This comprehensive inspection took place on 26 July 2017 and was announced. We gave the registered manager two working days’ notice as the location provided a service to people in their own homes and we needed to confirm the registered manager would be available when we inspected.

The last inspection took place on 26 and 27 July 2016, when we identified breaches of Regulations relating to safeguarding people from abuse and improper treatment, safe care and treatment, the need for consent and good governance. We also rated the service ‘Requires Imporvement in three of the key questions we ask providers and overall. After the inspection, the provider sent us an action plan dated 4 November 2016 detailing how they would address the issues raised at the inspection. During the 26 July 2017 inspection, we saw improvements to the service had been made.

Graceful Care is a domiciliary care agency that provides care to people in their own homes. At the time of the inspection there were 146 people using the service. The service offered personal care and support to a range of people, for example, people living with dementia, and the support hours varied depending on people’s needs.

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.

At the inspection on 26 July 2017, we saw that the provider had updated their safeguarding policies and procedures. Care workers had received safeguarding adults training and the care workers we spoke with could identify the types of abuse and how to respond to keep people safe from potential harm.

Risk assessments had been reviewed and updated and provided guidance about how to minimise risks to people.

People using the service and their relatives said they were satisfied with the care provided by the service. There were sufficient numbers of staff and the service was in the process of updating their electronic system to monitor calls’ start and end times more efficiently.

Care workers did not administer medicines but had undertaken medicines training and there was a medicines policy and procedure available for reference.

Care workers had the relevant training and support through supervisions and appraisals to develop the necessary skills to support people using the service

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People’s dietary requirements and nutritional needs were met and relevant health care professionals were involved to maintain people’s health and wellbeing.

People using the service had developed positive relationships with care workers, were involved in day to day decision making and said care workers were kind and caring.

People were involved in their care plans which were comprehensive and person centred. Care workers had clear guidelines for how to meet people’s needs including identified preferences such as language.

People and care workers said the registered manager was accessible and approachable. People told us they felt able to raise concerns.

The service had a number of systems in place to monitor and manage service delivery. This included a complaints system, service audits and satisfaction surveys.

The inspection took place on 26 and 27 July 2016 and was announced. We gave the registered manager two working days’ notice as the location provided a service to people in their own homes and we needed to confirm the registered manager would be available when we inspected.

The service registered with the Care Quality Commission (CQC) on 22 April 2014 and this was their first inspection.

Graceful Care is a domiciliary care agency that provides care to people in their own homes. At the time of the inspection there were 85 people using the service. The service offered support to a range of people, for example, people living with dementia. Support hours varied from 24 hours a day to two hours a week. The local authority of Hammersmith & Fulham funded the care of people who used the service.

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 service was not always safe. Policies and procedures were not always followed to keep people safe. People had generic risk assessments but there was a lack of individual risk assessments and guidance to identify and manage risk. Not all staff files had two references which meant the provider had not taken sufficient steps to ensure staff were suitable to work with people who used the service. We have made a recommendation the provider ensure references are always obtained prior to appointing new staff.

The registered manager did not understand their responsibilities under the Mental Capacity Act 2005 and the service had not always assessed people’s capacity to consent to care and treatment. We saw a care plan where a family member had signed on behalf of the person using the service although there was no indication that the person was unable to sign for themselves.

There were systems in place to monitor the quality of the service delivered to ensure peoples' needs were being met and to identify where improvements to care could be made but these were not always effective as there was a lack of analysis to guide future improvements of service delivery.

The service had a medicines policy. Care workers did not administer medicines but did undertake medicines training.

The service had policies for safeguarding people who used the service and care workers were aware of how to respond to safeguarding concerns, incidents and accidents.

Care workers were suitably trained, supervised and appraised.

People's health and nutritional needs were recorded and monitored.

People who used the service and their families were happy with the level of support they received. People were involved in their care plans and reviews. Support was flexible and people and care workers had developed good relationships.

Care workers were kind and caring. They knew the people who used the service and were able to meet their needs.

People who used the service, staff and relatives told us the registered manager and care coordinator were approachable. There was a complaints system and people felt able to raise concerns.

We found breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safeguarding service users from abuse and improper treatment, safe care and treatment, need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.