This inspection was conducted over three days on 3 July and 16 and 20 August 2018.

Day and Nite (Kingston) is a home care agency. It provides personal care to people living in their own homes in the community. At the time of our inspection this agency was providing a home care service to approximately 180 mainly older people, four younger adults and two children living in the south London Boroughs of Kingston-upon-Thames, Wandsworth, Merton and Sutton. Most people using the service were living with dementia, while some people also had physical disabilities or complex health care needs associated with old age or mental ill health. Both the children using the service had a learning disability or autistic spectrum disorder. In addition, five people received a 24-hour home care service from this agency and had live-in care staff.

Approximately fifteen percent of the 180 people currently using the service did not receive a regulated activity from Day and Nite (Kingston). The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service continues to have a registered manager/owner in post, although this individual was no longer in operational day-to-day charge of the agency following the appointment of a new manager in January 2018. The new manager has not yet applied to the CQC for us to consider registering them as the service’s new manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a 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 service’s last CQC inspection, which we carried out in July 2017, we found the provider had improved the way they notified us about incidents involving people using the service. We rated the service ‘Good’ overall, although we had also received some mixed feedback from people about staff sometimes missing their scheduled visits or being late.

At this comprehensive inspection although we continued to rate the agency ‘Good’ for the key question, ‘Is the service caring?’, we found some aspects of practice had deteriorated. Consequently, the overall rating for the service and the three key questions, ‘Is the service safe, effective and responsive?’ have been downgraded from ‘Good’ to ‘Requires improvement’, while the key question, ‘Is the service well-led?’ remains ‘Requires improvement’.

This was partly because the risk management plans that were in place to help staff take the appropriate action and prevent or deal with risks people might face were not always sufficiently detailed. This meant the provider had not done all that they could to mitigate identified risks and keep people safe.

Staff did not have all the right knowledge and skills to effectively carry out their roles and responsibilities. For example, staff who supported children had not received any child protection (safeguarding) or learning disability/autism awareness training. In addition, staff who supported adults living with dementia, mental ill health or behaviours that challenged the service had also not completed relevant awareness training in the areas outlined above.

Furthermore, although governance systems were in place to monitor the quality and safety of the service provided; we found they were not always operated effectively. For example, essential information obtained through these governance processes was always evaluated. This meant the provider did not always reflect on their practice to learn lessons and consider how they might improve the home care service they provided.

These shortfalls represent three breaches of the Health and Social Care (Regulated Activiti

The last Care Quality Commission (CQC) inspection of Day and Nite Services (Kingston) was carried out on 14 and 15 November 2016. At that time although we rated the service as 'Good' overall, we found the provider to be in breach of fundamental standards and regulations. This was because they had failed to notify us in a timely manner about allegations of abuse involving people receiving a service from the agency, which they are required to do so by law. The provider sent us an action plan in 2017 which stated what they would do to make the necessary improvements.

Since our last inspection we also received information from people using the service, relatives and staff concerned about the way the agency recruited, trained and supported staff. A number of people also expressed concern that staff did not always turn up on time for their scheduled visits.

This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focused inspections, by selecting the 'all reports' link for ‘Day and Nite Services (Kingston)’ on our website at www.cqc.org.uk.

Day and Nite Services (Kingston) is a domiciliary care agency that provides personal care and support to people living in their own homes mainly in the London Boroughs of Wandsworth, Merton and Sutton. At the time of our inspection 101 people received care and support from this agency. Three of these people had 24 hour live-in care workers and another person who lived in a nursing home regularly received one-to-one support from the agency. People using the service were mainly older adults living with a range of health care needs and conditions, including dementia.

Since our last inspection the service has a new registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC). Registered managers like registered providers 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 new manager was registered with us in April 2017, replacing the previous registered manager/owner, who was now the Company Director.

During this focused inspection, we found that the provider had followed their action plan and now met legal requirements and fundamental standards. Specifically, the provider had improved the way they kept the CQC informed about the occurrence of any incidents and events that adversely affected the health, safety and welfare of people using the service.

We received some mixed comments from people using the service and their relatives regarding staff turning up for their scheduled visits on time, although most people told us they did not have any major concerns about their regular care worker’s punctuality. In response to concerns raised by a few people about their care workers’ time keeping the provider had introduced a new electronic system that would allow the care coordinators to closely monitor staff punctuality and length of their stay. This would help the provider plan care workers’ scheduled visits more effectively.

We saw staff recruitment procedures continued to prevent people from being cared for by unsuitable staff.

Staff also continued to be suitably trained and support by the providers management team to ensure they had the right knowledge and skills to effectively meet people’s needs. Managers monitored staff training to ensure their existing knowledge and skills remained up to date. Managers and senior staff were also in regular contact with the staff team to check they were clear about their duties and responsibilities to the people they cared for.

This inspection took place on 14 and 15 November 2016 and was announced. We brought the inspection forward after we received some concerns about the service. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried on 4 and 9 February 2015. At that time we rated the service as 'Good' overall, although we found the provider to be in breach of regulations in respect of clinical governance. This was because the service did not operate effective governance systems to assess, monitor and improve the quality and safety of the service they provided. We asked the provider to take action to make improvements. We went back to the service on 25 September 2015 to carry out a focused inspection and found the provider had made the necessary improvements and now met the regulations.

Day and Nite Services (Kingston) is a domiciliary care agency that provides personal care and support to people living in their own homes. At the time of our inspection 49 people received a service from the agency, which included four people who had live-in care workers. People using the service were mostly older adults who had a wide range of health care needs and conditions. Most people receiving a service were living with dementia.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Providers are required to inform the CQC when there are significant events in a service, including any allegations of abuse. These are called statutory notifications. We found the provider had not notified us about a safeguarding incident involving a person who received a service from the agency.

We identified a breach of the Care Quality Commission (Registration) Regulations 2009 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

People were satisfied with the overall standard of personal care and support they received from this provider. People told us staff that provided their care and support were kind and caring.

People felt safe with the care and support they received from staff working for the agency. Staff were supported to take appropriate action to ensure people were protected if they suspected they were at risk of abuse or being harmed by discriminatory behaviour or practices. Risk of injury or harm posed to people by their specific health care needs and home environment had been assessed .However guidance for staff on how to ensure these risks were minimised needed to be improved.

People were supported by staff that were suitable and fit to work for the service. Employment and criminal records checks were carried out on all staff before they started work. People did not have major concerns about staff turning up late or missing a scheduled visit. This indicated there were sufficient numbers of staff available to support people. Staffing levels were continuously monitored by managers and senior staff to ensure people experienced consistency and continuity in their care and that their needs could be met at all times.

Staff received training to meet people’s needs. Training was in areas and topics relevant to their work. Managers and senior staff monitored training to ensure staff skills and knowledge were kept up to date. Staff received regular supervision (one to one meetings) and appraisal so that they were appropriately supported to care for people. They felt well supported by managers who they said were approachable.

Staff were knowledgeable about the people they supported. This included their preferences, routines and their support needs. Staff provided people with the support they required in line with their care pla

We carried out an announced comprehensive inspection of this service on 4 and 9 February 2015 and breaches of legal requirements were found. This was because the service did not operate effective governance systems to assess, monitor and improve the quality and safety of the services they provided. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on the 25 September 2015 to check that they had followed their action plan and to confirm that they now met legal requirements. This inspection was also announced. We told the registered manager two days before our visit that we would be coming to ensure they would be available.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Day and Nite Services (Kingston) on our website at www.cqc.org.uk

Day and Nite Services (Kingston) is a domiciliary care agency that provides people living in their own homes personal care and support designed to meet their individual needs and circumstances. At the time of our inspection 68 older people and younger adults were receiving services from the agency. The needs of these individuals’ were varied and included people living with dementia or mental ill health and people with physical or learning disabilities.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During our focused inspection we found that the provider had followed their action plan which they had told us would be fully implemented by June 2015. We saw legal requirements had been met by the provider because they operated effective governance systems that ensured they routinely assessed, monitored and improved the quality and safety of the services they provided.

This inspection took place on 4 and 9 February 2015 and was announced. At the last inspection of this service, which was carried out on 8 May 2014, we found they were meeting the regulations we looked at.

Day and Nite services is a domiciliary care agency that specialises in the care and support of older people who may be living dementia or have physical disabilities in South West London.

There were 40 people receiving services from this provider when we inspected them.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Although the agency had systems in place to regularly monitor the quality of the service they provided; we found failures by the provider to routinely analyse and learn lessons from adverse events, incidents, errors, near misses, complaints and safeguarding concerns. This meant people using the service might be at risk of receiving inappropriate or unsafe care and support. This is a breach of the Health and Social Care (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People said they were happy with the quality of the care provided by the agency and that care workers turned up on time, stayed for the agreed length of time and completed all the care and support tasks they were expected to do. People told us their care workers looked after them in a kind and caring way, and always respected their right to privacy and dignity.

People felt safe receiving services from this domiciliary care agency. Staff knew how to protect people if they suspected they were at risk of abuse or harm.

Risks to people’s health, safety and wellbeing had been identified and steps were taken to minimise these without restricting people’s choice and independence. Care workers were given guidance on how to minimise identified risks to people and to keep them safe from harm or injury in their own home.

There were enough care workers available to meet the needs of people using the service. Senior staff matched people with care workers who were able to meet their specific needs and preferences. The provider ensured they were suitable to work with adults who were at risk of abuse by carrying out employment and security checks before they could start work. Care workers received appropriate training and support and senior staff ensured their skills and knowledge were kept up to date.

People received their medicines as prescribed and staff knew when to prompt people to take them.

People were encouraged to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. Care workers monitored people’s general health and wellbeing, and ensured external health and social care professionals were contacted without delay if the health of people using the service deteriorated.

Each individual was involved in making decisions about their care and had been given a care plan that focused on their needs. People had agreed to the level of support they needed and how they wished to be supported. Where people's needs changed, staff responded and reviewed the care provided.

The agency had a clear management structure and sought the views of people using the service and their relatives in relation to how the care and support they received could be improved.