What life is like for people using this service:

People using the service and their relatives spoke positively about the kind and caring nature of staff who supported them and the positive relationships they had developed. People were treated with dignity and respect.

The provider ensured that language and cultural requirements were considered when carrying out assessments and allocating staff to work with people. People and their relatives highlighted how important this was for them when receiving their care and support.

People had regular care workers who knew how they liked to be supported. We saw staff responded to changes in people’s needs and contacted the relevant health and social care professionals when required.

People told us they felt safe using the service and were confident with the knowledge and skills of the care workers that supported them, especially with moving and handling procedures and managing their medicines.

The provider monitored care workers visits and timekeeping as an electronic call monitoring system where staff logged in and out of their calls had been implemented since the last inspection. This had been discussed with people, their relatives and the staff team to explain why it was being used.

People and their relatives felt the care they received was personalised and that the provider listened to them and was flexible in accommodating their needs. Reviews were carried out if care workers reported any changes to people’s health conditions.

People and their relatives knew who to contact if they needed to make a complaint and felt comfortable raising any issues or concerns. We received positive feedback about how any issues with the service had been dealt with. Health and social care professionals felt the provider was responsive and followed up any concerns accordingly.

The provider continued to promote an open and honest culture and people and their relatives were confident with the management of the service. Staff spoke positively about the support they received, the working environment and told us they felt valued in their role.

More information is in Detailed Findings below.

Rating at last inspection: Good (report published 24 June 2016).

About the service: Home and Community Services is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger disabled adults and children. At the time of the inspection the service was supporting 380 people in the London Borough of Tower Hamlets.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor information and intelligence we receive about the service until we return to visit as per our re-inspection guidelines. We may inspect sooner if any concerning information is received.

This inspection took place on 19, 22 and 26 April 2016 and was announced. 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. At our previous inspection on 5 February 2014 we found the provider was meeting the regulations we inspected.

Home and Community Services is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing support to 184 people in the London Borough of Tower Hamlets. The majority of people who used the service and the care workers who supported them used Bengali as their first language. All of the people using the service were either funded by the local authority or the NHS.

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.

People and their relatives told us they felt safe using the service and care workers had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns.

Risks to people were managed and care plans contained appropriate risk assessments which were updated when people’s needs changed. The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. People had regular care workers to ensure they received consistent levels of care by staff who knew how to look after them.

There was a comprehensive induction based on the Care Certificate and a six month probation period for new staff. Staff members also took part in a training programme to support them in meeting people’s needs effectively and were always introduced to people before they started supporting them. They shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were happy with the supervision they received.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Care workers respected people’s decisions and gained people’s consent before they provided personal care.

Care workers were aware of people’s dietary needs and food preferences. Care workers told us they notified the management team and people’s relatives if they had any concerns about people’s health and we saw evidence of this in people’s care plans. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, occupational therapists and social services.

People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. Care workers understood the importance of getting to know the people they worked with and showed concern for people’s health and welfare in a caring manner.

People told us that staff respected their privacy and dignity and promoted their independence. There was evidence that language and cultural requirements were considered when carrying out the assessments and allocating care workers to people using the service.

People and their relatives were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. Care was personalised to meet people’s individual needs and was reviewed if there were any significant changes, with health and social care profession

During our inspection we spoke with four senior staff and six care staff. We also spoke with 13 people who used the service and 19 relatives of people by telephone. People told us they were happy with the service. One relative told us, "the care workers are very good." Another relative told us, “our care workers and I have built a very good relationship and as a result my relative gets the best care possible.”

We found that people who used the service had initial assessments and care plans in place. People's needs were agreed and consent was obtained before any care or support was provided. Care plans were then reviewed on a regular basis. This showed the provider had systems in place to gain and review consent from people who used the service.

We found there were effective systems in place to reduce the risk and spread of infection. One person told us, “care workers do wear gloves when assisting me.” Another person told us, “my care worker wears disposable aprons.”

There were sufficient skilled and experienced staff to safely meet the needs of people who used the service. In the staff files we saw evidence staff had received appropriate training and were supported in their role.

People were made aware of the complaints system. All the people we spoke with said they were confident about how to make a complaint. People thought the service would respond promptly and effectively if they made a complaint. One relative said, "I did not think the care worker was doing a good job with my relative. I complained and she was replaced with someone who is excellent."

This was the first inspection of this service, which specialised in providing home care and support to people in the local Bangladeshi community. At the time of the inspection 120 people were using the domiciliary care service.

We spoke with ten relatives and one person who used the service. All these people told us they were satisfied with the service provided. One person said, "the carers should get a medal. They are totally professional and give space when needed."

People told us they were involved in decisions about their care and their wishes were respected in everyday practice by staff from the agency. We saw that care records gave staff clear information to help them to meet people's needs safely.

The agency had its own policies and procedures in place regarding the safeguarding of vulnerable adults. The staff we spoke with demonstrated a good understanding of the signs of abuse and how to report their concerns.

Monitoring by senior staff ensured that staff followed support plans and respected the wishes of people using the service. There were sufficient skilled and experienced staff to safely meet the needs of people who use the service.