St Gregory's Homecare Ltd

St Gregory’s Homecare Ltd is a domiciliary care service providing personal care. At the time of our inspection the service was supporting 77 people. The service provides support to older people and younger adults including people living with dementia, physical disabilities, sensory impairments, mental health conditions and learning disabilities.

Not everyone who used the service received personal care. The Care Quality Commission (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 provider had made significant efforts following the last inspection to improve their quality monitoring and governance systems. Despite this, these systems had not been effective and further changes had not been embedded or sustained. People told us they experienced inconsistencies in their care visit times, with these taking place earlier or later than planned. This remained an ongoing issue from previous inspections. The registered manager was reviewing this and making changes but we could not be assured these would improve people’s experiences and outcomes.

People felt safe with the support they received. Risks to people were identified and managed and appropriate safeguarding processes were in place to protect people. People’s care visits were not always organised to allow sufficient gaps between medicine doses. The provider’s medicines audits were not always robust and identifying this shortfall.

People’s care was not always effective and did not always promote a good quality of life for people. People’s care visits were not always consistent and this affected the majority of people using the service. One relative said, “It can be very chaotic. The times are all over the place, [person] is constantly ringing to find out when the carers are coming.” Although staff had received training to support them in their roles, people and their relatives told us there were variations in the standard of care they received.

Staff provided kind, empathetic care to people. People and their relatives spoke positively about the approach by individual care staff. People’s dignity, privacy and choices were respected.

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.

Care plans reflected people’s preferences and helped staff provide person-centred care. People’s communication needs were met. Further work was needed to demonstrate how people had the opportunity to discuss their future care wishes. People and their relatives knew how to raise any concerns or complaints and gave mixed feedback on whether actions taken to address these were sustained.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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 7 February 2023) and there were breaches of regulation.

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 had addressed some breaches in regulation but remained in breach of regulations.

Why we inspected

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

Enforcement and Recommendations

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

St Gregory’s Homecare Ltd is a domiciliary care service providing personal care. 138 people were receiving care from the service at the time of the inspection. The service provides support to people living with dementia, learning disabilities and/ or autism, mental health needs, sensory impairments and physical disability and older people and younger adults across the Lancashire and South Cumbria areas.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where services provide this care, we also consider any wider social care provided.

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

Although the provider had made improvements following the last inspection, people remained at risk of not receiving high-quality and person-centred care. The provider’s systems and processes meant there continued to be shortfalls in the governance of the service and this placed people at risk of harm. The provider was not effective in monitoring all aspects of the service and driving improvement; their quality assurance system had not identified issues we found on inspection.

People were at risk of harm as they were not always protected against the risk of abuse. Actions by the provider and staff had led to safeguarding concerns being raised about the service. Risks to people were not always identified or managed effectively to keep people safe. The provider did not always have systems in place to ensure people received their medicines properly and safely.

People did not always receive effective support to meet their care and support needs. Care staff had not always had their competence assessed to enable them to provide aspects of people’s care needs, including specialist tasks. The timings and lengths of people’s care visits did not always ensure their needs were fully met. People and their relatives told us there were variations in the quality of care they received.

People were not always 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 did not always support people’s choice and control across all aspects of their care.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

People and their relatives gave mixed feedback about their experiences of care. Although there were positive examples of individual care staff being caring, respectful and supporting people’s independence, the provider’s approach did not always promote this.

People did not always receive person-centred care that reflected their preferences. For example, where people had preferences for female care staff, this was not always accommodated and impacted on people’s support. When people’s care needs changed following them receiving end of life care, this was not always recorded fully in their care records to guide staff in their support needs at that time.

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 04 April 2022) and there were breaches of regulation.

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 had addressed some breaches in regulations but remained in breach of other regulations which had not been met.

At our last inspection we recommended that the provider reviewed and implement the Accessible Information Standard (AIS) guidance to identify how to support people to access information. At this inspection we found the provider had acted on this recommendation and made improvements.

The service is now rated requires improvement. This service has been rated requires improvement or inadequate for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, safe care and treatment, safeguarding people, staffing and good governance. We issued a warning notice for the breach of good governance. You can see what action we have asked the provider to take at the end of this full report.

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 ‘Requires improvement’. The service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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. For this service, the ‘Well-led’ key question has been rated ‘Inadequate’ for the past two inspections.

If the provider has not made enough improvement within the 6 month’s 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 of 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.

St Gregory’s Homecare Ltd is a domiciliary care service providing care to 209 people at the time of the inspection. The service provides support to the whole population. At the time of inspection, the majority of people receiving personal care from the service were older people and people living with dementia.

Not everyone who used the service received personal care. The Care Quality Commission (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 good quality care. There were significant and widespread shortfalls in the governance of the service, placing people at risk of harm. The provider did not have robust or effective systems in place to monitor quality across the service and drive improvement. The provider did not have a positive culture that promoted person-centred, open care that achieved good outcomes for people.

People did not always receive safe care and were not always protected from the risk of abuse. The provider did not always learn from safeguarding concerns which showed a theme of people experiencing late and missed care visits. People and their relatives told us this remained an issue. Poor communication of rota changes and a lack of care staff travel time contributed to this. People were at risk of harm as information about their risks was not always effectively assessed and managed. People told us effective infection prevention and control practices were not consistently followed.

People did not always receive effective, consistent care; feedback from people and their relatives showed there were times when their care needs and preferences were not met. This included times when people did not receive appropriate support to access food and drink. Care staff did not always receive appropriate training or support to enable them to carry out their duties.

It was not clear that 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 did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. ‘Right Support, right care, right culture’ is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of ‘Right support, right care, right culture’. At the time of inspection, the service was not providing personal care to any people with a learning disability and/or autism. The provider’s policy did not show the provider’s model of care would support people to have maximum choice, control and independence, enable people to access the community or follow best practice in relation to its ethos, values and behaviours. The provider told us they would review their policy and whether they could provide care to all the service user groups they were currently registered for.

People did not always feel well supported, cared for or that their dignity was maintained. The service was not organised in a way that promoted person-centred care. This led to people experiencing rushed care visits and not having their preferences listened to or acted on by care staff. People’s equality and diversity needs were not well documented. Information about people’s communication needs was limited. We have made a recommendation about this.

People and their relatives did not have confidence that they would receive appropriate and responsive care to meet their care needs. They described regularly receiving early and late care visits and at times, care visits being missed. People’s care plans were not personalised to reflect their individual needs, including where people required end of life care. Complaints by people and their relatives were not always responded to effectively.

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 05 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care people were receiving and safeguarding concerns. A decision was made for us to inspect and examine those risks.

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.

The provider has shared information with us, including care visit records to show some improvements have been made.

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 monitor the service.

We have identified breaches in relation to person-centred care, consent, safe care and treatment, safeguarding, nutrition and hydration, complaints, governance and staffing. Please see the action we have told the provider to take at the end of this report.

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 authorities 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 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.

St Gregory's Homecare Ltd, provides personal care and support to people living in their own homes across South Cumbria, Lancaster, Blackpool and Preston. At the time of this inspection they provided 2500 hours of personal care to approximately 170 people across these four areas. The number of hours and people supported varied on a daily basis.

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

People felt safe as a result of the care they received. People gave us mixed views about their experiences of using the service. In some areas people found visit times were not always on time and some people felt they were not kept informed when visits were going to be late. One person reported having to miss medical appointments due to the lateness of visits. We have made a recommendation about staffing.

The service had completed assessments which ensured they were able to meet people's needs. People told us their needs had been reviewed and were properly identified. People said staff had the right skills and knowledge to support them. Staff followed guidance provided by other professionals which ensured care was effective. Staff ensured they sought consent from people before providing care.

People told us staff were caring and kind. Most people felt comfortable when they received personal care and praised the staff’s efforts to put them at ease. One person had not always had their preference for female carers met. People felt their views were respected and felt staff protected their privacy and dignity.

Person-centred care plans included sufficient detail of people's needs and preferences. People had been involved in regular reviews and assessments which helped ensure their care remained appropriate. People were able to raise their concerns and complaints. Some people were not satisfied their concerns had been responded to in relation to the times of visits and consistency of carers.

The registered manager and management team worked closely with staff to embed the aims and values of the organisation. Staff said they felt part of a cohesive team. The registered manager followed effective governance systems which helped ensure care quality was maintained. People were consulted about their experiences of the service including surveys and questionnaires. People told us they knew how to contact the office and managers.

Rating at the last inspection

At the last inspection the service was rated good. Published June 2019.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received, we may inspect sooner.

St Gregory's Homecare Ltd, provides personal care and support to people living in their own homes across South Cumbria, Lancaster, Blackpool and Preston. At the time of this inspection there were approximately 2500 hours of personal care to approximately 180 people across these four areas. The number of hours and people supported varied on a daily basis.

People's experience of using this service:

People gave us mixed opinions of their experience of using the service. Some people were very satisfied with the care and support provided. Some people said visits were not always at the time they preferred. We discussed this with the director who advised visits were at the arranged time or within an agreed 30 minute tolerance.

Safeguarding policies and procedures helped to protect people from the risk of abuse and avoidable harm. Staff were trained to recognise concerns and reported them appropriately.

Risk management policies ensured people were supported to manage the risks in their daily lives which related to the care and support provided.

Medicines were managed safely, where the provider had responsibility for supporting people with medicines.

Staff had been recruited safely with all necessary checks being completed prior to them starting work. Staff had received appropriate training to support people safely and effectively.

Thorough assessments identified people's needs and preferences to ensure the provider could meet them.

Staff we spoke with said the team worked well together and followed advice and guidance from community based health staff. People were supported to make medical appointments.

Staff were aware of the importance of getting consent before providing personal care. People who needed support to make decisions had been supported following the best interest principles detailed in the Mental Capacity Act (MCA).

Most of the people we spoke with praised the kindness and caring nature of the staff, where there had been concerns these had been addressed through the provider's complaints process. People were supported to express their views. Staff had received training about dignity in care and could describe how they supported people respectfully. Care plans included details of goals people were aiming for to maintain and promote their independence.

Person-centred care plans included sufficient detail to allow people to receive bespoke support which reflected their preferences. Regular reviews and reassessments helped ensure people's care remained appropriate to their needs and preferences.

The provider had a complaints process which had been followed and the outcomes recorded properly.

End of life care was available including overnight support from the rapid response team which worked closely with hospitals and community based health professionals.

The service was well-led, with a clear focus on high quality person-centred care. Staff reported feeling valued and supported by the management team.

Rating at last inspection:

At the last inspection the service was rated good. Published November 2016.

Why we inspected: We carried out this inspection based on the previous rating of the service.

Follow up:

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

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

St. Gregory’s Homecare Ltd is a domiciliary care agency based in Carnforth offering a range of services in people's homes, including people living with dementia, learning and physical disabilities and people with palliative care needs. Services provided includes, domestic support, waking and sleep in night services, 24 hour care and respite care. The service covers an extensive area of the South Lakes with a large rural area and parts of North Lancashire. At the time of inspection the registered provider was supporting 150 people and employed approximately 100 staff.

The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure someone would be in at the office.

There was a registered manager in place. A registered manager is a person who has registered

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

A comprehensive inspection of St Gregory’s Homecare Ltd took place between the period of May and June 2015. At the inspection breaches of Regulations were identified in relation to health and safety of people, management of medicines, and delivery of person centred care. Following the inspection visit, the registered manager submitted an action plan to show what improvements they were going to make to ensure they met the fundamental standards.

A focussed inspection was carried out in February 2016 to check that improvements had been made. At this inspection visit it was noted improvements had been made to ensure medicines were suitably managed and person centred care was delivered, however there was a continuing breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014 as risk was not sufficiently managed to ensure people were kept safe. We took enforcement action against the provider following this visit.

We used this inspection carried out in November 2016 to ensure action had been taken to ensure all fundamental standards were now being met. We also carried out a comprehensive inspection to review the rating of the service.

At this inspection visit, carried out in November 2016, we found the required improvements had been made. Following the previous inspection visit a working group had been developed to look at care planning systems and ways to improve the quality of the care plans and risk assessments. During the inspection visit it was noted the service was in the process of changing the care planning documentation to make them easier to follow. Systems had been implemented to manage and monitor risk to promote safety.

We noted care plans and risk assessments were reviewed and updated when people’s health care needs changed or when new risks were identified. People who used the service told us their nutritional and health needs were met.

People told us when they required assistance with their medicines, staff were reliable and knowledgeable. Although we received positive comments about the management of medicines we found arrangements for managing and administering medicines were not consistently applied. We have made a recommendation about this.

People spoke positively about the quality of service provided. People consistently told us improvements had been made within the service in the past year. They said staff were reliable and turned up when expected. At the time of the inspection visit the service was in the process of implementing a call monitoring system to track and record staff attendance at visits. The registered manager had introduced the system following concerns being raised about missed visits.

People spoke highly about the staff. They told us staff retention was good and said they had formed positive relationships with staff.

People were protected from the risk of abuse. They told us they felt safe and secure. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

People’s healthcare needs were monitored. Care plans were developed and maintained for people who used the service. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and the relevance to their work. Capacity was routinely assessed and good practice guidelines were referred to when a person lacked capacity.

Training was provided for staff to enable them to carry out their tasks proficiently. The service was currently working proactively to identify staff training needs. Staff praised the training on offer.

Suitable recruitment procedures meant staff were correctly checked before starting employment.

The registered manager had implemented a range of assurance systems to monitor quality and effectiveness of the service provided. We saw evidence of audits being carried out on a monthly basis by the senior management team, and noted action had been taken when concerns were identified.

Systems were in place to seek feedback from all people who used the service as a means to develop and improve service delivery. Feedback received from the last survey carried out in July 2016 showed 90% of the respondents were happy with the service they were receiving.

People who used the service praised the registered manager and their transparent way of working. People said the registered manager was approachable and they were confident if they had any concerns the registered manager would listen and take action.

People who used the service told us they were aware of the complaints procedure and their rights to complain. People and relatives who had experiences of making complaints told us they were happy in the way in which their complaints were managed and the outcome of the complaint.

Staff were positive about ways in which the service was managed and the support received from the management team. They described a positive working environment.

St. Gregory’s Homecare Ltd is a domiciliary care agency based in the town of Carnforth. It offers a range of services in people's homes, including care and support for people living with dementia, learning and physical disabilities and people with palliative care needs. Services also provided includes, domestic support, waking and sleep in night services, 24 hour care and respite care. The service covers rural and urban areas of South Cumbria, Lancashire and North Yorkshire.

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

At the last inspection in July 2015 we asked the provider to take action to make improvements to the following (Regulated Activities) Regulations 2014, safe care and treatment including the proper and safe management of medications and person centred care. This inspection focussed on whether those actions had been met.

During this inspection we found that there was a continuing breach of Regulation 12 Safe care and treatment of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the assessing of risk to health and safety of people using the service and doing all that is reasonably practicable to mitigate any risks.

Although people told us that they felt safe receiving care and support from this service we found the provider was not identifying all of the risks associated with providing safe care and treatment. Where risks had been identified they had not always been recorded.

The quality and accuracy of care plans and risk assessments recorded were not consistent and some information about some people’s current care needs had not always been recorded. Where care plans had been reviewed previous risks identified had not always been included in the reviewed care plans.

Where risks were evident staff had not always relayed them to the senior staff who manage the care plans or identified them in people’s care records themselves.

Most people received support from a regular team of staff who they knew and who understood the care and support they required. We saw that people were treated with kindness and respect and people made positive comments about the staff who visited their homes.

During this inspection we found improvements had been made to the management of medications. The provider was still working on systems and processes to continue to improve the safe management of medications.

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

Following the inspection in June 2014 the provider undertook a voluntary agreement not to take new people on to receive services in order to provide a safer delivery of the service. This inspection was to check whether the provider and manager had completed the required improvements to the safety and quality of the service identified when we visited in July 2014.

This was an unannounced inspection. Our inspection team was made up of three Inspectors and we visited the service over three days. We spoke with 20 people who used the service, visited 12 people in their own homes with their permissions; spoke with five relatives, eight care staff, senior management and the registered provider. The local authority commissioning Quality Manager had provided support, advice and guidance to the provider and registered manager since our last visit in June 2014. The provider had also employed a private consultant for advice and guidance to improve the quality and safety of the service.

At the time of our inspection there were 155 people receiving care and support from St Gregory's Homecare Ltd and approximately 100 employed staff.

We inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

Prior to this inspection we received concerning information in relation to the safety of people who used the service. Between 1 August 2014 and 23 October 2014 St Gregory's Homecare Ltd had submitted 17 statutory notifications to the CQC for allegations of abuse concerning a person who used the service. We saw new policies and procedures had been implemented to support new systems in identifying and acting upon any safeguarding concerns. At the time of the inspection it was difficult to confirm that the new systems would be entirely effective.

One person who used the service told us that where their individual rota had unallocated care staff they were phoned prior to the visit to inform them of who was coming. Another person we spoke with told us that on the odd occasion there had been problems at their night time call running late due to the care staff having to travel quite a distance between visits. We were told by both care staff and people using the service that issues occurred when no travelling time was allocated between visits. A relative we spoke with told us, 'Staff numbers have increased and there is a better consistency of carers'.

For one person we visited in their own home we found that their medications were stored in a locked cupboard for safety. However we did not see any risk assessment about the safe keeping of these medications. There was no guidance available in the person's home for staff to follow to ensure the medications were kept stored safely.

Is the service effective?

Since our visit in June 2014 there had been significant changes in the systems used to organise the running of the service. One of these changes was the implementation of a new care planning tool. However during our inspection we found concerns with some of the newly reviewed care plans. We looked at 17 of the reviewed care records and plans for people using the service and found issues with six of those.

At this inspection we found that new training facilities had recently been established at the office that allowed care staff to access on line training whenever they wished. All staff had been enrolled for on line training and progress was being monitored regularly. On one of the days we inspected we saw face to face training for the induction of new care staff. Staff we spoke with told us they had received training updates in moving and handling, safeguarding adults and medication management.

Is the service caring?

During this inspection people we spoke with told us the service they were receiving had greatly improved over the last few months. People using the service had been made aware of the concerns we had found in June 2014 because the provider and registered manager had informed them.

People we spoke with told us they were happy with their care and spoke highly of the care staff attending them. One person told us, 'Girls that come are very good and always make sure I have everything before they leave'. Another person told us 'My carer is very good and knows me well. They [care staff] have sorted out my OT [Occupational Therapy] assessment to help me with my independence.

Is the service well-led?

Care staff we spoke with told us they felt more supported by the senior management and directors. One person told us, 'I've had two supervisions recently prior to that I had only one since I started working here. I feel better supported'. Another person told us. 'One of the directors came to see me while I was working and asked me how things were. It was nice to see they cared'.

At the time of our visit we had a number of concerns that had been brought to our attention via statutory notifications and two complaints about the number of missed visits to people using the service. These had been recognised by the care management system and dealt with via the customer liaison officer. Following investigations made by the service it was found that the majority of these had been caused by the management of rotas. The rota system used was electronic however the information required to generate the rota was done manually and mistakes had been made.

Is the service responsive?

In a number of care plans we looked at we found errors. One care plan we viewed when visiting a person using the service stated that 'family supervise medication' however when we spoke with a relative they told us the family did not have any involvement with the medication and relied on the care staff to manage the medications. Another person's care plan we viewed in their home referred to them having the option of a bath or shower. This person did not have a bath in their home.

The records we looked at for complaints showed that they had been dealt with quicker and that the senior management had analysed the audits. This had helped them to recognise trends and take action to prevent reoccurrence of the concerns that had been raised. The new systems we saw in place were based on a traffic light system which enabled staff to immediately recognise what course of action to take. This meant that the service was learning from the comments or complaints made.

Below is a summary of what we found:

Is the service safe?

During our visit we found concerning information in relation to the safeguarding of a person using the service.Whilst the senior on call considered they had acted appropriately based on the information they had been given at the time. We informed the operations manager to report it to the appropriate authority. This meant that information being received, that indicated people may be at risk of harm, was not appropriately recognised or managed by the service.

We last visited this service in April 2014. We did not see evidence at this visit that the quality monitoring systems in use had been effective in reducing the number of concerns and complaints being raised by people using the service. Nor did we see that where concerns relating to the safety and well being of people had been appropriately recognised or recorded on all occasions. This meant that people who used the service could not be sure that the safety and quality of the service was being effectively monitored and managed by the provider. Nor did we see that comments and complaints had always been taken into account to improve the service.

Is the service effective?

We spoke with the senior administrator who does not have any responsibility for the planning of care. She told us that her role, since our last visit, had been focused on meeting the regulation requirements for the recruitment of staff. We were told they were aware that the appropriate assessments and plans of care had not been completed due to the lack of sufficient staff to manage the workload.

We saw that new checking systems since our last visit were effective in ensuring the required information was in place before people commenced working in people's homes .

Is the service caring?

We visited, with permission, four people receiving care and treatment from St Gregory's Homecare Ltd in their own homes. We also spoke with two relatives.People we spoke with told us they were 'more than happy' with the carers that they received care from. One person told us,"The carers that come are marvellous' and another said 'They are all lovely'.

People who used the service who we spoke with during our visit told us they had also experienced missed or late visits. This meant that the delivery of care was not planned in an appropriate way in order to meet the needs of the people using the service.

During our visit we looked at the most recent completed satisfaction survey questions asked of some people using the service. This had been completed in May / June 2014 by 17 people. We saw that 15 out of 17 strongly agreed that they felt comfortable and safe with their carers. The same amount of people said their carers treated them with respect and dignity.

Is the service well-led?

People we spoke with during our visit told us they were unhappy with the organisation of the rotas. We were told that on a regular basis people receiving services did not know who or if a carer would be visiting.

Staff we spoke with told us that they did not receive regular supervision or appraisal. One person told us they had not had any supervision since November 2012. Staff also told us of the low morale and pressures of working extra hours. We noted from the action plan audited on 10th June 2014 that the identified required outcome for supporting workers recorded that staff were regularly supervised and had an annual appraisal. This meant that staff had not been appropriately supported in their responsibilities to enable them to deliver care and treatment to services users safely and to an appropriate standard.

Is the service responsive?

We looked at a sample of the reports for calls made to the office during opening times from 16/06/2014 to 22/06/2014. These records highlighted that a number of people using the service were unhappy with the provision. During the period of the week one relative contacted the service three times to report missed visits. Ten calls were made reporting people had been unhappy with the service received. We saw that only one of these had been recognised as a complaint by the service.

We saw that new checking systems since our last visit were effective in ensuring the required information was in place before people commenced working. A comprehensive audit on the records of staff recruitment had been completed in May 2014 and we saw that this had been repeated in June 2014.

We looked at minutes of a manager's meeting held on 9th June 2014. The meeting was recorded as being called to discuss the events that occurred during the last weekend as the on call person had reported having to go out to cover visits due to staffing problems. The meeting was also to discuss how they were to manage the shortfall of 300 hours gaps on the rotas. It was recorded in the meeting minutes that two office staff were to change their working hours to accommodate supporting the gaps on the rota at the weekends.