handle and respond to complaints that had been made by people who used the service and their relatives.

People had not been asked to provide feedback about the quality of service they received. Where people had given feedback this had not been recorded or acted upon by the registered manager and the provider.

The provider had no systems in place to assess and monitor the quality of the service and the concerns we raised at the inspection had not been identified. Risks had not been mitigated to ensure people were receiving safe, effective and responsive care.

Some people told us that staff treated them in a caring way and showed dignity and respect when they provided support. However, some people told us that their dignity had not been respected and people’s choices were not always listened to or acted upon to ensure that they had control over the care they received or at a time that they needed it.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.