This comprehensive inspection took place on 8 and 13 November 2018 and was announced. At the previous comprehensive inspection on 4 April 2018 we were unable to rate the service. At the time of the inspection, only one person had been receiving personal care for a limited period of time. This meant that although we were able to carry out an inspection we did not have enough information about the experiences of a sufficient number of people using the service over a period of time to give a rating to each of the five questions and an overall rating for the service.

This service is a domiciliary care agency. It provides nursing and personal care to people living in their own homes in the community. It provides a service to older adults, younger disabled adults and children. At the time of the inspection they were supporting 11 people across the London Boroughs of Wandsworth, Enfield, Croydon, Bromley, Camden, Barnet, Southwark, Lewisham and also Essex. Nine of these people were young children. Not everyone using Emergency Personnel Homecare Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post at the time of our inspection. 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.

Risks to people were identified during an initial assessment. Detailed guidance was in place with information from health care professionals to enable staff to support people safely and meet their complex care needs. Risk assessments were updated when people’s needs changed and information was shared with staff that supported them.

People who required support with their medicines received them safely. Care records included information about people’s medicines and the level of support they needed. All staff had completed training in medicines within the last six months and was scheduled to be refreshed annually.

Relatives told us that they felt safe using the service and staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults and children from abuse and had a good understanding of how to identify and report any concerns.

People were supported to maintain their health and wellbeing through access to health and social care professionals, such as paediatricians, community nurses, social workers and respiratory consultants. The provider worked closely with them to ensure effective communication and any changes in health were reported and updated accordingly.

The provider understood the legal requirements of the Mental Capacity Act 2005 (MCA). Agreements were in place and recorded how people consented to their care and support.

Registered nurses and care workers received specialist training to support them in meeting people’s complex needs. Shadowing opportunities and staff competency assessments were completed before staff started work with people. Staff felt supported and were happy with the supervision they received and the content of the training available.

People’s nutritional needs were recorded in their care plans with detailed information about the level of support required. Nutritional risks were highlighted with further guidance available for people who needed extra support.

Relatives told us that staff were kind and compassionate and knew how to provide the care and support they required. People had regular nurses and care workers who had built up positive working relationships with them and their families. Staff respected people’s privacy and dignity a

This inspection took place on 4 April 2018 and was announced. Emergency Personnel Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and children. At the time of the inspection, one person was using the service.

The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

This is the first comprehensive inspection of the service since registration with the Care Quality Commission (CQC) in March 2016. However, we were unable to give a rating for each of the five questions we inspect and an overall rating of the service. This is because the provider had provided care for a limited period. We could not ascertain the effectiveness of the systems of care delivery and there were not enough experiences of people using the service and their relatives’ about the range of services on offer for us to provide a rating.

The service did not have a registered manager. A manager was in the process of applying for registration with the CQC. A registered manager is a person who has registered with the 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.

Staff knew how to protect people from the risk of abuse. The manager identified risks to people’s safety and well-being. Staff followed guidance in people’s risk management plans to deliver care safely. Staff had received medicines management training.

People underwent an assessment of their needs. The manager planned people’s care delivery and took into account their needs and preferences. Staff provided care in line with current legislation based on best practice guidance.

The provider followed appropriate recruitment procedures to ensure people received care from staff suitable for their role. People had their needs met by sufficiently experienced staff. Staff minimised the risk of infection and reported incidents.

People received care in line with the requirements of the Mental Capacity Act 2005. Best interests meetings supported a person who may lack mental capacity to make decisions about their care.

Staff received support to undertake their roles. The manager had plans to carry out supervision and appraisal to review staff’s practice and to identify their development needs. Staff attended training to develop their skills and knowledge about how to undertake their roles.

Staff delivered care in a kind and caring manner. People’s care delivery promoted their dignity and privacy. People using the service and their relatives were involved in planning their care and support.

Staff worked closely with relatives to support people to maintain good health. People received the support they required with their nutrition and hydration. Staff followed healthcare professionals’ guidance to meet people’s dietary needs.

People using the service and their relatives knew how to make a complaint. The provider had plans to promote an open and honest culture at the service. Staff were encouraged to learn from incidents when things went wrong.

Systems were in place to monitor the quality of the service. However, these had not been fully applied because the service had provided care to people for a limited time.

People using the service and their relatives had an opportunity to share their views about the service. The manager acted on their feedback to make improvements. The provider had plans to work closely with other agencies to deliver care effectively.