About the service:

• Haven Care provides personal care to adults who live in their homes and those recovering from hospital admissions, receiving rehabilitation or need short term personal care until alternative care arrangements are made.

• The service's office is based in Ilford, London. Care is provided in the London boroughs of Redbridge and Waltham Forest.

• At the time of our inspection, 204 people used the service and there were 130 staff.

People's experience of using this service:

• People and their relatives told us that the service was safe. There were enough staff to support people. However, we identified that staff were not always punctual.

• There were systems in place to ensure that medicines were administered safely. Staff had received training in medicine administration.

Personal and environmental risk assessments were completed for people. However, we identified some risk assessments did not contain guidance for staff on how to mitigate the risks. We made a recommendation on risk assessment.

• Staff received a variety of training and demonstrated knowledge, skill and competence to support people effectively. Staff were supported by the registered manager and senior staff.

• People were supported by staff with their nutritional and hydration needs.

• People had access to health and social care professionals where required and staff worked together cooperatively end efficiently.

• Staff treated people with kindness and compassion. Staff had positive relationships with people and knew what is important to them. People and relatives told us the staff were kind and friendly.

• People, their relatives and staff members commented positively about the management of the service and felt that the service was well led. The provider was approachable to people and staff.

• There were appropriate auditing systems in place, which ensured that issues were identified and acted upon to ensure improvement were made to the service.

Rating at last inspection:

The service was rated as good at the last full comprehensive inspection, the report for which was published on 18 July 2016.

Rating at last inspection:

Why we inspected:

• This was a planned inspection based on the previous inspection rating.

This inspection took place on 18 July and was announced. The provider was given 48 hours’ notice because the manager of the location was off and we needed to be sure that someone would be in the office and able to assist us with the information we required for the inspection. At our previous inspection of this service on 13 February 2015 we found they were not meeting the legal requirement relating to people's cultural specific nutritional requirements, ineffective monitoring systems, staff training, supervision and appraisal. At this inspection they met these legal requirements.

Haven Care provides personal care for over 200 people ranging from older adults to younger people with disabilities in the London boroughs of Redbridge and Waltham Forest. They also provide reablement services. The reablement service is usually provided for up to six weeks and is aimed at promoting and encouraging people to function independently after they have been discharged from hospital.

The service had a registered manager application in progress. 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.

People told us they felt safe and were satisfied with the care provided by most staff. They told us they were treated with dignity and respect by pleasant and polite staff who respected their wishes.

Staff underwent an induction before they were able to work in people’s homes and were offered training, supervision and appraisals to ensure they were able to deliver care safely. Regular staff meetings and newsletters were produced to ensure staff were kept informed of changes and given an opportunity to speak out about any concerns.

There were robust recruitment policies and procedures in place to ensure that only staff that had undergone the necessary checks were employed.

People told us they were supported to take their medicine safely when it was in their care plan to do so. Where people needed support with meals, this was completed according to their personal or religious preferences.

Staff were aware of the mental capacity act and how they applied it in practice to ensure the person’s voice was heard. They were aware of the policies and guidelines in place to safeguard people from harm avoidable harm.

Care plans were person centred and reflected people’s current needs. There were risk assessments in place for the environment and for people and staff were aware of the steps to take to mitigate any identified risk.

Staff told us there was an open culture where they could raise concerns. There were systems in place to monitor the quality of care delivered.

This inspection took place on 13 February 2015 and was announced. The provider was given 48 hours’ notice because the manager of the location was off and we needed to be sure that someone would be in the office and able to assist us with the information we required for the inspection. At our previous inspection of this service on 04 June 2014 we found they were not meeting the legal requirement relating to medicines management. At this inspection they met this legal requirement. However, we found that they were not meeting legal requirements in relation to quality assurance.

Haven Care provides personal care for over 200 people ranging from older adults to younger people with disabilities in the London borough of Redbridge. They also provide reablement services. The reablement service is usually provided for up to six weeks and is aimed at promoting and encouraging people to function independently after they have been discharged from hospital.

The service had a registered manager application in progress. 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.

Although there were systems in place to investigate and respond to complaints and to ensure that learning took place, the main issues highlighted by people had not yet been fully addressed. These included late visits and the quality of staff at weekends.

The registered manager and staff understood their roles well. We saw some audits in place but we identified shortfalls in areas such as staff meetings, frequency of monitoring visits and methods of obtaining feedback from staff and people who used the service.

Risks to people and the environment were assessed and managed well. Accidents and incidents were reviewed to identify patterns and provide the right support to people.

People were supported to understand how to stay safe. Staff had a good understanding of how to recognise abuse and how to help protect people from the risk of abuse. Safeguarding procedures had been followed to keep people safe.

Recruitment procedures were safe ensuring only staff who were suitable worked with people who used the service. Staff were supported through induction, supervision and training.

Medicines management was safe and only staff assessed as competent administered medicines. Checking procedures were in place to ensure people were administered medicines as prescribed.

Staff understood the Mental Capacity Act 2005 and decisions were made in people’s best interests.

Staff were kind and treated people with dignity and respect. Care plans reflected people’s views on how they wanted their care to be delivered.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found.

Is the service safe?

Staff had received training to enable them to support people safely and appropriately. People’s individual files indicated the risks to the person and how these could be minimised to ensure that they were supported as safely as possible by staff. However the system for the administration of medication was not robust and did not safeguard people from the risks associated with medication administration.

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Overall people were satisfied with the service provided but felt some further improvements were needed with regard to staff punctuality and weekend support offered by the agency. The three social care professionals we spoke with told us that service delivery was good and they were all happy to use and recommend the service.

People's care needs were assessed and as far as possible plans of care were developed with them. People we spoke with were aware of the purpose of their care plans and knew where their copy was.

Is the service caring?

Overall people were satisfied that they were receiving a caring service. Some told us that their carers ‘went that extra bit’ to ensure they were happy. Others said that their carers ‘did the minimum required.’

People's preferences and diverse needs were recorded and care and support was provided in accordance with this. Their religious, cultural and social needs were identified as part of this.

Is the service responsive?

The service was responsive to peoples changing needs. One social care professional told us that the agency was “flexible” and made changes to suit individual needs and preferences. Another said that they were responsive and an asset for the local authority.

Care staff we spoke with told us that they contacted the ‘office’ if a person was unwell or if they were concerned about a person’s safety or welfare. They told us that the ‘office’ were good at following these issues up and reporting to the relevant person to deal with these.

Is the service well led?

The service had a registered manager in place and a clear management structure. Staff we spoke with said they that the management team provided the support and guidance that they needed to carry out their duties and to meet people’s needs.

The provider had a number of different quality assurance systems in place to enable them to monitor the quality of care provided. This included telephoning people for feedback and also an annual quality assurance survey to seek people’s views about the service.

At our previous inspection of this service we found that detailed care plans were not in place and people who used the service told us not all staff understood their needs. At this inspection we found that improvements had been made. People told us they were happy with the support provided and that staff knew how to meet their needs. One person said "they get used to the routine" and a relative of a person who used the service told us "definitely they know how to support her."

We found the care planning system had been revised since our previous visit. Care plans contained detailed information about how to meet people's assessed and individual needs. Care staff we spoke with had a good understanding of the need's of people they worked with and how to support them.

We found that care plans were in place for people. However, these did not provide clear and detailed information on how to support people. A relative we spoke with said that not all staff knew how to provide support. They told us "we have had people (staff) turn up who don't appear to have any idea about what mum needs."

People told us they felt safe when carers were at their homes. A relative replied "absolutely" when asked if they felt their parent was safe. We found that staff had a good understanding of their responsibility with regards to safeguarding vulnerable adults and that they had undertaken training on this subject. We found the service had carried out checks on staff before they began working with vulnerable adults including employment references and Disclosure and Baring Service checks.

People told us they were asked for their views on the service, and when they raised issues they were addressed. A relative told us "they are always helpful when I ring them up." We found the service had various systems in place for monitoring the quality of care and support provided. We found that records were stored securely and kept up to date.

People we spoke with said they were treated with dignity and respect. One person said "the girls (care staff) are lovely. They are considerate and helpful." We found that care plans and risk assessments were in place for people, and people told us staff knew how to meet their needs. People told us that they generally had the same regular carers, and that carers were punctual.

People told us they felt safe, and that they knew who they could raise any issues or concern with if they needed to. One person said "yes, I do feel safe with them." We fond that the service had procedures in place for safeguarding vulnerable adults. However, staff we spoke with had only a limited understanding of their responsibilities with regard to safeguarding, and that not all staff had undertaken training on safeguarding vulnerable adults.

We found that the service had recruitment procedures in place, but that these were not being followed in relation to obtaining employment references for all staff. People told us there were on-going monitoring systems in place to ensure they were happy with the support provided. One relative said "they do come and visit at my dad's house. We talk about how things are going." We saw records of monitoring visits to assess the quality of support provided.