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Inspection carried out on 27 March 2018

During a routine inspection

The inspection took place on 27 March 2018 and was announced.

This service is a domiciliary care agency, it provides personal care to people living in their own homes in the community. Courage Limited is registered to provide a service for people living with dementia, older people, people living with physical disabilities, sensory impairments and learning disabilities.

Not everyone using Courage Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection Courage Limited supported seven people with personal care.

When we last inspected Courage Limited in August 2017 we found breaches of regulations 11, 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to maintain robust governance of the service, record keeping was poor, management of medicines was not safe, risks to people’s safety and wellbeing were not appropriately assessed or managed, staff lacked training, their competencies were not assessed and there was a lack of engagement and involvement of people who used the service. This was the first time the service had been rated as ‘Requires Improvement’.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least good.

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

The registered manager had made significant improvements to how the service operated since the previous inspection in August 2017. However there were some areas that needed further development and embedding into daily practice. A training plan had been developed for the staff team however, this needed to be further developed so the registered manager could assure themselves that people’s needs were met safely. Record keeping had improved, however some further development was needed to promote a personalised service in terms of details included in care plans and risk assessments. People told us that they felt the service was well managed. Staff told us that they were confident of support should they need it out of office hours. The registered manager had a system of routine audits and checks to help drive the quality of the service provision forward. The registered manager kept themselves up to date with changes in the care sector and changes in legislation by being a member of care provider associations and communications from CQC.

Recruitment processes had been made more robust since the previous inspection and there were enough staff available to meet people’s needs safely. Risks to people’s safety and wellbeing were assessed and mitigated where possible. Staff had received training to enable them to support people to transfer safely by means of a mechanical hoist and their competency to do so was assessed. Staff had attended training to enable them to protect vulnerable people from abuse. People received their medicines from staff who had been trained to administer them safely. People felt safe using the services of Courage Limited. The registered manager had arrangements in place to manage and monitor infection control practices.

The staff team had the basic knowledge and skills necessary to meet people's personal care needs and promote their health and wellbeing. Staff received support and supervision from the management team to help them provide people with effective care.

Inspection carried out on 30 August 2017

During a routine inspection

This inspection took place on 30 and 31 August 2017 and was announced. This is the first inspection of this service since first registered in March 2016. As part of the inspection process we contacted people and staff for feedback on the 31 August 2017. Courage Limited is a domiciliary care service which provides personal care and support to people in their own homes. The service was supporting 7 people at the time of our inspection.

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 and associated Regulations about how the service is run.

People and their relatives were positive about the service they received. However we found that the systems and processes that were in place to manage the safety and quality of the service were ineffective. We found risks to people’s safety and wellbeing were not consistently well managed. The staff team did not have the necessary skills and knowledge to enable them to support people safely.

People’s medicines were not always managed safely. The registered manager told us staff had received safeguarding training but staff members were not able to demonstrate to us they knew how to identify and manage potential abuse concerns. The recruitment process was not followed to ensure pre-employment checks were properly completed in accordance with the company’s recruitment policy so we could not be assured that staff were of good character and suitable for the roles they were employed. There were no systems in place to monitor staff arrival or departure times. However people told us staff did usually arrive at the agreed time and stayed for the duration of the visit.

People told us the staff were kind and caring and they received care that was consistent. The provider was not able to give us any evidence that people were involved in the development or review of their care plans. People’s likes and dislikes and personal information were not included in care records.

We saw that risk assessments were basic and lacked the level of details to inform staff how to manage risks effectively. Consent was not routinely obtained or recorded on people’s care records and staff did not understand when we asked them about the arrangements for obtaining consent and also did not understand how this related to the principles of The Mental Capacity Act (2005).

There was no evidence of staff induction or training and staff were unable to demonstrate that they had the knowledge and skills to support people safely and effectively. There was no evidence of any competency checks. There were no systems were in place to monitor and check the training and skills of staff. The registered manager told us staff received supervision although they were unable to provide any evidence of this at the inspection. Staff told us they did speak with the registered manager regularly but this was not always documented.

Where required people were supported to eat and drink sufficient amounts to remain healthy. We could not check if people were supported to maintain their health as this information was not included in the care plans we reviewed.

We could not be assured that complaints were acted upon or that when feedback was received that it was acted upon. We found the provider had a limited understanding of how they should be meeting the regulations and also in relation to our regulatory role.

The provider did not have any quality monitoring processes in place and therefore had not identified shortfalls found during our inspection. The registered manager had not always informed the CQC of significant events in a timely way which meant we could not check that appropriate action had been taken. The provider was not able to show us any completed audits in place to ens