The inspection took place on 12 and13 June and 3 July 2018. The inspection was announced.

This service is a domiciliary care agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. Not everyone using Boldglen Limited Medway Swale receives 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. At the time of inspection, although the service supported approximately 250 people in total, approximately 120 people were receiving personal care in their own homes.

A registered manager was employed at the service by the provider. 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 on 11 March 2016, the service was rated as ‘Good’. At this inspection, we found that there were now areas that required improvement. This is the first time the service has been rated Requires Improvement.

Individual risks were not always identified to ensure measures were put in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were documented to keep people and staff safe from identified hazards.

Some areas of the management of people’s prescribed medicines needed improvement to ensure safe administration by staff at all times. Gaps were evident in medicines administration records (MAR). Guidelines and information about the medicines people took were not available.

A safeguarding procedure for staff to follow should they have concerns about people was available to staff. People told us they felt safe and knew who they would talk to if they did not.

Staff followed safe practice to control the risk of infection and always had enough equipment such as disposable gloves and aprons available to wear.

The provider and registered manager followed safe recruitment practices to make sure only suitable staff were employed. Enough staff were available to be able to run an effective service and be responsive to people’s needs. People told us they always, had the same staff supporting them; staff were on time when visiting; always stayed for the full time they were allocated.

Staff had suitable training at induction when they were new as well as continuing regular updates. Staff were supervised by a manager regularly to check their competency and offer support.

People told us they made their own decisions and choices. The registered manager understood the basic principles of the Mental Capacity Act 2005 and made sure their processes upheld people’s rights.

Although many people did not require the assistance of staff with their nutrition and hydration needs, some people did require this support. People and their relatives told us they were happy with the support given by staff and it worked well.

Many people did not require the assistance of staff to look after their health care needs as they either managed this themselves or had a relative or friend to help. Where support was required, people told us staff were observant and offered advice or to make appointments with healthcare professionals.

The positive and caring approach of staff was clear from the responses of people and their relatives, telling us how happy they were with all the staff who supported them. People told us they had regular staff providing their care and support so had got to know them well, creating confidence and trust. People were given a service user guide at the commencement of their care and support with the information they would need about the service they should expect.

An initial

We inspected the service on the 28 January 2016. This inspection was unannounced on the first day, arrangements were made for a second day at the home on the 1st February 2016.

Boldglen provides personal care to older people, including people with dementia and physical disabilities in their own home and support in the community. The agency provides care for people in the Medway area and Swale which includes Sittingbourne and the Isle of Sheppey. There were around 200 people receiving support to meet their personal care and community support needs on the day we inspected.

The service had a registered manager. 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 were protected against the risk of abuse. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

Risk assessments were detailed and gave staff guidance about any action staff needed to take to make sure people were protected from harm.

Effective recruitment processes were in place and followed by the registered manager. Staff had the opportunity to discuss their performance during one to one supervision meetings and annual appraisal. Staff also received appropriate training with timely refresher training so they were supported to carry out their roles.

There were suitable numbers of staff on shift to meet people’s needs. People’s planned care was allocated to members of staff and at appropriate times.

People were supported and helped to maintain their health and to access health services when they needed them.

People told us staff were kind, caring and communicated well with them. People’s information was treated confidentially. Paper records were stored securely in locked filing cabinets.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was in place which included steps that staff should take to comply with legal requirements.

People’s view and experiences were sought through review meetings and through surveys. People’s views about the service were positive.

People were supported to be as independent as possible. People had access to additional resources through the service to prevent loneliness.

People told us that the service was well run. Staff were positive about the support they received from the registered manager. They felt they could raise concerns and they would be listened to.

Audit systems were in place to ensure that care and support met people’s needs.

Communication between staff within the service was good. They were made aware of significant events and any changes in people’s behaviour.