Archived: Sonia Heway Care Agency Also known as Sonia Heway Care Agency

Sonia Heway Care Agency is a domiciliary care agency providing personal care to 11 people 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’s experience of using this service and what we found

The acting manager and nominated individual did not have full oversight of the service. The provider’s electronic call monitoring system had not been working for three days, and no one working at the service had realised until this was bought to their attention during the inspection. The acting manager did not have access to essential information needed to have oversight of the service, including information about people’s healthcare needs and handover information, due to a technical error. Staff supported people to manage their healthcare needs.

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 21 October 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staff responding to people’s deteriorating healthcare needs. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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.

We have found evidence that the provider needs to make improvements. Please see the 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.

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

Enforcement

We have identified a breach in relation to good governance. Please see the action we have told the provider to take at the end of this 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.

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 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.

Sonia Heway is a domiciliary care agency providing personal care to people living in their own homes across London. At the time of the inspection 15 people were using the personal care 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

Risks to people’s health and well-being were not thoroughly assessed and managed in way a that reduced the likelihood of harm to them. Incident and accidents were not always recorded. The administration and management of people’s medicines were not safe. Care was not always planned and delivered in a person-centred manner. Records were not always up to date and consistent.

The registered manager and other management staff did not ensure the service was safe and effective. The systems in place for monitoring the service were not effective in identifying shortfalls in the service. The management team were not working towards the same objectives. They lacked teamwork, trust and common purpose which affected their effectiveness. The registered manager was not clear about the requirements attached to their CQC registration as the registered manager of the service.

Staff were deployed to meet people’s needs. People told us they received their scheduled care visits at the right time to meet their needs. There were no missed visits recorded. Recruitment checks were completed as required to keep people safe.

Staff told us, and records showed that staff had completed training relevant to their roles and were supported to improve their performance. Complaints and concerns were investigated and managed in line with the provider’s procedure.

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 and the service was placed in special measures (published 03 April 2020) as there were multiple breaches of regulations. The provider completed an action plan after our inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still 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.

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

Enforcement

We have identified seven breaches of regulation in relation to the management of risk, safeguarding people from abuse, staffing, recruitment, person-centred care, receiving and acting on complaints and good governance.

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 ‘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.

Sonia Heway is a domiciliary care agency providing personal care to people living in their own homes across London. At the time of the inspection 22 people were using the personal care 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

People’s health and well-being were sometimes neglected as staff did not always take actions to safeguard people. Staff did not always act to protect people from abuse or neglect. People’s medicines were not managed in a safe way. People did not always receive their medicines as prescribed.

There were not always enough staff to meet people’s needs. People did not always receive their scheduled care visits to meet their needs. There were several occasions of missed and late care visits recorded. Recruitment checks were not robust to make sure only suitable staff were employed to work with people.

Risk management plans were not always detailed to ensure staff had correct instructions on how to keep people safe. Incidents and accidents were not always recorded. Care plans were not always tailored and delivered to meet people’s care needs and preferences.

Staff were not always trained and supported to be effective in their roles. Staff did not demonstrate competency in their roles and actions were not always taken to improve staff performance and competency.

Complaints and concerns were not thoroughly investigated and managed in a way that ensured lessons were learned from them to improve the service.

People were supported to have maximum choice and control of their lives and the policies and systems in the service supported this practice.

The provider and management staff lacked oversight of the day to day management of the service. The regional manager told us there had not been any missed visits but we found several instances of missed care visits. Systems and processes in place were effective in identifying pitfalls in the service. The culture of the service was not focused on achieving good outcomes for people.

Staff were not committed to their roles and delivering good care to people. Staff did not always demonstrate they were caring towards people. People were not always involved in day to day decisions about their care.

People’s care needs were assessed and documented. People were supported to access health care services to maintain good health. People were supported with their nutritional and hydration needs. Staff followed infection control procedures.

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 and the service was placed in special measures (published 19 September 2019) as there were multiple 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 sufficient improvements had not been made and the provider was still 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.

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

Enforcement

We have identified seven breaches of regulation in relation to the management of risk, safeguarding people from abuse, staffing, recruitment, person-centred care, receiving and acting on complaints and good governance.

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 ‘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.

Sonia Heway is a domiciliary care agency providing personal care to people living in their own homes across London. At the time of the inspection about 130 people were using the personal care 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 service was not safe and people were at risk of avoidable harm. The systems in place to schedule staff visits to people were ineffective. Staff were often scheduled to be in two places at once or had no time to travel between calls which meant people did not receive their care as planned or in line with their needs and preferences. There had been a large number of safeguarding concerns raised, across multiple London boroughs and the provider had not notified us of all of these issues. They had also failed to inform the relevant local authority of some safeguarding concerns which placed people at risk.

Incidents, accidents and complaints were not managed effectively to ensure lessons were learned from them and to reduce the risks of incidents reoccurring. Complaints were not always investigated fully to establish what had happened so appropriate actions could be taken to rectify the issue.

People’s care needs were not always assessed fully in line with best practice guidance. Risks to people were not identified and there were no management plans or guidance for staff to follow to reduce risks. Staff had also not been trained in areas such as diabetes, Parkinson’s, catheter care or skin integrity and this further increased this risk. People did not always receive care that meant their individual needs, preferences and promoted their safety. People’s care plans were not always accurate and did not provide guidance for staff to support people appropriately.

Staff had not received appropriate training to support them to carry out their roles effectively. People were not always treated with respect and consideration by staff. People’s healthcare needs were not always met. Staff did not always follow up on recommendations from healthcare professionals. People’s language and communication needs were not always met.

The provider and registered manager lacked oversight of the service. Documents we asked for as part of the inspection were not readily available. People’s feedback was asked for but was not always acted on. There were no effective systems available to assess and monitor the quality of service delivered. We found multiple failings in the service during this inspection which had not been identified by the provider.

Records showed people’s medicines were managed safely. Staff received training in infection control and were provided with personal protective equipment they needed to reduce the risk of infection. People were supported with their nutritional needs. People’s end of life care needs were met appropriately.

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.

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 23 August 2018). There were two breaches of regulations in relation to management of medicines and quality assurance. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

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 service had met the breach with regards to medicines, but the service had deteriorated and there were eight other breaches of regulations including continued breach around risk management and quality assurance.

Why we inspected

The inspection was prompted in part due to concerns received about unsafe care and ineffective staff deployment. We decided to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

Enforcement

We have identified eight breaches of regulation in relation to the management of risk, safeguarding people from abuse, staffing, recruitment, respect and dignity, person-centred care, receiving and acting on complaints and good governance.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating. We will work with the 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 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.

At our previous inspection on 12 and 13 April 2017, we found breaches of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medicine administration records (MARs) were not completed correctly. There were gaps in the recording of the medicines administered to people although people were receiving their medicines as prescribed. The provider had not maintained a manual or electronic call monitoring (ECM) system record to show that they had monitored visits to people homes to ensure they received visits at the correct times, including when they were running late.

At this inspection we saw that the provider had made some improvements in the completion of MAR charts. However, we saw that people’s MAR charts were not always completed in full as they recorded that people had self-medicated when their care plans showed that medicines needed to be administered. Although the provider had introduced and operated an ECM system, they were not using it to monitor visits to people homes to ensure they received visits at the correct times, including when they were running late or arriving ahead of schedule and following this up effectively with clients and staff to address why calls were carried out later or earlier than scheduled. The provider did not use the ECM system to record notes to detail why staff were arriving late or early for calls.

The service had 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.

There were safeguarding procedures in place and staff knew how to safeguard people and how to raise any concerns. There were enough staff deployed to meet people's care and support needs. People were protected from the risk of infections. The provider carried out appropriate recruitment checks before staff started work. Records showed that the manager followed safeguarding protocols and submitted safeguarding notifications when required to the local authority as well as CQC.

Staff completed a programme of induction and mandatory training. Staff were supported through regular supervisions and appraisals. People's needs were assessed to ensure the service could meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff asked for people for their consent before providing care and support. People were supported to have a balanced diet if required and had access to a range of healthcare professionals when required in order to maintain good health. Staff worked effectively with each other by ensuring that daily notes were completed in full to ensure there were effective handovers.

People said that staff were kind and caring. People said staff respected their privacy and treated them with dignity and they were encouraged to be independent whenever possible. People were provided with information about the service in the form of a ‘service user guide’ before they joined the service.

Care plans were regularly reviewed and people were involved in planning their care needs. People were aware of the complaints procedure and knew how to make a complaint if they needed to. Complaints were logged and dealt with in a timely manner. Learning from complaints was disseminated to staff. People’s care plans had a section to record people’s end of life care wishes if required.

People and staff were complimentary about the manager and the service. Regular staff meetings were held and feedback was sought from people about the service through evaluation monitoring surveys. The provider worked with the local authority to plan and deliver an effective care.

This is the second time this service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

At our previous comprehensive inspection on 24 and 26 August 2016 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the provider had not taken action to make sure medicines were managed safely and had not put in place risk management plans to mitigate the risk for people. People and their relatives where appropriate were not involved in the assessment and development of their care plan and the care plans were not person centred. Effective systems were not in place to monitor and improve the quality and safety of the service provided to people.

Following that inspection we imposed conditions on the provider’s registration at the location. We told the provider to carry out monthly audits of all care plans, risk assessments and management of medicine and send CQC a report of actions taken as a result of these audits. We also placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

In line with the conditions we imposed, the provider had sent us reports from the results of the audits they carried out and the improvements they had made. As the provider had demonstrated improvements and the service is no longer rated as inadequate for any of the five key questions, it is no longer in special measures.

At this inspection we found people’s medicines were managed appropriately and they were receiving their medicines as prescribed by healthcare professionals. Senior staff completed risk assessments for people who used the service which provided sufficient guidance for staff to minimise identified risks. The provider involved people and their relatives, where appropriate, in the assessment, planning and review of their care. Staff supported people in a way that was caring, respectful and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date. The service sought the views of people who used the services. Staff felt supported by the provider.

The service worked effectively with health and social care professionals and commissioners. Feedback from social care professionals also stated that the standards and quality of care delivered by the service to people was good and that they were happy with the management and staff at the service.

Since our inspection in August 2016, the provider had made improvements in the systems used to assess and monitor the quality of the care people received. The provider had taken action to make sure that most of the systems for monitoring and improving the quality and safety of the services provided to people were operating effectively.

However, at this inspection we identified some further improvements were required in specific areas. We found gaps in the recording of the medicines administered to people although people were receiving their medicines as prescribed. The provider had not maintained a manual or electronic call monitoring (ECM) system record to show that they had monitored visits to people homes to ensure they received visits at the correct times, including when they were running late had been followed up effectively and identify any patterns to address.

The above issues were a continued breach of Regulation 17 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

The service had a system to manage accidents and incidents to reduce reoccurrence.

The service provided an induction and training and supported staff through regular supervision and annual appraisal to help them undertake their role. The service had enough staff to support people and carried out satisfactory background checks of staff before they started working. The service had an on call system to make sure staff had support outside the office working hours.

The service had 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.

People’s consent was sought before care was provided. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation.

Staff supported people with food preparation. People’s relatives coordinated health care appointments to meet people’s needs, and staff were available to support people to access health care appointments if needed.

The service had a clear policy and procedure for managing complaints. People knew how to complain and would do so if necessary. The service had maintained a complaints log, which showed when concerns had been raised senior staff investigated and responded in a timely manner to the complainant.

We took enforcement action following that inspection and served a warning notice on the provider in respect of the most serious breaches requiring them to become compliant with Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We also asked the provider for an action plan to address the less significant breaches found.

We undertook an announced focussed inspection on 09 July 2015 to check that improvements required had been made following the enforcement action we had taken. We found that action had been taken to improve safety.

Additionally we carried out a comprehensive inspection on 22 and 23 October 2015, we found several breaches of legal requirements. The staff did not receive appropriate levels of supervision, people’s care plans were task oriented and not centred on each person’s individual needs, there were inadequate systems to assess, monitor and improve the quality and safety of the service provided, care and treatment was not provided in a safe way as risks were not identified or action taken to reduce risk, and arrangements to administer medicines were unsafe.

We took enforcement action following that inspection and served a warning notice on the provider in respect of the most serious breaches requiring them to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also asked the provider for an action plan to address the less significant breaches found.

We undertook an announced focused inspection on 05 April 2016 to check that improvements required had been made following the enforcement action we had taken. We found that action had been taken to improve safety, however we found that staff were prompting people to take medicines and applying creams to people when they were not suitably trained to do so and this required improvement.

This announced inspection took place on 24 and 26 August 2016. Sonia Heway Care Agency Ltd is a domiciliary care service providing support to people living in their homes. At the time of our inspection 19 people were using the service.

At this inspection we found that the arrangements for the safe management of medicines were not robust; staff were not assessed to be competent to administer medicine. Potential risks to people were identified but risk management plans to mitigate the risk for people were not put in place.

The provider did not carry out, collaboratively with the relevant person, an assessment of the needs and preferences for the care and treatment of people. People and their relatives where appropriate were not involved in the assessments and development of people’s care plans. The care plans were not person centred on each person’s individual needs and there was no guidance for staff about how to deliver specific aspects of care and meet the identified needs of people.

The provider did not establish systems or processes, to assess, monitor and mitigate the risks relating to the health, safety and welfare of people. The service did not have adequate systems to monitor the quality of the service and the issues identified from the audits were not actioned.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 and their relatives felt safe using the service. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. The service had a system to manage accidents and incidents to reduce reoccurrence.

The provider carried out recruitment checks to reduce the risks of employing unsuitable staff. There were sufficient numbers of staff to meet the needs of people.

Staff were supported through monthly supervision, annual appraisal and training programmes.

People’s consent was sought before care was provided. The provider considered every person currently using the service to have the capacity to make decisions for themselves.

Staff supported people to eat and drink sufficient amounts to meet their needs. People’s relatives coordinated health care appointments and health care needs, and staff were available to support people to access health care appointments if needed.

Staff supported people in a way which was caring, respectful, and protected their privacy, dignity, and human rights.

The service had a clear policy and procedure about managing complaints. People knew how to complain and would do so if necessary.

The service sought the views of people who used the services and their relatives. Staff felt supported by the manager.

We found three breaches of the Health and Social care Act 2008 (Regulated Activities) regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 consider the process of preventing the provider from operating this service. This may 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 and there is still a rating of inadequate for any key question or overall, we may take action to prevent the provider from operating this service. This may 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.

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

We took enforcement action and served warning notices on the provider in respect of more serious breaches requiring them to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 11 December 2015.

We undertook this focused inspection on the 5 April 2016 to check that they had complied with this regulation.

This report only covers our findings in relation to the follow up on the breaches for the safe management of medicines and risk management. We have asked the provider to send us an action plan telling us how and when they will become compliant with the other breaches. These breaches will be followed up at our next comprehensive inspection of the service.

Sonia Heway Care Agency Ltd provides personal care for people in their homes. There were five people receiving personal care at the time of our inspection visit.

A registered manager was 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.

At our focused inspection on the 5 April 2016, we found that action had been taken to improve safety. The provider had arrangements in place to manage and report on the accidents and incidents. The provider had stopped the administration of medicines to the people who used the service in response to the warning notice. However, staff were involved in the prompting of medicines and application of creams to people when they were not suitably trained to do so. This required improvement.

We also found the provider completed risk assessments for every person who used the service. The risk management plans were up to date with brief guidance for staff to reduce risks. However, the guidance on the updated risk assessment was not detailed and a new member of staff would not benefit from the information about the correct equipment to use and a step by step process and this required improvement.

The provider had completed all appropriate staff recruitment checks including; satisfactory criminal records checks and written references before staff began work.

We found people using the service were involved in decisions about their care and were treated with dignity and respect. They experienced care that met their needs and were cared for by suitably skilled and experienced care workers. However, the provider had not completed all appropriate checks for some care workers and an office staff member before they began work. The provider had systems in place to monitor the quality of the service people received.