This was an announced inspection carried out on 19 and 25 June 2018.

Alpenbest is a home care agency. The service provides personal care and support to mainly older people, although some younger adults use the service as well, living in their own homes in South West London and Surrey. At the time of our inspection approximately 380 people with a range of health and personal care needs were receiving a home care service from this agency. This included people living with dementia, physical disabilities, mental ill health, learning disabilities and autistic spectrum disorders and sensory impairments. In addition, six people received a 24-hour home care service from this agency and had live-in care staff.

40 people who received a service from Alpenbest did not receive a regulated activity from them. The CQC only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service had a newly registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a 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 home care agency’s last comprehensive CQC inspection, which we carried out in May 2016, we rated them ‘Good’ overall and for all five key questions we always ask, ‘Is the service safe, effective, caring, responsive and well-led?’ At this comprehensive inspection we found the provider continued to meet all the regulations and standards we looked at and had improved the way the service was managed and led. Consequently, we have continued to rate them ‘Good’ overall and for all five key questions described above.

People and their relatives told us they remained happy with the standard of the service provided by this home care agency. We saw staff continued to look after people in a way which was kind and caring. Our discussions with people, their relatives and community health and social care professionals supported this.

People continued to feel safe with the staff who regularly provided their care and support. There remained robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider continued to assess and manage risks to people's safety in a way that considered their individual needs. Staff recruitment procedures prevented people from being cared for by unsuitable staff. People did not have any major concerns about staff turning up late or missing a scheduled visit. This indicated there were sufficient numbers of staff available to support people. Staffing levels were continuously monitored by managers and senior staff to ensure people experienced consistency and continuity in their care and that their needs could be met always. Where the service was responsible for these medicines continued to be managed safely and people were administered their medicines as they were prescribed.

Staff continued to be suitably trained and supported to ensure they had the right knowledge and skills to effectively meet people's needs. Managers monitored staff training to ensure their existing knowledge and skills remained up to date and were in regular contact with the staff team to

check they were clear about their roles and responsibilities. Managers and staff continued to adhere to the Mental Capacity Act 2005 code of practice. People were supported to eat healthily, where the agency was responsible for this. Staff also took account of people’s food and drink preferences when they prepared meals. People received the support they needed to stay healthy and to access healthcare services. Staff were knowledgeable about the signs and symptoms to l

We carried out this announced inspection on 9 & 11 May 2016. We last inspected this service in September 2014. At that inspection we found the service was meeting all of the regulations we assessed.

Alpenbest is a domiciliary care provider which provides support and care to 369 people living in their own homes. People who use the service are mainly older adults living within the local community, some of whom have dementia. The service also supports some younger adults.

There was a registered manager employed 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 received good and effective care from their regular staff. However they said that when changes were made to the rota and at weekends, some difficulties were experienced in that they did not always receive care from their regular car worker.

We talked about this with the director and we discussed people’s concerns about the continuity of staff and their use of the English language. He told us the agency had recognised this was a problem and explained several strategies they had put in place to address these problems. This included changes to the recruitment process; induction training and staff supervision. We found evidence that indicated positive progress had been made that would continue to improve the issues that were raised.

People told us they felt safe with the care and support they received. Staff were aware of the different forms of abuse and knew what to do if they encountered concerns.

Appropriate risk assessments were in place that helped keep people and staff safe and minimise any potential risks. Accidents and incidents were recorded and monitored so appropriate action could be taken to prevent further occurrences.

There were good levels of staffing that helped meet people’s needs. Recruitment processes were robust as were the arrangements for prompting and administering medicines to people.

All staff received training at induction and then annual refresher training. Staff told us access to training was good. They said they found training very helpful.

Our inspection of staff records indicated that staff received effective monthly supervisions and annual appraisals.

The staff demonstrated that they were aware of people's capacity to make decisions about their care and documented this in people's written records.

We found that people who used the service were supported to have a nutritious and balanced diet. Where necessary the provider ensured people were appropriately supported with their healthcare needs.

People we spoke with said the staff who supported them were caring and polite. People told us staff treated them with kindness and compassion and always respected their dignity and privacy.

People said that they felt listened to by staff, the registered manager and the care coordinators. Commissioners were positive about the support offered by the agency to people.

People indicated that they felt that the service responded to their needs and individual preferences. Staff supported people according to their personalised care plans. Care plans were reviewed annually or earlier if people’s needs changed.

We saw there was an appropriate complaints policy in place that people were aware of. People told us that the provider encouraged people to raise any concerns they had and responded to them positively and in a timely manner.

The director, the registered manager and the staff team were helpful and well organised. We found there was a positive culture in the agency and good leadership. There were effective systems in place to continually monitor the quality of the service and people were asked for their opinions via feedback su

When we inspected the service on 21 May 2014, we found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the recording and safe administration of medicines. We asked the provider to send us a report by 17 June 2014, setting out the action they would take to meet this standard. They wrote to us on 13 June 2014 with a plan which set out how they intended to make improvements to the management of medicines. They told us that they would do this by 12 September 2014.

We returned to the service on 19 September 2014 to check whether these improvements had been made. This inspection was carried out by an inspector and a pharmacy inspector.

We considered our inspection findings to answer the question: Is the service safe? Below is a summary of what we found. The summary is based on speaking to people who used the service and reviewing records. We also spoke with five senior or office-based staff and four members of care staff. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that significant improvements had been made since our last visit. The changes had taken longer than expected due to the size of the service, the number of employees and the number of people being supported with their medicines.

Staff had received further training in medicines administration and supervisors checked they were competent to administer medicines both as part of the training and via unannounced quality checks. There was a quality assurance system in place to ensure that medicine records were properly completed and if they were not, processes had been followed to address any deficits. The provider had improved the information available to staff about people's medicines to enable staff to administer medicines safely.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, their relatives and the staff supporting them and from looking at records. We spoke with ten people who used the service, 11 relatives of people who used the service and one professional representative of a person who used the service. We spoke with seven members of staff and reviewed eight people’s care plans.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service used a detailed risk assessment document. The form allowed the service to identify and put in place actions that would reduce risks to people’s safety and welfare. The action plans did not always show risks that were specific to individual people, which may mean some hazards were overlooked at times. Staff were trained to respond to emergencies and showed awareness of what to do if a person fell or if there was a fire.

Staff were trained in food hygiene awareness to help ensure that people’s food was prepared safely. Staff kept records of people’s food and drink intake to ensure people were safeguarded against the risks of inadequate nutrition and hydration.

The service had the proper procedures in place with regard to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people’s human rights were properly observed.

The service made sure that medicines were kept safely and took steps to address this if they were not. Staff were trained in the safe administration of medicines. However, we found that there were shortfalls in the quality of records about medicines, including medicines administration records and information in files about medicines to be given as and when required. This meant that people were not safeguarded against the risks of inappropriate or unsafe administration of medicines by the maintenance of accurate and complete records. We have asked the provider to tell us what action they intend to take to ensure this standard is met.

Is the service effective?

There was evidence in people’s care plans that people and their relatives were involved in planning care. Records kept by staff showed that they asked people’s consent before delivering care and if people declined to receive care this was documented. This helped to ensure that people only received the care they agreed to have, taking into account people’s changing moods and wishes. Care plans were reviewed annually and updated more often if required so that information held about people reflected the care and support they needed and wished to have.

The provider assessed the needs of each person before they used the service so that they were familiar with people’s needs, preferences and expectations of the service. People we spoke with told us the care they received met their needs and said, “They’ve never let us down.”

The service took advice from other professionals to help them plan for people’s individual needs. Staff had an induction based on national standards to ensure the care they delivered reflected relevant research and guidance. Regular training updates were given so staff were up to date with their knowledge and skills.

Is the service caring?

People told us, “The staff are all very nice” and “The staff are devoted to their work and thoroughly professional.” One relative said this was “very variable and depended on the carer that turned up.”

People were provided with a choice of suitable and nutritious food and drink including balanced meals and healthy snacks such as fruit, tea and fruit juice. This was designed to take into account their preferences and cultural needs. One person said “I think the food my carer makes is lovely”. Another person told us “most of the meals the carers prepare my mother look and smell pretty good”. The provider gave people advice on caring for themselves during times when staff were not present.

Is the service responsive?

We saw evidence that the service had contacted social services to request increased care hours when a person’s needs changed and they required extra support. People and their relatives told us staff were flexible. One relative said, “They go out of their way to make sure I’m pleased.”

The service had a training plan which was designed to meet the needs of people using the service. This showed that the provider responded to the needs of people who used the service by ensuring that staff were equipped with the necessary skills and knowledge to meet their needs. The provider referred people to social services if they identified any unmet needs that the service could not assist with.

People we spoke with said the agency was responsive to their feedback. People told us, “They always listen” and, “They act immediately. They will always act on your feedback.” There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. Eight people we spoke with told us the service had taken on board their comments and made improvements as a result.

Is the service well led?

The provider ensured effective communication with staff by means of regular memos, newsletters, supervision and team meetings. Staff were enabled to work towards their professional development, including qualifications relevant to their work.

The provider carried out a number of quality assurance checks, such as audits, spot checks and surveys. This helped to ensure that people’s care reflected their current situation in terms of needs and preferences. They asked people and their relatives if they were satisfied and there was evidence that should a staff member fall short of the expected standards, this was addressed in supervision or training and further spot checks had been carried out or planned to ensure improvements were made.