People’s experience of using this service:

• Allfor Care Alpha Care Recruitment West and Home Care Service Limited is a privately owned domiciliary care agency providing personal care to people who live in their own homes in the London Boroughs of Ealing and Hounslow and surrounding areas. At the time of our inspection the agency offered a service to 36 people. Some of the people were older adults with associated health and personal care needs and some were younger adults with learning disabilities or mental health needs. The provider had two other registered locations providing domiciliary care services one located in the London Borough of Harrow and one in the London Borough of Kensington and Chelsea.

• The administration of people’s medicines was not always recorded accurately to confirm they were taken as prescribed.

• Risk management plans were not always in place to provide care workers with the information to enable them to mitigate identified risks when providing care.

• When incidents and accidents occurred, they were not investigated to identify appropriate actions which could be taken to reduce the risk of reoccurrence.

• Care workers were not always deployed appropriately to ensure there was additional staff to cover visits during period of annual leave or sickness.

• People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

• Information was not always provided in an appropriate format to enable people to be involved in decisions about their care.

• Records did not always provide up to date information relating to people’s care.

• The provider had quality assurance processes in place but these were not robust to provide adequate information to identify areas requiring improvement.

• People told us they felt safe when they received support from the care workers in their own home. The provider had a process in place to respond to concerns relating to the care provided.

• People were happy with the care they received, they felt the care workers treated them with dignity and respect as well as helping them maintain their independence whenever possible.

• Care workers received training and appropriate equipment to help manage risks associated with the spread of infection.

• People were supported to eat and drink where required.

• People told us they knew how to raise concerns about their care.

Improvement action we have told the provider to take:

• The service has been rated requires improvement and we have identified four breaches of regulations. These were in relation to person-centred care, need for consent, safe care and treatment and good governance. Please see the action we have told the provider to take in the section towards the end of the report.

Rating at last inspection:

• The last inspection took place on 23 June 2016. At this inspection we rated the service good overall and for all of the key questions we ask. (Report published 15 July 2016)

Why we inspected:

• This was a scheduled inspection based on the previous rating

Follow up:

• We will be requesting an action plan from the provider identifying how they are going meet the regulations and improve the service to at least a good rating. We will also continue to monitor the service.

The inspection took place on 23 June 2016 and was announced. We gave the provider 48 hours' notice because they provide a domiciliary care service and we wanted to make sure they would be available to speak with.

The last inspection of the service was on 31 January 2014 when we found no breaches of Regulation.

Allfor Care Alpha Care Recruitment West and Home Care Service Limited is a privately owned domiciliary care agency providing personal care to people who live in their own homes in the London Boroughs of Ealing and Hounslow and surrounding areas. At the time of our inspection the agency offered a service to 21 people. Some of the people were older adults with associated health and personal care needs and some were younger adults with learning disabilities or mental health needs. The provider had one other registered location providing domiciliary care services located in the London Borough of Harrow.

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 and associated Regulations about how the service is run.

People who used the service were happy with the care they received. They said that care workers were kind, caring and polite. They felt their needs were being met and the care workers arrived on time. People felt involved in planning their care and told us the agency was responsive to their concerns and feedback.

The staff received the support, training and information they needed to care for people safely and meet their needs. There were appropriate procedures for recruitment which meant that only suitable staff were employed. The staff had opportunities to meet with the manager and discuss their views and experience.

There were clear and appropriate systems for assessing the quality of the service. These included asking people who used the service for their opinions and regularly checking that they were happy with the service. The manager and senior staff knew the service well and had a good knowledge of individual people who used the service, their needs and the staff who cared for them. They had improved systems for coordinating and monitoring the service and were looking at ways for continued improvements. They liaised with the local authorities who purchased the care and other providers to keep themselves up to date with changes in good practice guidance and legislation.

During our inspection we spoke with two people, one relative, two staff members and the assistant manager. All people confirmed that the care delivered by the agency was good and met their needs. People told us that they were involved with their care planning from the time they started to use the agency. They told us their care was continuously reviewed with their involvement and consent.

People told us that they felt respected by staff. One person said, “I feel respected and valued always".”

The agency ensured people using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent this from happening.

Staff were aware of their role in safeguarding.

Staff we spoke with told us that they were supported by the agency in their work. Comments from staff included, "We feel supported, adequate training and support is available".

We found that the agency had good systems in place to assess and monitor the quality of service provision.

Everyone we spoke with said they were happy with their regular care workers and gave us positive feedback about them. People told us their regular care worker knew their needs well and how they liked things to be done. Several people said they had had the same care worker for a long time and had developed a good relationship with them.

None of the people we spoke with, or their friends and family members, said that they had ever had any concerns about the treatment they received from care workers. People told us that the agency telephoned them from time to time and occasionally visited them at home to check they were happy with the service they received.

We looked at three care records, spoke with two people who use the service and three members of staff. People who use the service told us they were happy with the care that they received. One person told us " I have been a client of the service since 2002 and I am very happy with the care I receive". Another person told us "I am very happy with the care I get".

We looked at the care records of people and found there was a system in place to ensure people consented to their care. People had an assessment of their care needs before they started using the service. A care plan was then implemented to ensure staff knew how to deliver care safely and effectively.

The service had suitable staff arrangements to ensure people's needs were met. The staff had been appropriately trained and therefore knew how to identify and report any concerns of abuse.

We looked at the provider’s complaints system and found people were able to make complaints if needed and these were dealt with appropriately.