Helmar Care and Community Services Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection 36 people were receiving a service.

A registered manager was 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.

The last inspection of Helmar Care and Community Services Limited took place in May 2017 when we found four breaches of Regulations relating to risk assessments, medicines management, quality assurance and recruitment checks. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

At this inspection we found the provider had made improvements to meet the Regulations but further improvements were required to attain an overall good rating. Some people using the service continued to experience inconsistencies in the way the service was provided and work was on-going to improve the quality of care documentation kept by the service. This view was shared by commissioners of the service.

People using the service told us they felt safe and the majority of people spoken with said they were supported by familiar staff who knew their needs well. They said that they were treated with dignity, respect and kindness by staff.

Staff had access to training and supervision and were supported by the service. They received safeguarding training and understood how to help protect people from abuse. Safeguarding and whistleblowing policies also gave guidance to staff on how to identify and report concerns they might have about people's safety.

Staff were organised in geographical areas and staffing rotas showed that care staff were consistently allocated to the same people using the service. However we received mixed feedback from people and/or their relatives about the timekeeping of staff. The registered manager told us they were experiencing difficulties in recruiting suitable staff with the right skills and experience.

Improvements had been made to care documentation with new computerised assessment and care plan formats being introduced. This work was on-going.

The service helped to protect people from the risk and spread of infection. Staff told us that they were supplied with the personal protective equipment (PPE) they required and staff members were supplied with gloves, aprons and shoe covers.

Safe recruitment practices were in place to help protect people from the employment of unsuitable staff.

Staff had received training in the MCA (Mental Capacity Act 2005) and understood the importance of gaining people’s consent before assisting them.

People and their relatives felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues.

This inspection took place on 23 and 25 May 2017 and was announced. We told the provider one day before our visit that we would be coming. This was the first inspection of this service under their new registered name of Helmar Care and Community Services Limited. Previously they had been registered as African Positive Outlook and the provider was African Positive Outlook Limited. The location, staff and management are the same as previously.

Helmar Care and Community Services Limited provide domiciliary care and support to 30 people living in Kingston and the surrounding area. This service includes assistance with bathing, dressing, eating and medicines, home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by CQC.

The service had a registered manager at the time of the inspection. 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 the service was not as safe as it could be. People did not have individual risk assessments in their care files. The forms we looked at had not been totally completed; they were not dated or signed by staff or the person receiving care. Where risks had been identified risk management plans were not in place.

We found the recruitment processes were not safe. Not all the checks made before a person started to work for Helmar Care had been completed. Specifically, criminal records checks were not in place for staff before they started work and nor had the provider obtained two references from people’s former employers before they started working for the agency. Without these checks the provider could not be assured that people would be kept safe by the people they employed.

Medicines were not administered safely. Medicines administration records [MAR] were not completed correctly. Staff had not always signed MAR charts correctly to evidence they had administered the person’s medicines. The recording errors we saw could mean people did not receive their medicines as prescribed by their GP.

The support plans we looked at did not detail people’s dietary requirements. They were no details about what a person liked to eat or any allergies they may have. The daily notes we looked at only detailed if a person had been given food or drink during a visit and not what they had actually eaten. This lack of information about people’s dietary needs could not ensure people were kept hydrated and nourished by staff when required.

We found the support plans were not as comprehensive as they could be. They did not describe who the person was, the daily support they needed and how they would like to receive that support. None of the support plans we looked at had been signed by the person receiving the support or their representative to show they had agreed to these plans.

The provider did not have effective quality monitoring systems in place so as to identify the issues we found during our inspection. The registered manager had not submitted to CQC the notifications of relevant events and changes as they are required to do by law.

Despite our findings above we received positive comments from people using the service and their relatives. Comments included “Staff are good at their job,” “Staff have been absolutely brilliant,” “They are professional and know what they are doing” and “Staff are caring professionals, they are like part of our family.”

We found the service had taken steps to help ensure staff were aware of how to safeguard adults at risk. All the people and relatives we spoke with said they felt safe with the service they receive

We carried out an announced comprehensive inspection of this service on 15 and 17 June 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to not having effective systems or processes in place to assess, monitor and improve the quality and safety of the service provided.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for African Positive Outlook on our website at www.cqc.org.uk.

After our last inspection the provider changed their name from African Positive Outlook to Helmar Care and Community Services because they believed this would better reflect the service they offered to all members of the community.

The provider sent us an action plan and told us they would make the necessary improvements by the end of November 2015. We undertook an announced focused inspection on 26 November 2015 to check they had followed their plan, to confirm that they now met legal requirements and to review the rating of the service.

Helmar Care and Community Services is a registered charity established to provide information and advice for people of African descent living in the United Kingdom and Africa. It is also a domiciliary care agency that provides domestic and personal care services to older people of any ethnic background in their own home. At the time of our inspection 31 people were receiving a personal care service.

The service had a registered manager at the time of the inspection. 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 this inspection we found the changes the provider had made had helped to ensure the systems they had to monitor and improve the quality of the service were effective. This helped to ensure people received safe and appropriate care and treatment.

The manager explained referrals were made through the email system and the initial assessment and support plans were drafted by the commissioning provider.

The manager had developed a one page summary of a person’s care needs with essential phone numbers. This was given to staff and kept at the person’s home.

Staff completed a daily log of the support they provided to a person in a communications book.

These daily notes were checked, signed and dated by the manager as correct.

Care plans we saw had been recently updated and signed by the manager as correct.

Medicine Administration Records were checked, dated and signed by the manager as correct. Any errors were actioned in a timely manner and steps taken to help ensure the risk of errors were minimised in the future.

The provider undertook spot checks to observe care being given, talked to people receiving care and spoke to families and kept comprehensive notes of visits and phone calls. The office staff kept comprehensive notes of phone calls, both outgoing and incoming, these were accompanied by notes of actions needs and the outcomes.

We saw the provider had systems to monitor the training staff received. Records showed that staff were receiving specialist end of life training, this would help staff to deliver the care needed by people.

The changes the provider had made meant the manager had a good oversight of the service and the quality assurance systems were used effectively to identify areas for improvement and ensure that prompt remedial action was taken to make improvements.

During our visit we spoke with the manager and five members of staff and with five relatives of people who used the service.

Relatives of people using the service told us that they were very happy with the care delivered and felt that their relatives were treated with dignity and respect by friendly and caring staff. Comments included, "Very respectful" and "More off a friend than a carer".

We saw that individualised care plans were developed following care need and risk assessments. These assessments documented the care and support needs people required. Relatives told us they had been involved in the planning of care. One person said, “Yes I was involved in my husband’s care plan”.

We found that the provider had a safeguarding of vulnerable adults policy and guidelines were in place. Staff had received safeguarding of vulnerable adults training. Prior to employment staff were screened through the Disclosure and Barring Service check (formerly known as Criminal Record Bureau checks).

Appropriate arrangements were in place for the recording of medication administration and we saw that records were signed and dated. There were effective recruitment and selection processes in place and documentation was appropriately collected, completed and recorded in staff files. We saw that staff received regular training and that a staff training log was maintained. Quality assurance systems were maintained including service satisfaction questionnaires and quality audits.

We were unable to speak directly to service users at this inspection as the inspection was based in the main offices of the agency and focussed on the management and systems in place to deliver care and assess the quality of service.

We found that there were procedures in place for ensuring people were involved in the assessment and delivery of their care and this was supported by a comprehensive Service User Guide. People were also involved in providing feedback about a care worker's work by signing a record of care provided on a daily basis.

We found that care workers were provided with support and training prior to taking on their own clients and that training included safeguarding, moving and handling and medication.

Recruitment checks were carried out prior to employment. We found that in some cases the provider had not adequately documented the recruitment decision making by the agency, making it unclear as to why some gaps in employment history, gaps in application forms or other issues were dealt with by the agency.

We found that there was close and regular communication between the agency and the board which governed the provider. We also saw that regular contact was made between the registered manager and people who use services. However, we were not able to see evidence of systems in place to enable the provider to formally assess the quality of performance by the agency or to assess the experience and feedback of people who use the service.

We spoke to people being cared for and their relatives by telephone to ask them for their views about the care and support being provided.

Feedback was positive and included ‘I’m satisfied’ and ‘always polite and respectful’. Other comments included ‘I really am impressed with them’, ‘I have confidence in them’ and ‘I can rely on them’.

A commissioner of the service reported that the agency ‘go the extra mile’ for the people using the service and the feedback they received from their care managers was positive.

We undertook an announced inspection of the African Positive Outlook Domiciliary Care Agency (DCA) on 15 and 17 June 2015. We told the provider two days before our visit that we would be coming. We did this because the service is small and the manager is often out of the office supporting care workers or providing care. We needed to be sure that they would be in.

African Positive Outlook is a registered charity established to provide information and advice for people of African descent living in the United Kingdom and Africa. It is also a domiciliary care agency that provides domestic and personal care services to older people of any ethnic

background in their own home. At the time of our inspection six people were receiving a personal care service. The inspection focused on them as they were the people that the regulated activity, personal care, applied to.

At our last inspection on 28 September 2013, we found the service was meeting the regulations we looked at.

The service had a registered manager at the time of the inspection. 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 using the service were safe. The provider took appropriate steps to protect people from abuse, neglect or harm. Care workers knew and explained to us what constituted abuse and the actions they should take to report it to help ensure the safety of people.

Risks to people’s health, safety and wellbeing had been identified and steps were taken to minimise these risks. Care workers were given guidance on how to minimise identified risks to people and themselves and to stay safe from harm or injury while working in a person’s home.

Care workers were aware of the reporting process for any accidents or incidents that occurred. These were detailed in the person’s daily notes log and the office informed so that any action needed was taken.

There were sufficient numbers of care workers available to keep people safe and to ensure that people did not miss a visit. Care worker personal files showed the necessary recruitment checks had been carried out before care workers were employed to ensure that people were cared for by care workers suitable to the role.

People’s medicines were managed safely and care workers had received training in medicines management.

People were supported by care workers who had the knowledge and skills required to meet their needs. Care workers told us they felt supported by the registered manager and had received appropriate training to carry out their roles. Supervision sessions with the registered manager did not always take place on a regular basis but care workers we spoke with confirmed that they had an opportunity to speak with the registered manager any time they came to the office or by phone.

Care workers were aware of and had received training in the Mental Capacity Act (MCA) 2005 and said they encouraged people’s full involvement in their day to day living decisions. The daily notes we looked at showed that people made decisions about how they spent their day.

People were supported at mealtimes to access food and drink of their choice. Care workers helped to prepare food for people and confirmed that before they finished their visit they ensured people were comfortable and had access to food and drink.

People had access to healthcare professionals to help keep them healthy. Records showed and care workers told us that they could support people to access healthcare appointments and liaise with health and social care professionals if needed.

People were satisfied with the care they received from their usual care worker. The friend of a person did say that when the regular care worker was not available they felt that care was not as thorough for that person.

The registered manager undertook spot checks and called on people, sometimes without notice to observe care being given and talk to the person in their own home to monitor the care people received.

Care workers told us they gave people privacy whilst they undertook aspects of personal care, but ensured they were nearby to maintain the person’s safety.

People and their families were involved in assessing and planning the care and support they received from the agency. Each person had their own support plan and a copy was kept in the office and another copy at the person’s home.

We saw that people's support plans included information about the person’s care needs but did not include a lot of information about the person themselves, such as where they were brought up, their former employment, hobbies or pastimes. From the support plans we looked at we could not see when people using the service had their care and support plans reviewed. This was because not all changes that we saw in the support plans had been dated. This meant that there were risks that people might not receive the care they needed because of the lack of up to date information in their support plans. We spoke with the registered manager about this.

Care workers kept comprehensive daily notes about each person, including any activities they accompanied the person on. These daily notes gave care workers a good insight into a person’s day and helped them to deliver a person centred service.

Relatives told us they felt comfortable raising any concerns or complaints with the agency. Information about how people could make a complaint was detailed in their “service user guide”, which people were given a copy of when they first started using the agency.

Some of the relatives told us they had regular contact with the care worker and the registered manager of the service and felt there was good communication with the care worker at the office. Two other relatives voiced the opinion that communication with the office could be poor.

The registered manager completed various audits to assess the quality of the service provided by the agency. However we found that these checks were not always as thorough as they could be to identify areas for improvement and errors so that that prompt remedial action could be taken.

This lack of oversight by the registered manager meant that people were not always protected against the risks of poor care and treatment and the provider was therefore in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.