This comprehensive inspection was commenced on 27 February 2018 and was announced. We spent two days at the provider’s office and also visited two people who used the service in their own homes. The inspection visits were completed on 19 March 2018 and we completed telephone calls to people who use the service and their relatives on 29 March 2018. The service was rated as Good at the previous inspection in December 2015. Safe, caring, responsive and well-led were rated as Good and effective was rated as Requires Improvement.

At the previous inspection on 3 December 2015 we had found that staff were not provided with Mental Capacity Act 2005 (MCA) training, which had meant that we had not been assured that the principals of the MCA were followed when staff assessed people’s capacity. We had made a recommendation for the provider to seek advice and guidance from a reputable source in relation to the requirements of the MCA training for social care staff. At this inspection we found that staff had received relevant training in this area. The staff we spoke with were able to clearly demonstrate their knowledge and understanding in regards to the MCA, and the minutes for staff’s one to one supervision sessions and team meetings showed that this topic was regularly discussed.

Home Instead Westminster is a domiciliary care agency which provides the regulated activity of ‘personal care’ to people living in their own houses and flats in the community. It provides a service to older adults, people with physical disabilities and people living with dementia who reside in the City of Westminster, City of London and some postcodes within the London Boroughs of Brent, Hackney and Southwark. The geographical boundaries were determined by the national franchise organisation. Not everyone using Home Instead Westminster receives regulated activity, the Care Quality Commission (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 the inspection the provider was providing services for 40 people, which included six people who received personal care.

There was a registered manager in post at the time of our inspection, who was the owner of the local franchise. A registered manager is a person who has registered with 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 representatives told us that they received an excellent service and felt confident about recommending the agency to other people. They described staff as being “lovely” and “kind” and spoke about situations where staff had shown enormous compassion and thoughtfulness. People and their representatives stated that the high quality of the service had very positively impacted on their comfort, wellbeing and safety. Staff told us that they had developed good relationships with the people they supported. This was aided by the provider’s policies to carefully match people with their care staff and ensure that all visits were a minimum of two hours duration.

People and their representatives regarded the management team as being dedicated to their roles and committed to providing an exceptionally high standard of care and support. We saw that the registered manager and members of the management team keenly worked towards supporting people living with dementia who used the service and at a wider level in the local community via fundraising, providing free training about dementia for the general public and through active membership of a local dementia care alliance.

Staff informed us that they felt well supported and trained by a provider that valued their contribution, and was interested in their we

Home Instead Westminster is registered to provide and personal care to people in their own home. At the time of our inspection 20 people were receiving support, six of whom had personal care needs.

The service was opened in March 2014.The service was registered in March 2014 and had not previously been inspected. We carried out an announced inspection of this service.

The registered manager had left the service couple of weeks before the inspection. At the time of the inspection the service was managed by a care manager and a director who had applied for the managers registration with the Care Quality Commission (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.

Staff were not provided with a Mental Capacity Act 2005 training and therefore we could not be assured that the Mental Capacity Act 2005 principals were followed when staff assessed people’s capacity to make decisions for themselves.

We have made a recommendation to seek advice and guidance from a reputable source, in relation to the requirements of the MCA training for social care staff.

People felt well supported by the service and that they had their needs met safely. Staff were aware about potential signs of abuse and supported people to manage the risks as required. There were enough staff to meet people’s needs. Safe staff recruitment processes were followed to ensure that staff had required knowledge and skills to support people. People received support to have their medicines safely and as prescribed. Regular health and safety checks were carried out to ensure people remained safe in their own homes and action was taken to rectify any maintenance issues identified.

Staff were supported to develop within their role that enabled them to provide effective care for people. Regular supervisions and appraisals were carried out to ensure that staff had sufficient knowledge to support people with their needs. Staff were required to attend induction an programme before they started working with people, including relevant to their role training courses. People were assisted to eat and drink nutritious food. Staff supported people with their health check-ups when required. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005. In relation to some people, we have advised the service to contact the local authority and discuss submitting applications for authorisation to the Court of Protection.

People felt their privacy was respected. The service provided choices to people as to who they wanted to be supported by and the times when they wanted to receive this support. Staff followed people’s care plans and ensured their interests and hobbies were maintained. People were supported to attend activities in the community when they wished to.

Regular review meetings were carried out to ensure people were involved in making decisions about their care. Staff encouraged people to do things for themselves that enabled them to maintain their independence for as long as possible. People and their relatives did not have any complains about the support received. Information was available to people and they knew how to complain if needed.

The management team provided support and advice to staff as appropriate. Staff were supported to take the initiative and work as a team that enabled them to provide good care for people. Internal and external audits took place to ensure the quality of the services provided for people. Individual checks on staff were carried out to identify their developmental needs for improving care delivery.