At our inspection in December 2016, we found two breaches of the regulations in relation to Safe care and treatment and Good governance and the service was rated Requires improvement. This was because there were errors in the recording of medicines administration and risks to people were not assessed in an individualised and person centred manner. In addition, the oversight and monitoring of safeguarding concerns, accidents and incidents and complaints was not robust.

Following the last inspection, the provider sent us an action plan and told us they would make all the necessary improvements by June 2017. At this inspection we found the provider has made the improvements they said they would make.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the They provide a service to older adults some of whom are living with dementia. A service is also provided to people with mental health concerns and younger disabled adults who may have learning disabilities, physical disabilities, sensory impairments and people who misuse drugs and alcohol.

Not everyone using Hanwell Community Centre 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. At the time of our inspection, the provider was offering personal care support to 81 people.

There was a registered manager in post. A registered 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.

During our inspection we found that the provider had made improvements to the risk assessment process. People’s risk assessments were more person centred. A new risk assessment format was being implemented and this supported staff to consider the individual. We noted that not all people had been assessed using the new format and some risk assessments were still written by hand which made it more difficult for staff to read. We brought this to the registered manager’s attention who agreed to address this.

Care staff had received medicines administration refresher training. We checked medicines administration and found that medicines were being administered appropriately by staff. The manager and service manager audited the medicines administration records to ensure staff were competent to manage people’s medicines.

The provider had taken action to improve their oversight and analysis of safeguarding concerns, accidents, incidents, and complaints. They had employed an administrator who had created a database to ensure that each concern was reported appropriately, investigated and the outcome evaluated.

During our last inspection, we found that some staff did not have a good command of English. We found that the provider now requested new staff to undertake a spoken English and literacy test before they were employed, to ensure their competency to communicate effectively with people receiving a service.

Auditing of the service has improved and the database prompted office staff to undertake people’s reviews in a timely manner, and highlighting when staff supervision sessions and training were due.

People and their relatives all spoke very positively about the service they received from the provider. Their comments included that care staff as, “Gentle and patient” and “Kind and friendly.” They found the office staff approachable and responsive and knew how to raise concerns and make complaints.

Care staff spoke positively about the people and told us how they offered choices to people and supported their wishes. They had guidance about how to communicate with people and took tim

The inspection took place on 6 December 2016. We gave the registered manager 24 hours’ 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 10 and 11 February 2016, when we identified breaches of six regulations relating to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance and notification of other incidents.

The provider sent us an action plan on 18 April 2016 indicating how they would address the issues raised at the inspection. At this latest inspection, we found improvements had been made, but further improvement was required.

Hanwell Community Centre is a Domiciliary Care Agency providing community support for people living with dementia, learning disabilities, autistic spectrum disorder, mental health needs, older people, physical disabilities and sensory impairment. Currently the service offers personal care to 70 people. The parent organisation is Support Direct.

The registered manager had a background in health and social care and was also a director of Support Direct. 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.

We found people had initial risk assessments but these were generic and did not provide enough detail about how to minimise risks specific to individuals.

We saw a medicines administration record (MAR) was incorrectly completed, so we could not be sure people were receiving their medicines correctly. However, the service had a relevant medicines policy and practice guidelines for care workers in the administration of medicines and health related duties.

The service did not always have robust management systems and there was a lack of analysis of the incident and accident forms, the safeguarding forms and complaints. Audits were not always effective. However, since the last inspection, the service had begun recording incident and accidents and logging safeguarding alerts. The local authority and the Care Quality Commission were being appropriately notified of alerts.

The service followed safe recruitment procedures, care workers knew how to report abuse and there were enough staff to meet the needs of the people using the service.

Care workers had the support and training they needed including induction training, supervision, appraisals and spot checks. However there was a language barrier for some care workers and we recommended on going competency testing to ensure staff have the skills to fulfil their role effectively.

People told us they were involved in their day to day care decisions.

People's health and nutritional needs were recorded.

People who used the service and their relatives were happy with the level of support they received. People were involved in their care plans and reviews, although this was not always recorded.

Care workers were kind and caring. They knew the people who used the service and were able to meet their needs. People and care workers had developed good relationships.

The service undertook care plans and reviews, however these were not always completed in a detailed or person centred way. We recommended care plans and reviews were fully completed in a person centred manner.

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

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at t

This inspection took place on 10 and 11 February 2016 and was announced. This was the first inspection of the service since 5 September 2013 when it was registered with the Care Quality Commission (CQC).

Hanwell Community Centre is a home care agency that provides personal care and support to people living with dementia, learning disabilities, autistic spectrum disorder and mental health difficulties as well as older people, people who misuse drugs and alcohol, people with an eating disorders, physical disabilities and sensory impairments. The service is actually named Support Direct Limited but is located at Hanwell Community Centre and the service is registered with CQC as Hanwell Community Centre.

On the day of our inspection, the agency provided approximately 1,200 hours of support on a weekly basis to 61 people. All of the people using the service were receiving personal care.

The agency had the registered manager in post who had been managing the service since it was registered with 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.

The registered manager did not have a full understanding of all the requirements related to the delivery of regulated activities. The agency did not notify CQC about important events, which occurred within the service as required by the law.

The agency did not have robust records and data management systems in place to audit the service delivery and ensure consistent, high quality of care.

The agency did not always protect people from harm and abuse, because they did not have systems to ensure effective reporting, monitoring, analysis and review of safeguarding concerns.

People did not always receive safe care and treatment, as the agency did not identify risks to their health, safety and welfare.

The agency did not monitor peoples’ medicine administration records (MAR), therefore the managers could not assess if people using the service received their medicines as prescribed.

The agency had a complaints policy and procedure in place, however, it was not effective and people using the service and their relatives raised their concerns directly with the local authority.

The agency did not always support people to express their wishes and people were not always actively involved in making decisions about their care, treatment and support.

People’s care plans did not always specify their nutrition and dietary needs as well as spiritual and cultural wishes, therefore staff who supported them did not have access to this information.

All staff received medicines training.

The agency had robust recruitment procedures in place to ensure they only appointed suitable staff to work with people who used the service.

The agency had a rota system to ensure all staff members knew who they were assigned to visit that week and that all staff planned absences were covered.

People said the staff usually arrived on time and they called if they were running late.

People told us they felt involved in their care and they trusted that staff would inform the agency if they were ill or needed the attention of another health professional.

The agency was working within the principles of the Mental Capacity Act 2005 (MCA).

The agency asked people using the service to give their consent before offering care and treatment to them.

Family members said they were happy with the care their relatives received from the agency and people using the service told us staff treated them with dignity and respect.

The agency assessed the needs of people using the service prior to agreeing the care package.

The agency had a service users’ feedback questionnaire to obtain people’s views about the care they received from the agency.

Staff