This inspection took place on 25 October 2016. The provider was given 48 hours’ notice because the service provides a domiciliary care service in people’s own homes and we needed to be sure that someone would be available to assist with the inspection. We last inspected the service in December 2013, when they were compliant with the regulations we checked.

Care Associates (Recruitment) Ltd provides personal care and support to people in their own homes, within the London Borough of Redbridge. At the time of our inspection, approximately 24 people were using the service. The service was employing 10 care workers who visited people in the community.

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 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.

There were systems in place to ensure people were protected from the risk of abuse. Staff were aware of the different types of abuse and how to report abuse. People had their individual risks assessed and staff were aware of the plans to manage the risks.

People received care at home from staff who understood their needs. When required, people received their prescribed medicines safely, which were administered by staff who had received training to do this.

The provider had sufficient numbers of staff available to provide support to people. Staff had been recruited following appropriate checks, although the service had not carried out recent Disclosure and Barring Service checks for long serving staff. We have made a recommendation about staff recruitment checks.

Staff received training in a number of topics that were important for them to be able to carry out their roles. They told us they received support and encouragement from the management team and were provided opportunities to develop. Staff were able to raise any concerns and were confident that they would be addressed. We have made a recommendation about staff training charts for monitoring purposes.

People were treated with privacy and dignity. They were listened to by staff and were involved in making decisions about their care and support. People were supported to meet their nutritional needs and were registered with health care professionals.

People told us they received support from staff who understood their needs and encouraged them to remain as independent as possible. However, care plans were not always personalised to include people’s opinions and preferences about how they preferred to be cared for. We have made a recommendation about developing more person centred care plans.

People and their relatives were encouraged to express their views and give feedback about their care. They told us they could raise any issues and that action would be taken although some people were not confident that they knew how to raise a formal complaint. We have made a recommendation about the accessibility of complaints procedures for people using the service.

The registered manager was committed to developing the service and monitoring the quality of care provided to people. They ensured that regular checks were completed and looked at where improvements could be made. However, we have made a recommendation about staff meetings to promote team building.

People who use this service and their relatives told us that they were very happy with the care and support that the agency provided. One person said "I have known two of my carers for a long time and I never have to tell them what to do, they know." A relative told us "my mother has consistent carers. We feel confident enough to leave her with the carer when we go out."

People's consent was sought and their views were taken in to account in the way the service was delivered. Their needs were assessed and care was planned and delivered in line with their individual care plan. People's care and welfare needs were being met by a consistent group of carers who were trained and skilled to meet their individual needs.

People knew who to contact if they were not satisfied with the support they received. They told us they had confidence the service would deal with any issues that arose. One person told us "when I had an issue I raised it with the manager. They took action to change things."

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency. This inspection was part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they could make choices about their care.

As part of the review we visited two people in their own home with a manager from the agency and spoke with five other people and their relatives about their experiences of the support they received. We also spoke with four care workers on the telephone. The Expert by Experience conducted telephone interviews with four people to seek their views about the service.

Everyone we spoke to made positive comments about the care and support they received. They told us that the care workers treated them with respect and their dignity was protected.

People told us that their care and treatment was planned and delivered in line with their individual care plan. A relative told us, " yes my mother has a care plan. I can't speak highly enough of them, they are absolute life savers."

People we spoke with told us that they felt safe when the care workers visited them and if they had concerns they would speak with a family member, friend or somebody from the office. One person said, "when somebody comes to your flat everyday you want some one you can trust. I feel safe with them very much."

People we spoke to had confidence in the skills and experience of their care workers.

One person said, " if they couldn't look after me properly I would change the agency straight away." A relative told us, " yes they have the right skills and have patience. They look after her as I would." Another relative said, "she shows a personal interest in my parents, she is very respectful and patient."

People said that they were asked for their views about their care and treatment and their feedback was listened to and acted upon.

We visited Care Associates (Recruitment ) Limited on 7th December 2010 and had a discussion with the manager of the service. Staff and people who use the service's records were examined. Another day was spent talking to people who use the service and their relatives by telephone as well as the staff/ care workers and the commissioners of the service at the London Borough of Redbridge and the Penderals Trust. People made a range of positive comments about the service,

"I have more or less the same carers every day. I have no complaints and feel safe with them"

Two relatives spoken to said,

"The agency retain some very dedicated staff which means continuity of care. They are very professional, reliable and trust worthy. The manager always rings me personally if a care worker isn't able to come."

"I am very happy with the voucher scheme and the agency. My wife has the same person looking after her each week and I feel confident when I leave my wife with the person."

The care workers also spoke highly of the managers, feeling supported and included in the agency.

However one relative of a person who receives a high needs, specialised service, stated some dissatisfaction with disruption to the continuity of care, when on occasion one care worker instead of two arrive or when a carer is on leave, which leads to changes in the way the service is delivered.