This comprehensive inspection took place on 28 July 2017 and was announced.

Astha Limited delivers personal care and reablement support to people in their own homes within the London Boroughs of Redbridge and some areas of Newham. At the time of our inspection, approximately 49 people were using the service. The service employed 29 care workers who visited people living in the community.

A reablement service aims to provide short term support to people in order for them to stay independently in their own home by regaining daily living skills and improving their quality of life often following a stay in hospital.

The service had a registered manager who had recently left the provider. There was a new manager in post at the time of our inspection and they were in the process of registering with the CQC to be the registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered care homes, 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.

We last inspected the service in June 2016 and found that the service required improvement because we had identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the risks associated with the unsafe use and management of medicines, an ineffective system for receiving and responding to complaints and for monitoring and mitigating risks relating to the health, safety and welfare of people who used the service and staff. After the inspection, the provider wrote to us and provided an action plan to say what they would do to meet legal requirements. The provider told us they would be compliant by February 2017.

As part of this inspection, we checked if improvements had been made by the service in order to meet the legal requirements. We found that the service was now compliant in these areas.

Medicine administration and recording was managed safely. When required, staff administered people’s medicines and had received appropriate training to do this. They recorded medicines that they administered to people on Medicine Administration Record (MAR) sheets, ensuring that all important and relevant information was entered.

The provider had sufficient numbers of staff available to provide support to people. Staff had been recruited following appropriate checks with the Disclosure and Barring Service. Staff provided safe care in people’s homes.

A complaints procedure was in place. People and their relatives knew how to make complaints, express their views and give feedback about their care. They told us they could raise any issues and that action would be taken by the management team. We have made a further recommendation about the provider’s complaints procedures.

The management team worked together to help develop the service and monitor the quality of care provided to people. They ensured that regular checks and audits were carried out and looked at where improvements could be made. Feedback was received from people, staff and relatives to help drive further improvement.

We found that systems were in place to ensure people were protected from the risk of abuse. Staff were able to identify different types of abuse and knew how to report any concerns.

People received care at home from staff who understood their needs. They had their individual risks assessed and staff were aware of plans to manage the risks.

Staff received training that was important for them to be able to carry out their roles. They told us that they received support and encouragement from the registered manager and were provided opportunities to develop. Staff were able to raise any concerns and were confident that they would be addressed by the management team.

People were treated with respect and their

The inspection was announced and took place on 9 and 15 June 2016.

Astha Limited is registered to provide domiciliary personal care and support services to people. At the time of our inspection the service was providing personal care to 27 people in their own homes. Astha Limited provided other types of care in the community to another 26 people but these were not regulated activities that fell under the remit of our inspection. Some people who use the service were supported through round the clock care where staff worked in shifts. The time and frequency of other visits depended on people’s individual needs.

Our last inspection was on 4 March 2014 where we found all standards were met.

At the time of our inspection the registered manager was on planned absence from work and cover was provided by the nominated individual for 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.

The feedback we received from people was mostly positive and three people told us they had seen improvements in the way complaints were dealt with. However some people were not confident in the complaints procedure and complaints were being used to record accidents and incidents reported by staff.

Two people told us that they had found difficulties in contacting the office outside of the usual working hours even though a telephone number had been given to them.

The safety of people who used the service was taken seriously and staff were aware of their responsibility to support people’s health and wellbeing. However, we found that the recording of medicines administration hadn’t always been safe. People had not always received all their medicines as prescribed and we found that one medicine administration record had been altered which was a risk to people’s health and welfare.

Staff had an understanding of people’s care needs and had the skills and knowledge to meet them. People received consistent support from staff who knew them well and all the people we contacted spoke positively about the care workers.

People valued the attention to culture, language and religion and the work done by the office to match care workers where possible. People had positive relationships with their care workers and felt that improvements had been made in the service through provision of the same workers who had built relationships with people and their families. There was a strong emphasis on valuing and respecting people’s culture, religion and language. People told us that they were treated with dignity and respect. Care plans considered people’s strengths and independence whilst assessing risk appropriately and planning outcomes. People received a service that was based on their personal needs and wishes. As most of the people using the service lived with other family members regard had been given to this.

The management team sought feedback from people and their families through making spot check visits, quality assurance phone calls and sending out questionnaires, however this was limited and did not capture the experiences of enough people to robustly inform improvements to the service. A new software system had been installed just prior to our inspection and staff were positive that this would lead to improvements in the service.

Staff were motivated to learn and develop and most of the care workers told us they were supported by the management team. Staff were encouraged and enabled to access training and this helped them to provide a quality service to people. However, staff were paying for some of their training which could disadvantage some staff without the funds to do this.

The nominated individual who was managing the service in the absence of the reg

People’s needs were assessed and care was planned and delivered in line with their individual care plan. People told us they were satisfied with the care and support provided. One relative of a person who used the service said "they have made a lot of effort to understand what he needs." We found that care plans and risk assessments were in place which set out how to meet people's assessed needs.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The service had a safeguarding vulnerable adult’s policy in place and staff were aware of their responsibility for reporting safeguarding concerns to their manager. However, not all staff were aware of the responsibilities with regard to whistleblowing. We found employment checks had been carried out on staff including Disclosure and Baring Service checks. These are to see if a person has any criminal convictions or are on any list that bars them from working with vulnerable adults or children.

The service had systems in place for seeking the views of people who used the service. A relative told us "the other day they came to see if everything was alright." We found records were up to date and stored securely.

We haven’t been able to speak to people using the service because people were not able to communicate verbally with us in a meaningful way. We gathered evidence of people’s experiences of the service by visiting them in their own homes, and speaking with their relatives. We saw that staff interacted well with people, and people appeared relaxed and at ease in the presence of staff. Relatives spoken to gave very positive feedback about the service. Comments included, “I can’t ask for anything better.” and “They understand the cultural and religious needs of mum.”