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Inspection carried out on 10 December 2018

During a routine inspection

The inspection took place on 10 December 2018 and was announced.

At our last inspection of the home in January 2018 the service was rated ‘requires improvement overall’. At that inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 12, safe care and treatment and Regulation 17, good governance. This was because risks to the health and safety of service users had not been consistently assessed and the provider did not have effective systems in place to regularly assess, monitor and improve the quality of service that people received.

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 to at least good. At this inspection we identified that improvements had been made with regard to Regulation 12 and 17 and the provider was no longer in breach of this regulation. This was because risks to the health and safety of service users had been assessed and plans put into place to reduce known risks, and quality assurance processes were in place to monitor and improve the quality of service.

Sabaoth Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults living in the North Liverpool area. At the time of our inspection 10 people were using 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.

Not everyone using Sabaoth Care receives regulated activity; CQC only inspects the service provided to people in receipt of ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. There was enough staff employed by the service to help people with their day to day support needs at the times they wanted.

There were systems and processes in place to ensure that people who received a service were safeguarded from abuse. This included training for staff. Staff we spoke with confirmed they knew how to raise concerns.

There was a process for recording, reporting and analysing incidents and accidents.

Risk assessments and support plans had been completed for everyone who received care to help ensure people's needs were met and to protect people from the risk of harm.

There was personal protective equipment (PPE) available for use, such as gloves and aprons.

The service supported people with medication. Medication was administered by staff who had the correct training to enable them to do this. Records were kept in line with current guidance.

Staff received training to enable them to support people safely and training records confirmed this. Staff engaged in regular supervision with their manager.

The service was operating in accordance with the principles of the Mental Capacity Act (MCA) and consent was sought in line with people's best interests. 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 at the service supported this practice.

People were treated as individuals, and their choices and preferences were respected by staff.

People's care plans were person centred and contained details about the person, their likes, dislikes, how they wanted to be supported and what they could do for themselves.

People's dietary needs were managed with reference to individual preferences and choice.

There was a complaints process in place. There

Inspection carried out on 5 January 2018

During a routine inspection

This inspection took place on the 5 January 2017 and was announced. The provider was given 72 hours’ notice of our plans to complete the inspection. This was because the provider was a small domically care agency and we needed to be sure someone would be available to assist with the inspection.

Sabaoth care provides personal care to adults living in their own homes in Liverpool. The service had previously operated from a different location and moved to its current location in July 2017. This service is a domiciliary care agency. At the time of our inspection, the service was providing personal care to 12 people living in their own homes in the community.

There was a manager in post at the service who became registered with the commission on 11 January 2018 following our inspection site visit. 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.

Some care records contained confusing and inconsistent information regarding risk and measures to mitigate risk. This was, in part, attributable to the fact that the provider had recently acquired a new electronic system and people's information had not been transferred fully as yet. This placed people at risk of harm in the interim as staff did not have access to all relevant information they needed to support people safely.

We saw some evidence of systems to monitor, review and assess the quality of service however; there was a lack of established and routine audit which meant some areas of the running of the service were not being effectively and consistently monitored.

The majority of people who used the service managed their own medication but received prompts and reminders from staff. People told us they were happy with the support they received with their medication. Staff had received training in the safe administration of medicines. We identified some anomalies with the recording on Medication Administration Charts which we brought to the attention of the registered provider during our inspection.

People were supported by sufficient numbers of staff. However, staff were not always effectively deployed to promote punctuality of visits. We have made a recommendation regarding this.

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 told us that consent was sought and staff offered them choice before providing care. However, care files did not always reflect this and people had not signed their own care plans. We have made a recommendation regarding this.

Care records contained confusing and conflicting information in respect of people's nutritional and hydration needs and what support staff were required to provide with this.

All of the people we spoke with who used the service told us they felt safe when receiving care and support from the staff at Sabaoth Care.

People were protected from the risk of harm because staff could identify the potential signs of abuse and understood the reporting procedures.

We found that staff were recruited safely to ensure they were suitable to work with vulnerable people.

Staff were assisted in their role through induction, training and supervisions and staff told us they felt well supported in their role.

Care records showed that people's health care needs were addressed with appropriate referral and liaison with external health care professionals when required.

People told us that staff delivering their care and support were caring and respectful when they visited their home.

Care files contained relevant information around people’s routines, preferences and level of care and support they requ