This announced inspection was carried out on 13 and 21 December 2018. We completed inspection activity on 25 January 2019. We gave the provider two days’ notice of the inspection to make sure that key staff we needed to speak with were available. The service was rated as Good at the previous inspection in May 2016. At this inspection we have rated the service as Requires Improvement.

Age UK Kensington and Chelsea is a domiciliary care agency which provides the regulated activity of ‘personal care’ to people living in their own houses and flats in the community. Not everyone using Age UK Kensington and Chelsea receives regulated activity. The Care Quality Commission (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 the inspection the provider was providing services for 47 people, which included 27 people who received personal care.

A registered manager is a person who has registered with CQC 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 the time of the inspection the manager had appropriately applied to CQC for registered manager status.

We found the provider did not always have detailed risk assessments in place to identify risks to people’s safety and well-being. For example, staff had recorded their concerns about a person’s skin integrity in their daily visit sheets but this was not reflected in the person’s risk assessment.

Recruitment practices did not always demonstrate that references for staff were checked to ensure they were genuine, to ensure that people who used the service consistently received care and support from staff with appropriate skills and background to work for the provider.

People who used the service felt safe with staff, who had received training to protect people from the risk of abuse and harm. Staff were also trained to protect people from the risk of cross infection and were provided with personal protective equipment to use at people’s homes.

Staff told us they felt well supported by the management team. Records demonstrated that staff had received induction, mandatory training, individual and group supervision, and annual appraisals. Team meetings were also held by the manager to bring staff together for discussions about their work and development.

Where required staff supported people to meet their nutritional needs and attend health care appointments. People were supported to meet their medicine needs where this formed part of their agreed care plan. Staff informed us they reported any concerns about a person’s health to their line manager so that applicable health care professionals could be informed.

The provider understood how to protect people’s rights and supported people to make choices about their care and support in line with their capacity to do so. People were supported in a respectful manner that promoted their dignity. Staff understood how to meet people’s religious and/or cultural needs. People and relatives liked receiving their care from a limited number of conscientious and reliable care staff that they got to know well.

The care plans were being reviewed and updated by the manager to ensure that people’s needs and wishes were described in a more individual and detailed manner. We noted that some plans needed more written guidance for staff to provide care and support that was tailored to people's unique needs and aspirations. People and relatives were given information about how to make a complaint. We saw that where complaints and safeguarding investigations had occurred, the provider carried out its own analysis to identify and address shortfalls in how the service operated.

People

The inspection was conducted on 29 April and 6 May 2016 and was announced. We gave 72 hours’ notice of the inspection to ensure that the staff we needed to speak with were available.

Age UK Kensington & Chelsea At Home Service is a domiciliary care agency which provides personal care services to people living in their own homes. At the time of our inspection there were 12 people using the personal care service. The agency also provides basic foot care services to approximately 300 people at several public locations within the Royal Borough of Kensington and Chelsea and neighbouring districts, and at people’s own homes. At our previous inspection on 9 October 2013 we found the provider was meeting the regulations we inspected.

There was a registered manager at the service. 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 told us they felt safe and happy with their care workers. We noted that there were systems in place to make sure that people were protected from the risk of harm. Staff had received safeguarding training and were familiar with the provider’s policies in relation to safeguarding vulnerable adults and raising any concerns about the conduct of the agency. Assessments were carried out in order to identify any risks to people’s safety and wellbeing, which were addressed through the implementation of individual risk management plans that took into account people’s wishes wherever possible.

Care planning records demonstrated that people’s capacity was assessed and documented in their care files. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and promoted people’s rights to make choices and decisions.

Staff were described as being punctual and reliable by people and their relatives. People developed positive relationships with their care workers as the provider ensured they received a consistent and stable service from the same regular care workers. We received complimentary comments from people and their relatives about the competent manner and friendly approach of the basic foot care workers. Robust recruitment practices were in place to make sure that people received care and support from staff with suitable qualifications and experience for their roles.

Staff undertook relevant training to understand and meet people’s needs. They received formal and informal support and guidance from the registered manager and care co-ordinator. Staff told us they were offered opportunities to develop their knowledge and skills and felt valued by the provider.

Assessments were conducted to identify people’s support needs and this information was used to develop their care plans. Staff had received training to prompt people to take their prescribed medicines and understood their responsibilities. The provider’s training programme, and policies and procedures, ensured that staff knew how to respond to any medical emergencies or significant changes in a person’s health and wellbeing.

The care plans contained meaningful details about people’s routines, social interests and daily lives at home, which enabled staff to provide personalised care. People’s privacy and dignity were promoted and staff recognised the importance of encouraging people to maintain as much independence as they could.

People and their relatives told us they had been provided with information about how to make a complaint and were confident that the provider would thoroughly investigate any complaints and concerns.

People and their relatives told us they thought the service was well managed. There were clear protocols in place to monitor the quality of the service, which included systems to seek and act on the views of people and their relative

We spoke by telephone to a small number of people who use the service. They said that they received the support that they needed. They were complimentary about the service. One person said “it has been wonderful. It has saved my life and sanity”. Another person said “ the staff couldn’t be kinder”. We also saw positive written feedback collected annually through a client satisfaction survey. People confirmed that their privacy and dignity was upheld.

People and their relative were involved in drawing up their care plan plans. The plan was based on their needs and their risk assessment. People had one main carer during the week. People confirmed that if there was a change from their usual care worker the office let them know in advance.

Appropriate checks, including disclosure and barring were carried out as part of the recruitment procedure before people started work.

The agency carried out an annual survey of clients’ views and collected other feedback informally.

People who used the service gave their consent and signed a contract before care was carried out. People told us that staff always asked them for their consent and did not carry out any activity unless they wanted them to. Staff assessed people’s mental capacity to make decisions, before carrying out care.

Each person had a care plan that was based on their risk assessment. People told us that they were "satisfied" with the quality of care they received. One person told us that they aware of their care plan and that staff were "really wonderful". Staff knew how to recognise the signs of abuse and how they should be reported internally. The provider had arrangements in place for team meetings, mandatory training, supervision and appraisals of staff members.

The provider’s record keeping policy complied with the Data Protection Act 1998. Written records were clear, concise and legible. Records were kept securely and could be located promptly when needed. Both people using the service and staff files were kept in lockable filing cabinets in the office and were easily accessible when required.

We spoke to a small number of people who use the service on the telephone.

People we spoke with said that were satisfied with the service and found staff kind, helpful and friendly. People confirmed that their privacy and dignity was upheld.

People we spoke with said that they received the support that they needed and that Age Concern Kensington and Chelsea also offered other support services which they found very helpful. People were not able to confirm if they had a care plan in their home but indicated that their care workers knew them well. People said that if the there is a change from their usual care worker the office will let them know in advance.

People confirmed that they felt safe with the service they receive. People were not aware of a formal complaints procedure and said they had no reason to complain.