About the service:

Dependability Limited is an agency providing personal care to people who lived in their own homes in the community. The agency also provided occupational therapy services to people living in the community. CQC does not regulate or inspect this aspect of the service. At the time of the inspection, 14 people were being supported with personal care (washing, dressing and help to take their medicines). The agency employed eight care workers to provide this care. All the people lived in Hertfordshire. The majority of people were older adults, although some people were under the age of 65 years and had physical disabilities.

This was the only branch of the provider. The director of the company was also the registered manager.

People’s experience of using this service:

The provider did not always ensure the safe management of medicines, because they did not assess the risks associated with these or make sure information about medicines and their administration was clearly recorded.

The provider's systems for improving the quality of the service and mitigating risks were not always operated effectively. This meant that people did not always experience safe or effective care.

There had been improvements in the way in which the provider recruited staff. However, some of the evidence of their suitability had not been obtained until after they started working at the service.

The provider did not always make sure people's consent to care and treatment was evidenced.

The staff had not always completed the training which would give them the knowledge and skills to provide effective care.

People using the service, their representatives and external professionals were happy with the service. They said that it met their needs and they felt safe with the staff. Their needs were described in care plans and these were updated to reflect changes in their needs and circumstances.

There was an emphasis on supporting people to maintain and develop their independence. The agency also provided an occupational therapy service, where they assessed people's needs relating to equipment and mobility. They worked with other healthcare professionals to make sure people had the right support and equipment to gain skills and remain as independent as possible.

People said that the staff were kind, caring and they had good relationships with them. The staff felt supported and said they had the information and support they needed. The staff said they were in regular contact with the registered manager and felt confident about their work.

Rating at this inspection:

We have rated the key questions of, 'is the service safe?', 'is the service effective?' and 'is the service well-led?' as requires improvement. We have rated the key questions of, 'is the service caring?' and 'is the service responsive?' as good. The overall rating of the service is requires improvement.

We found breaches of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. You can see what action we have asked the provider to take within our table of actions.

Rating at last inspection:

The last inspection of the service was 4 December 2017 when we rated the service as requires improvement. This was because we found the recruitment of staff was not always carried out safely.

Why we inspected:

We conducted this inspection of the service as part of our planned schedule of inspections based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if we receive any concerning information.

This inspection took place on the 4 December 2017 and was announced. We told the provider two working days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

The service is a domiciliary care agency and is registered to provide personal care to people living in their own houses and flats in the community. It provides a service to older adults, some of whom could be living with dementia, physical disability, sensory impairment, learning disability, and autism. At the time of our inspection, the provider was offering a service to two people.

This was the service’s first inspection following their registration with the Care Quality Commission on the 7 December 2016. 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.

Perivale Office is part of the provider Dependability Limited.

During our inspection, we found the recruitment of staff was not always carried out safely. This was because the provider had not obtained and recorded some staff references in a robust manner. We found one breach of the Regulations with regard to Fit and Proper Persons employed. You can see what action we have asked the provider to take at the back of the report.

People had risk assessments in place for staff guidance to identify measures to mitigate the risk of harm.

The registered manager and office staff undertook regular checks and audits to assess the quality of the service provided. However, our findings during this inspection showed that these had not been effective in the area of recruitment.

There were enough staff deployed on duty to meet people’s support needs. Staff had received training and supervision to support them in their role.

The registered manager, office staff and care staff understood their responsibility to report safeguarding adult concerns so appropriate action could be taken to investigate and deal with cases of allegations of abuse.

People and relatives spoke very positively about the service they received and described staff as kind and caring. Staff demonstrated an empathy with the people they supported and understood both their physical and emotional support needs. The provider placed an emphasis on supporting people’s emotional wellbeing as such staff spent time talking with people and ensured they felt listened to. Staff demonstrated they respected the people they worked with and maintained their privacy and dignity.

It was a strength of the service that the office staff was a qualified occupational therapist and physiotherapist, as such they were knowledgeable about people’s moving and handling support needs and advised people and their relatives how to access other services to obtain equipment and adaptations.

Staff supported people with their health needs and kept good records for people’s health monitoring. They supported people to eat and drink healthily.

The registered manager was aware of their responsibility under the Mental Capacity Act 2005. People gave their written consent to care and treatment. Care staff asked people for permission before supporting them and gave people choices to promote independence.

The registered manager completed assessments of people’s care prior to the service commencing and people’s care plans were individualised.

People and relatives told us they knew how to complain and felt the registered manager would respond to their complaints in an appropriate manner. The provider asked people for feedback on the quality of the service provided.

The provider had a clear vision for the future of the service and the registered manager k