Oasis Private Care Limited

Oasis Private Care is a domiciliary care service providing personal care. The service provides support to people in their own homes. At the time of our inspection there were 35 people using the service and receiving support with personal care.

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

People, and their relatives were aware of who the registered manager was and found the office team approachable, supportive and that communication was good. Most staff told us the registered manager was supportive when approached. However, one staff member felt they were bullied and intimidated at work.

The service did not always notify CQC about reportable events. A notification is information about important events which the provider is required to send us by law.

People told us staff were always punctual and that they had not experienced any missed visits. Some staff told us short travel times meant they were sometimes late. Systems to monitor late or missed visits were not always effective or accurate.

Systems to monitor the quality of the service were in place. Action plans were used to improve the service. Outside consultants were used to audit processes and procedures and we saw the registered manager used the results to drive improvements. However, these systems did not identify our concerns relating to notifications.

People were kept safe from abuse and harm, and staff knew how to report any suspicions concerning abuse. The service had systems to report and investigate concerns. Risk assessments identified how potential risks should be managed to reduce the likelihood of people experiencing harm. Staff we spoke with understood the risks to people and delivered safe care in accordance with people's support plans and knew how to seek guidance if needed. Some staff told us there were not always enough staff to keep people safe and meet their needs.

People felt they were treated with kindness and spoke very positively about staff. Staff recruitment checks including criminal checks with the Disclosure and Barring Service were carried out to ensure people were protected from being supported by unsuitable staff.

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

Why we inspected

The inspection was prompted in part due to concerns received about missed visits, poor communication and a failure to report notable events to CQC. A decision was made for us to inspect and examine those risks. This was a planned focused inspection of the service.

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have identified a breach in relation to Regulation 18 Care Quality Commission (Registration) Regulations 2009 (Good Governance) at this inspection.

You can see what action we have asked the provider to take at the end of this full 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.

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

Follow up

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

Oasis Private Care Limited is a domiciliary care service providing personal care to people living in their own homes.

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 were protected from the risk of harm by staff who understood their responsibilities to report

concerns. Improvements had been made to risk assessments and risks to people were managed effectively. There were systems in place to ensure people received their care calls as needed and minimised the risk of missed visits. Medicines were managed safely. There were processes in place to enable the provider to make safer recruitment decisions.

Care plans had improved and provided detailed guidance for staff in how to meet people’s needs. Care plans were person-centred and reflected people’s choices. Staff regularly reviewed people’s needs to ensure they were providing the right support. The provider had a complaints policy and procedure in place and people were confident to raise concerns.

There were effective systems in place to monitor and improve the service. These systems had been introduced since the last inspection and due to the previous concerns around the effectiveness of management systems we needed to be sure the improvements could be sustained. We received positive feedback about the management of the service. The registered manager had made links with outside agencies to improve their skills and knowledge.

People were supported by staff who had the skills and knowledge to meet their needs. Care plans reflected current guidance and standards. Care plans identified people’s dietary needs and how these were met. People were supported to access health and social care professionals when required.

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 were supported by staff who were kind and caring. Staff treated people with dignity and respect and their privacy was protected. People were involved in all aspects of their care and staff respected their choices. People were encouraged to maintain their independence.

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 24 January 2019). The provider has sent monthly reports to CQC to evidence their improvement. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Since this rating was awarded the service has moved premises. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

This service has been in Special Measures since January 2018. 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

At our previous inspection in June 2018 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found some improvements had been made. However, we identified two continued breaches of the regulations.

Oasis Private Care Limited is a Domiciliary Care Agency (DCA) who provide personal care to people with a variety of needs living in their own homes. At the time of inspection, the service was delivering personal care to 16 people.

There was a registered manager in post who was also the registered 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 always kept safe because there were continuing issues with risk management at the service. Risk assessments did not always provide sufficient or accurate information to provide direction for staff, or information about how to reduce risks.

People’s care records were not always accurate and did not give clear guidance to staff on how to support people to meet their needs.

Staff understood their responsibilities to identify and report concerns related to harm or abuse. Medicines were managed safely. There were sufficient staff to meet people’s needs.

Staff treated people with kindness and compassion. People told us that they were treated with dignity and respect by caring staff.

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.

People were supported to access health care professionals to aid them to lead healthier lives. The service was responsive to people’s changing needs.

Staff were well supported through regular supervisions and felt listened to. Staff benefitted from training to ensure they had the skills and knowledge to meet people’s needs. People were positive about the knowledge of staff supporting them.

Although there were some systems in place to monitor the service these required further development to ensure they were effective in providing an overview of the service. This would enable the provider to identify areas of improvement.

Due to the continued breaches identified at this inspection we could not be sure the registered manager and provider fully understood their responsibilities in relation to their regulatory requirements.

At our inspection in January and June 2018 we rated the service inadequate overall. As a result, the service remained in special measures during this time. At this inspection in December 2018 we found the service had made some improvement but further improvements were needed. The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures' as well-led continues to be rated inadequate.

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.

Oasis Private Care Ltd. is a Domiciliary Care Agency (DCA) who provide personal care to people with a variety of needs living in their own homes. At the time of inspection, the service was delivering personal care to 19 people.

There was a registered manager in post who was also the registered 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.

At our inspection in September 2016 we found the service to be inadequate overall. As a result, the service was placed 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, it will be inspected again within six months.

We returned to inspect the service in February 2017 and found the service had made some improvements. However, it was rated as requires improvement as we could not be assured the improvements made were sustainable.

At our last inspection in January 2018 we found the service had not sustained the improvements and were rated inadequate in safe and well led. At that time the service was not meeting the regulations related to safeguarding service users from abuse and improper treatment, safe care and treatment, good governance, fit and proper person employed, person-centred care and notification of other incidents. The service was rated as inadequate overall. This resulted in the service being put back into special measures.

At this inspection in June 2018 we found the service had not made the necessary improvements.

People were not kept safe because there were continuing issues with risk management at the service. Risk assessments did not always provide sufficient information to provide direction for staff, or information about how to reduce risks. This breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People did not always have their visits on time. The registered provider did not have an effective system in place to assess or monitor missed or late visits to ensure they are meeting the care needs of people who use the service and to improve the quality and safety of the services provided in the carrying on of the regulated activity. This breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicine records where inaccurate and didn’t always include all medications currently prescribed for people. PRN (as required) medicines did not have any guidelines so staff did not have enough information on when or how to administer it. This breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered provider failed to inform others as appropriate about concerns or findings relating to a person’s fitness. This breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s care plans did not have sufficient and personalised guidance to enable staff to identify and respond to people’s needs and we could not be assured that people were always involved in the development of their care plans. This breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered manager failed to notify us of a reportable event in a reasonable timeframe. This breached the Regulation 18 of Care Quality Commission (Registration) Regulations 2009.

People told us that they were treated with dignity and respect.

There were sufficient staff to meet people’s needs.

People told us they had their nutrition and hydration needs met. Staff told us they monitored people’s nutrition and hydration.

People were happy with the care team that supported them.

Staff received an induction and ongoing training, to help them meet and understand the care needs of the people they supported. Staff said they felt supported in their roles.

The provider had not taken action following our last inspection and failed to identify and address concerns and breaches of regulatory requirements. This has led to risks to the quality of care and to people's health and wellbeing.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Regulation 18 of Care Quality Commission (Registration) Regulations 2009. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations have been concluded.

The overall rating for this service remains ‘inadequate’ and the service remains 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.

Oasis private Care Domiciliary Care Agency (DCA) provides personal care services to people in their own homes. At the time of our inspection 24 people were receiving a personal care service.

At our inspections in September 2015 we found the service was not well led and we rated the service as inadequate in well led. At our inspections in September 2016 we found that the service was inadequate in safe and well led. As a result we placed the service in special measures. Services in special measures are kept under review. We inspected Oasis private care again in February 2017. We found that the provider had made changes. However, due to concerns surrounding the sustainability of the improvements we rated the service as ‘requires improvement’. We found at this inspection the changes made had not been sustained by the registered manager.

People were not always protected from abuse and improper treatment. We asked people if they felt safe receiving care from Oasis private care. Although most people said they felt safe, comments made by people and their relatives indicated they were not always protected from abuse or improper treatment.

Systems designed to safeguard people were ineffective. There was an absence of effective systems to enable the provider to have an oversight of the quality of the service.

People were not always protected against the risks of associated with epilepsy. The registered manager and provider did not have an effective risk management process in place to manage medicines safely. The provider had recruitment procedures in place. However, these procedures were not always followed.

The service did not always support people in line with the principles of the Mental Capacity Act (2005). People had not always consented to care.

The system designed at recording and handling complaints was not effective. People were not always involved in developing and reviewing their own care plans.

People and their relatives gave a varied response when talking about the caring nature of staff. Relatives told us people were not always treated with dignity and respect.

The overall rating for this service is 'Inadequate' and the service is 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.”

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 (Registration) Regulations (2014). We are taking further action in relation to this provider and full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations have been concluded. In the interim we have asked for and received a plan from the provider telling us how they are going to address these concerns to inform our ongoing monitoring of this service.

Oasis private Care Domiciliary Care Agency (DCA) provides personal care services to people in their own homes. At the time of our inspection 16 people were receiving a personal care service.

We carried out an announced comprehensive inspection of this service on 18 May 2016. We found the provider was not meeting the legal requirements of four of the fundamental standards. After the comprehensive inspection, we took enforcement action and issued a warning notice to require the provider to meet the legal requirements of one of the fundamental standards. We also issued a notice that placed a restriction on admissions to the service.

At our previous inspection on 18 May 2016 we found that risks to people were not always managed safely. This is a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). We found the provider had not acted in accordance with the principles of the MCA and associated code of practice. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We found that staff training records were not always accurate. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not operate an effective system for dealing with complaints. This was a breach of Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.Records relating to peoples care were not always accurate or complete. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified that there were no systems in place for the registered manager to monitor and audit the service. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our previous inspection on 18 May 2016 we found that the service was still falling to report safeguarding incidents to the Care Quality Commission. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014). We took enforcement action and issued a warning notice. At this inspection we checked that they had met the legal requirements of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014).

Since our last inspection we found the service had made significant improvements to address these concerns.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager of the service had informed the CQC of reportable events.

Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe.

The registered manager and staff understood the Mental Capacity Act (MCA) 2005 and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

Records relating to peoples care were accurate and complete. The service was embedding systems to assess the quality of the service provided. The registered manager was able to identify how these new systems would support them in identifying and learning from the audits it would produce. This would promote people's safety and quality of life.

There was a complaints policy and procedure in place which had recently been reviewed. Details of how to complain were kept in people’s homes and people had been informed of the new policy and procedures.

People told us they were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training.

People received their medicines as prescribed. Records confirmed where people needed support with their medicines, they were supported by staff that had been appropriately trained.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. People told us and staffing rotas confirmed there were sufficient staff to meet people's needs. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with the staff who had a caring approach to their work..

People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

This service has been in Special Measures. 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.

Oasis Private Care provides personal live in care services to people in their own homes. At the time of our inspection 18 people were receiving a personal care service.

We had previously carried out an announced comprehensive inspection of this service on 6 August 2015 and identified a number of areas where improvements were needed to ensure that people were receiving care that was safe, effective, caring, responsive and well-led. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 (Registrations) Regulations 2014. This was because the service had failed to notify us of a safeguarding incident, The registered manager did not adequately monitor the quality of the service and that the registered manager and staff did not have a clear understanding of the principles of the Mental Capacity Act 2005.

We undertook this inspection to follow up the concerns that had been raised prior to our inspection and to check the service had made the required improvements from the inspection in August 2015. The improvements had not been made.

At this inspection in May 2016 we found there was a failure to recognise and report when people had been put at risk or had been subject to harmful situations, records relating to peoples care were not always accurate and that the registered manager was not adequately monitoring the quality of the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Following our last inspection in August 2015, the registered manager submitted an action plan that included: safeguarding update training for all staff, a review of company policies, the distribution of new safeguarding policy’s and local procedures to be distributed to people and staff, the review of care records, staff to be trained in personalised care, the review of quality monitoring and assurance policy to ensure compliance, service user satisfaction surveys to be collated and reviewed by management.

However during our inspection we found no evidence that these points had been actioned despite the original action plane stating that these would be completed within a specific timeframe and that some actions were already ‘In place’.

Services are required to by law to display their most recent ratings on their website and at the providers principle place of business. Ratings were not displayed on the services website or in the office.

At our inspection in August 2015 we identified that the registered manager had not raised a safeguarding alert. At our inspection on 18 May 2015 we found that the service was still falling to report safeguarding incidents within the service to the Care Quality Commission.

The registered manager did not routinely monitor the quality of service provided. This meant the registered manager could not identify patterns and trends that would allow them to improve the service. The service did not always have up to date and accurate records around the day to day management of the service.

Staff told us they received regular supervision. However records relating to staff supervision did not reflect that staff were receiving regular supervision. Records in relation to staff training were inaccurate.

The registered manager and staff did not demonstrate a good understanding of the principles of the Mental Capacity Act (MCA) 2005. Mental capacity assessments had not been used correctly and were incomplete.

We could not be confident the rights of people who lacked capacity were protected.

Risks to people were not always managed safely. Risk assessments did not always provide guidance for staff on how to reduce the risk.

Relatives we spoke with told us that staff were not deployed effectively and that the service was regularly late for its visits and that some visits were missed.

Risks to people were not always managed safely. Where people were identified as being at risk, assessments were not always in place or accurate. Care records did not always demonstrate that the service was responding to people’s individual needs.

We looked at the complaints file and noted one complaint was recorded for 2016. However, we could find no evidence this complaint was investigated. One person had contacted the registered manager to complain about staff punctuality. Whilst we saw the complaint had been closed the complaint had not been recorded and we could find no evidence it had been investigated.

People and their relatives knew how to raise concerns. However they did not always feel confident that action would be taken.

Some care records contained details of people’s personal histories, likes, dislikes and preferences and included people’s preferred names, interests and hobbies. However not all the care records were accurate or complete and did not always contain details of people’s preferences, likes and dislikes. People’s care plans were not always reviewed regularly.

People told us they benefitted from caring relationships with the staff and that staff were friendly, polite and respectful when providing support to people.

Relatives told us that people were supported to be independent. People told us staff sought permission and let them know what was going to happen before supporting them with personal care.

The overall rating for this service is ‘Inadequate’ and the service is in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel their 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 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.

Everyone we spoke with told us that care workers asked for consent to care. One person told us, 'They always ask me, they're good'. One relative told us, 'they are always very good on that front. The carers always ask and they know when they're [my relative] happy'.

Everyone we spoke with was happy with the service they received. One person told us, 'They are excellent, I have no concerns'. A relative told us, 'We wouldn't be without them. They give us such peace of mind'. We also noted that care workers were responsive to people's changing needs.

Care workers were supported appropriately. Care workers told us that there was always good communication between staff and management. We saw that detailed staff meetings were conducted. We found that arrangements had been made for care workers to receive supervision regularly.

The views of people were sought and their comments and concerns were acted upon. The provider monitored the quality of the service frequently and conducted detailed audits of the service to help improve the service people received.

We looked at records following concerns raised at our last inspection in March 2013. We noted that the provider had taken appropriate action. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People who used the service, their representatives and staff were always asked for their views about their care and treatment but these were not recorded. Relatives that we spoke with said that their relatives felt very safe with the agency. One relative told us "if I had concerns about my relative's care, I would immediately speak to the manager .

One relative told us "We feel there are enough trained staff to meet my relative's need because the manager provides most of the care herself. She will bring another carer to assist with hoisting, bathing and carrying out some of the delegated nursing tasks. Another relative told us "the manager and her staff are available at anytime I need them. Relatives that we spoke with told us they were asked for their views about their relatives each time the manager visited, but this was done informally.

Many records were out of date and needed filing or destroying after seven years. The administrative management of the agency was not kept up to date. The manager agreed that this would be addressed as soon as possible.