The inspection took place on 12, 13 and 14 December 2017. The provider was given 48 hours’ notice as they provide a care service to people in their own homes; we needed to be sure someone would be available to us.

Care Support Newham Branch is a domiciliary care agency. It provides personal care to people living in their own homes. Most of the people receiving a service are older adults. At the time of our inspection they were providing care to approximately 140 people.

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 2008 and associated Regulations about how the service is run.

At the last inspection in November 2016 we issued the provider with three warning notices which required them to address breaches of our regulations regarding safe care and treatment, person centred care and good governance. The provider had taken steps to address our concerns about governance and person-centred care, but issues with the safety of the service remained.

Risks to people were identified through the care plan assessment and review process. However, the measures in place to mitigate risk lacked detail and were not always clear.

People were supported to take medicines by their care workers. However, the systems in place did not ensure this was managed in a safe way as there were discrepancies between the information held in care files and medicines records. Medicines records were not always complete.

The provider had completed work to improve the quality and detail in care plans. However, the level of information varied and not all plans contained sufficient detail to ensure people received personalised care. The provider demonstrated they understood the level of detail required. They submitted updated plans and an action plan to ensure all care plans contained the required level of detail.

The provider had not submitted all the notifications they were required to submit to us by law.

The quality assurance and improvement systems were not effective in fully addressing the concerns identified at the last inspection. However, the registered manager responded positively to our feedback and submitted a creditable and realistic action plan following the inspection.

People told us they were visited by regular care staff. Records showed care was not always delivered on time and the provider recognised they faced challenges with the number of staff employed at specific times of the year. Staff were recruited in a way that ensured they were suitable to work in a care setting.

People felt safe with their care workers. Staff had a good understanding of safeguarding adults from avoidable harm and abuse. The provider had systems in place that ensured action was taken in response to incidents and allegations of abuse.

People were protected by the prevention and control of infection and staff told us they were well supplied with personal protective equipment.

People’s abilities and preferences in relation to their care were assessed through a comprehensive needs assessment process which was reviewed regularly. Care plans contained information about people’s religious beliefs, cultural background and personal history. The provider did not explore the impact sexual orientation may have on people’s experience of care. We have made a recommendation about ensuring the service is following best practice for people who identify as lesbian, gay, bisexual and transgender.

People told us care workers supported them to prepare and eat their meals. Care plans contained details of people’s dietary preferences. Where people were at risk of not eating enough to maintain sufficient nutritional intake care workers maintained records of what people ate to assist healthcare professionals in providi

We inspected Care Support on 15, 16 and 24 November 2016. This was an announced inspection. The provider was given 48 hours’ notice as they are a domiciliary care provider and we needed to be sure staff would be available to meet us. The service was last inspected on 14 December 2012 when it was found to be compliant with the outcomes inspected.

The service had 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 2008 and associated Regulations about how the service is run.

At this inspection we found three breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 regarding risk assessments, support planning and governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after representations and appeals have been concluded.

People were at risk of harm and poor support because risk assessments did not give guidance to staff on how to manage and mitigate risk for people. Support plans were not personalised and lacked detail. The service had not identified the issues we found at the time of inspection.

Staff received up to date training, supervision and appraisal. Staff had a good understanding of application of the Mental Capacity Act (2005). We found recruitment checks were in place to ensure new staff were suitable to work at the service. Staff had positive views about the leadership and staff culture of the service.

People and their relatives told us they felt safe using the service. Staff knew how to report safeguarding concerns. Medicines were administered safely. People using the service had access to healthcare professionals as required to meet their needs.

Staff knew the people they were supporting. People using the service and their relatives told us the service was caring. Staff respected people’s privacy and encouraged independence. People and their relatives knew how to make a complaint. The service supported people to maintain their culture and religious practices.

We found the agency obtained people's consent before they delivered care to them. People told us they were "happy" and "satisfied" with the care they received. We found care workers understood what the different forms of abuse were and they knew how to recognise the different signs of abuse.

We found the provider had undertaken the appropriate checks on staff before they started work with the agency and delivered care to people. We found staff were supported in their roles, there was evidence care workers had regular supervisions and a yearly appraisal. People told us they felt staff were "good" at their jobs.

We found care worker's and people's records were securely kept and located promptly when we requested them. The provider had a policy in place for the management and archiving of people's records.

During this inspection we visited four people to find out their views about the service.

“Carewatch has been great, I could not manage without them. All the girls have been great. They have made it possible for me to stay at home; it's as simple as that.” (Comment from person using the service).

“As far as they can they try to suit you. Staff made it through the snow and blizzards. If there is any kind of scoring for this service it is 10 plus out of 10.” (Comment from person using the service).

“They are lovely, I can't say a bad word. They are all very nice and very helpful. They do everything they can. They are in the right job.” (Comment from person using the service).

“They have got a way with her; they have a laugh and a joke with her. Life would be unbearable if we did not have this good support”. (Comment from the relative of a person using the service).