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Date of Assessment: 19 June to 14 July 2025. This was a comprehensive assessment of all 5 key questions triggered by our ongoing monitoring of the service. This was our first inspection of the service. The service is a care at home service providing support to adults of all ages living in their own homes. CQC only inspects where people are receiving the regulated activity personal care. This is help with tasks related to personal hygiene and eating. At the time of the assessment 23 people were using the service. The provider was motivated to learn and improve the service for people. However, their overall ambition was limited by a lack of established risk and quality monitoring systems. This meant they had not been aware of the shortfalls we found in relation to recruitment records and people’s risk assessment and risk mitigation plans. Improvements had therefore not been made prior to our inspection. There was a positive learning culture, where the provider was pro-active in seeking feedback and implanting learning to make improvements. People and relatives knew how to give feedback and were confident the provider took it seriously and acted on it. People were protected and kept safe from abuse. Staff were happy to raise any safety concerns and felt they would be dealt with properly. There were sufficient numbers of staff in place. Some improvement was needed to recruitment records. People were consulted around how they wished their care to be carried out. Staff understood and managed risks related to people’s care. However, risks were not always assessed and documented in people’s care plans. This was also confirmed by professionals involved in people’s care. Safe systems were in place to ensure medicines were administered appropriately where required by competent staff. Staff worked with stakeholders involved in people’s care to promote the best outcomes and safe transitions when people moved between services. The schedule of planned care calls was only allocated to staff on a daily basis, although staff were aware of the area they would be working in. Allocating these calls further out would help staff know who they were working with and give people more notice as to who was supporting them. The registered manager made sure staff received training to maintain high-quality care. Attendance at team meetings was good with meetings being held online. Staff cared for people with dignity and respect and promoted their independence. People were treated with kindness and compassion and had a good level of consistency in care staff. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt able to give feedback and were treated equally. The registered manager worked with stakeholders in the local community to deliver the best possible care and were receptive to new ideas. The provider was in breach of the legal regulations in relation to safe care and treatment, and good governance.
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