About the service: Clarendon Home Care provides a domiciliary care service to 142 people living in Kingston and the surrounding area. This includes personal care such as assistance with bathing, dressing, eating and medicines, home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by the Care Quality Commission.

People’s experience of using this service:

• The service meets the characteristics of a good service and therefore we have rated it ‘Good’ overall and for all five key questions, ‘Is the service safe, effective, caring, responsive and well-led?’

• People told us they were happy with the overall standard of care and support provided.

• People received a home care service from staff who were in the main suitably trained and supported to meet their personal care needs. However, additional training was needed for staff who supported people with specific needs.

• Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met. People were protected from avoidable harm, discrimination and abuse.

• Appropriate recruitment checks took place before staff started working for the service.

• The agency had procedures in place to reduce the risk of the spread of infection.

• Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

• Where people needed assistance with taking their prescribed medicines this was monitored and safely managed in line with best practice guidance.

• Staff routinely sought the consent of the people they supported. Managers and staff adhered to the principles of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.

• People were supported to maintain a balanced diet where staff were responsible for this.

• People received the support they needed to stay healthy and to access health care services as and when required.

• We noted in people’s daily records that in some cases care workers did not always stay for the whole of the allotted time. We have made a recommendation to the provider to review this practice.

• People received support from staff who were kind and compassionate. Staff treated people they supported with dignity and respect and ensured people's privacy was always maintained particularly when supporting people with their personal care needs.

• People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives. People, and where appropriate their relatives and professional representatives, were involved in discussions and decisions about the support they would receive.

• People's concerns and complaints were dealt with by the provider in an appropriate and timely manner. The provider had effective systems in place to assess and monitor the quality of the service people received.

• The service was well-led and management support was always available for staff when they needed it. There was an open and transparent and person-centred culture.

• People, their relatives and staff were all asked to share their feedback about the service.

• The provider worked in partnership with other health and social care professionals and agencies to plan and deliver an effective home care service.

Rating at last inspection:

At our last inspection, the service was rated Good overall and Requires Improvement in Safe. Our last report was published on 27 September 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received and to see if the provider had improved Safe to Good.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspecti

This inspection took place on 30 August 2016 and was announced. We told the provider 24 hours before our visit that we would be coming. At our last inspection in January 2014, we found that the service was meeting all of the standards that we inspected.

Clarendon Home Care provides a domiciliary care service to over 200 people living in Kingston and the surrounding area. This includes personal care such as assistance with bathing, dressing, eating and medicines, home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by the Care Quality Commission.

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.

The provider had arrangements to administer medicines and overall these were safe. In some circumstances staff had not always sign the medicines administration records charts to say they had administered the medicines. There were also no protocols in place where people were prescribed a variable dose of medicines so staff were clear when to administer the relevant dose.

People on the whole received visits according to their care plan. Some people said they did not receive the same care workers consistently and at times the care workers were late and they were not informed. The registered manager had a plan to address these concerns.

People told us they felt safe with the support they received from staff. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place to inform people who used the service and staff how to report potential or suspected abuse.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe. The provider ensured there were safe recruitment procedures in place to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Staff received training in areas of their work identified as essential by the provider. We saw documented evidence of this. This training enabled staff to support people effectively.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. Records showed people were involved in making decisions about their care and support and their consent was sought and documented.

People were involved in planning the support they received and their views were sought when decisions needed to be made about how they were supported. The service involved them in discussions about any changes that needed to be made to keep them safe and promote their wellbeing.

Staff respected people’s privacy and treated them with respect and dignity. Staff supported people according to their personalised care plans.

The provider encouraged people to raise any concerns they had and responded to them in a timely manner.

Staff gave positive feedback about the management of the service. The registered manager was approachable and fully engaged with providing good quality care for people who used the service.

The provider had sent out to staff and people the core company values to “Promote a flexible, service user centred approach to care provision”.

The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions and action plans were developed where required to address areas for improvements.

Our inspection of 26 and 27 June 2013 found concerns about the scheduling systems the provider had in place and with the arrangements for handling of medication. There was a lack of auditing across the organisation and records were not being well maintained. The provider wrote to us and told us they would review their scheduling and medication management procedures, quality audit processes and record management methods within three months.

During this inspection we found improvements had been made to reduce the risks to people who used the service. We saw that a system that highlighted priority visits to people who required time sensitive care had been implemented. A quality assurance team were now responsible for ensuring up-to-date information was kept in people’s homes. Appropriate arrangements were in place for the safe administration of medications although we found some gaps in medication record keeping. We saw that medication records were not completed to indicate when a visit had been cancelled.

A structured quality audit process had been implemented and monthly audits were conducted to check that records were being recorded correctly. However we found the new processes required improvement as some audit sheets did not include the outcomes of audit investigation. Changes to record management had been implemented.

The inspection team was led by a CQC inspector joined by an Expert by Experience who had personal experience of using or caring for someone who uses this type of service and two registered pharmacists. We spoke with 36 people who use the service or their representatives and with 16 members of staff. We reviewed 19 manually completed care records and five staff files.

Most people told us they were consulted and included in discussions about their care. One person said “I did get a say in my care plan which was good and was consulted throughout”. People said they were supported in promoting their independence and treated with dignity and respect. “Absolutely they help me do as much as I can for myself and treat me appropriately for my age”.

We saw completed risk assessment documents and care plans which showed that people had their needs assessed. People commented positively about the care workers who attended to them regularly, "We build up a relationship with people who come in regularly". Late attendance of care workers and not being informed was cited a consistent problem by the majority of people we spoke with.

Staff received induction and annual refresher training in line with the roles they performed, one care worker said, "The training is pretty good". The provider had systems in place to assess the quality of service provided, although we found gaps in the quality of audits they conducted. The quality of manual care records we reviewed were inconsistent.

As this inspection focused on the systems and processes of the agency itself, there were no service users present. However, we saw evidence of regular contact between the agency and people who use the service and that people’s views are actively sought through care assessments, questionnaires and telephone contact with the office.