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Inspection carried out on 28 March 2018

During a routine inspection

This inspection took place on 28 March 2018. We gave the provider two days’ notice of the inspection as we needed to make sure the manager and staff would be available at the location. This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service mainly to older adults. Not everyone using Home Healthcare receives the 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.

Home Healthcare is an independent care agency providing personal care support to people living in their own homes. At the time of our inspection there were approximately 21 people using the service. 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.

At our last inspection of the service on 11 and 12 May 2017 we found breaches of regulations and took enforcement action serving a warning notice on the provider and registered manager, requiring them to address concerns we had identified. This was because medicines were not always managed and administered safely. Risk assessments were not detailed and did not provide guidance for staff to ensure people's safety and well-being. Staff recruitment systems were not consistently applied. Care plans and records lacked detail. Systems and processes in place to assess, monitor and improve the quality of the service were not established and operated effectively. At this inspection we found significant improvements had been made, the warning notice had been met and all required actions had been completed.

Medicines were managed and administered safely. There were safeguarding policies and procedures in place and staff knew what actions to take to protect people from harm. Risks were assessed, managed and reviewed to ensure people’s needs were safely met. Detailed guidance for staff on managing risk and needs were appropriately documented. Appropriate recruitment checks took place before staff started work and there were enough staff to meet people’s needs. There were systems in place to ensure people were protected from the risk of infections.

Assessments of people’s care and support needs were conducted and documented. Staff completed an induction when they started work and received appropriate training. Staff were aware of the importance of seeking consent and demonstrated good knowledge of the Mental Capacity Act 2005. There were arrangements in place to comply with the Mental Capacity Act 2005. People were supported to meet their nutritional needs where appropriate and people were supported to access health and social care professionals when required.

People told us staff were caring and respectful. People were consulted about their care and were provided with information about the service that met their needs. People received personalised care that met their diverse needs. People knew about the provider’s complaints procedure.

There were systems in place to assess and monitor the quality of the service provided. The provider took into account the views of people using the service and staff. There was an out of hours on call system in operation that ensured management support and advice was always available.

Inspection carried out on 11 May 2017

During a routine inspection

This announced inspection took place on 11 and 12 May 2017. We told the provider the day before our visit that we would be coming, as we wanted to make sure the registered manager and office staff would be available. The inspection was prompted in part by notifications of concern from local commissioning authorities. This inspection looked at the safety of people using the service in relation to missed or late calls. At the last inspection of the service in February 2016 the service was meeting regulatory requirements.

Home Healthcare is a small domiciliary care service that provides care and support to older people living within their own homes within the borough of Bromley. At the time of the inspection there were approximately 34 people using the service.

At the time of our inspection 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.

At this inspection we found breaches of regulations. We served a Warning Notice against the provider for the breaches found and we will re-inspect the service to check they have complied with the notice. You can see information about action we have asked the provider to take at the back of the full version of this report.

Medicines were not always managed and administered safely. Risk assessments assessing the levels of risk to people's physical and mental health were not detailed and did not provide guidance for staff in order to promote people's health and safety. Staff recruitment systems were not consistently applied and followed to ensure potential staff were suitable to work in the health and social care sector. Care plans and records lacked detail, did not address people’s lifestyle and cultural needs and did not contain guidance for staff on how to manage people’s needs and risks. Systems and processes in place to assess, monitor and improve the quality of the service were not established and operated effectively to ensure the safety and welfare of people using the service.

There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. There were appropriate numbers of staff to meet people’s needs. Staff new to the service were inducted appropriately and staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs were met and people had access to health and social care professionals when required. People told us they were treated with respect and staff were kind and supportive. People were provided with information on how to make a complaint. People using the service and their relatives were asked for their views about the service.

Inspection carried out on 10 February 2016

During a routine inspection

This announced inspection took place on 10 February 2016. We told the provider two days before our visit that we would be coming, as we wanted to make sure the office staff and registered manager would be available. At the last inspection on 3 December 2013 the service was meeting all the regulatory requirements we looked at.

Home Healthcare is a small family run domiciliary care service registered for personal care and treatment of disease disorder and injury. They provide care and support to older people in the borough of Bromley. At the time of the inspection there were 25 people using the service. At this inspection we were unable to inspect the regulated activity treatment of disease disorder and injury as this was not being provided at the time. The manager told us they had provided this through registered nurses when this was required as part of someone’s personalised care and support needs. One of the current senior office staff was an experienced registered nurse.

There was a registered manager in post and they had a previous background of work in the NHS. 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 service was outstanding in the way it responded to people’s needs. It had a strong person centred ethos. Care and support was flexibly organised to respond to any changing needs and to reflect people’s preferences and likes and dislikes. People and their relatives had a say in how they wanted to be cared for and this was respected by staff. The registered manager had a strong sense of equality, diversity and empathy and put these into practice in the way the service assessed and responded to people’s needs. We saw examples and professionals commented on the responsiveness and individualised nature of the service. People were encouraged to participate in a range of activities they enjoyed and the service worked proactively to reduce their isolation and access links in the community.

People told us they felt safe and that care workers were always very kind and caring. We saw many examples where care workers supported people above or beyond what was expected of them. Staff knew the people they cared for well and demonstrated a commitment to provide a good service.

Staff had received training on safeguarding adults and understood the possible signs to look out for and what action they needed to take. There were enough staff to meet the needs of people using the service. Medicines were managed safely. Risks to people such as environmental risks or risk of falls were identified and assessed and plans were put in place to reduce the risk of them occurring. There were effective recruitment procedures to reduce the risk of unsuitable staff. People were supported to have enough to eat and drink when this was part of the plan of support.

There was a range of suitable training and support for staff and the registered manager fostered a culture of positive learning and development. People told us they were asked for their consent before any support was given. There were arrangements to comply with the Mental Capacity Act 2005. Complaints were managed appropriately and there were systems to monitor the quality of the service including obtaining people’s views. Care workers told us they worked well as a team and were complimentary about the open, approachable and enabling style of the manager.

Inspection carried out on 6 December 2013

During a routine inspection

People we spoke with were happy with the care they received from the agency. We reviewed comments people made about the service in the satisfaction surveys that had been undertaken in 2013. Comments included �I am very satisfied with the service� and �the carers are doing a splendid job�. People told us the carers arrived on time, were reliable and delivered excellent care.

We found that people were involved in the decision about their care and were given adequate information about the service. The care was planned and delivered in a way that met people's needs. Risk assessments and care plans were individualised and reflected people�s needs. The provider monitored the quality of the service and the standard of care being delivered and responded to any concerns raised promptly. Staff received the appropriate training and supervision to support them in carrying out their role as carers and companions. People were supported in taking their medication and liaised with other healthcare professionals when necessary.

Inspection carried out on 28 November 2012

During a routine inspection

People we spoke with told us that they were very happy with the service provided and that staff were reliable and punctual. People said that staff were polite, courteous and nothing was to much trouble for them. A relative told us that the cost was fully explained and they had a copy of the agreement in a file with the care plan and the manager carried out spot checks regularly to make sure they were happy. People told us the staff were 'excellent' and 'nothing was to much trouble'

We found that care plans had been re written and reviewed on a regular basis and information was clearly documented. Records were stored securely and there were systems in place to report safeguarding incidents. There was a policy and process in place for ensuring that appropriate trained staff were recruited and the safety checks were completed.

Inspection carried out on 20 September 2011

During a routine inspection

People we spoke with told us that staff were polite and caring and always treated them with respect.

A relative we spoke to said �Staff are warm and friendly, the service is fantastic and flexible.

we were told that staff are always on time and provide a good service.

People told us that although the care was good they would like to have the same carers at every visit.