This inspection was carried out on 9 August 2017 and was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available at the service.

Our last inspection of Hope Care Agency took place in July 2015. The service met the regulations inspected at that time. We indicated that some areas of service delivery required improvements.

Hope Care Agency is registered to provide support and personal care for adults. At the time of our visit three people were using the service and had been receiving support from this service for the past two years.

The service had a registered manager. 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 registered manager was available at the time of our visit.

Care plans were developed by consulting with people and their family members. Where people were unable to contribute to the care planning process, staff worked with people’s relatives and representatives and sought the advice of health and social care professionals to assess the care needed.

A range of risk assessments had been completed. These included assessments covering issues such as falls prevention and guidance around food, nutrition and personal care.

Risks to people were monitored and reviewed to ensure action was taken to avoid accidents and the deterioration of people’s health. There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being.

Relatives described the staff who supported them as caring and respectful. People’s independence was promoted and staff understood the importance of respecting people’s privacy and dignity.

Relatives told us family members received their support visits consistently and always received the care they needed. Staff were required to record arrival and departure times and all tasks completed in people’s daily log books.

People were supported at mealtimes to access food and drink of their choice. Staff were required to prepare simple meals of their choice or reheat and serve food prepared by family members.

Staff had completed training in food hygiene and preparation and had access to guidance about how to support people to eat healthily.

Recruitment practice was robust and protected people from the risk of receiving support from staff who were unsuitable.

Staff were familiar with the provider’s medicines policy and procedures. At the time of our visit, people using the service were not being supported with medicines as this task was overseen by family members.

People told us they received care from competent staff who had the skills and knowledge to carry out their work. Records confirmed that staff received appropriate training and support to carry out their duties and meet people’s needs effectively.

There were policies and procedures in place to protect people from harm or abuse. Records were available in staff files to demonstrate that staff had attended relevant safeguarding training.

People were asked for their views of the service and said they knew how to make a complaint about the service if they needed to.

There were arrangements in place to assess and monitor the quality and effectiveness of the service and use these findings to make ongoing improvements.

We carried out an unannounced comprehensive inspection of this service on 16 and 17 December 2014. We identified a number of breaches in the regulations relating to person-centred care, safe care and treatment, complaints handling, good governance and notification procedures.

Following this visit, we asked the provider to send us an action plan by 1 May 2015 describing the actions they were going to take to meet the legal requirements and what they intended to achieve by their actions. After a further request for this information we received the provider’s action plan on 26 May 2015.

Due to the significant number of breaches we found during our previous visit, we undertook another full comprehensive inspection on 24 July 2015 to check that the provider had followed their plan of action and to confirm they now met legal requirements. This inspection was announced.

During our inspection on 24 July 2015 we noted improvements had been made to the care planning process and risk assessments had been fully completed and updated. The provider had introduced Health Action Plans for people using the service though these lacked important information such as the details of health professionals involved in people’s care and a record of healthcare appointments. The registered manager had improved the quality of monitoring systems though we identified shortfalls in this area in relation to medicines management.

Hope Care Agency provides support and personal care for adults and children. At the time of our visit six people were using the service.

The service had a registered manager. 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 registered manager was not available at the time of our visit.

The service received the majority of its referrals via email or telephone from social workers based in the London boroughs of Barnet and Ealing. A care manager from the agency visited people in their own homes to carry out an initial assessment and create a plan of care. This process ensured that people’s individual care and support needs were able to be met by the service before a package of care was organised and care staff allocated.

Care plans were developed by consulting with people and their family members. Where people were unable to contribute to the care planning process, staff worked with people’s relatives and representatives and sought the advice of health and social care professionals to assess the care needed.

A range of risk assessments had been completed. These included assessments covering issues such as falls prevention and guidance around food, nutrition and personal care.

The staff we spoke with knew about people’s interests as well as their day to day lives at home with their families. People’s independence was promoted and staff understood the importance of respecting people’s privacy and dignity.

There were policies and procedures in place to protect people from harm or abuse. However, records were not always available in staff files to demonstrate that staff had attended relevant safeguarding training and staff were not always able to demonstrate a clear understanding of safeguarding.

People were supported at mealtimes to access food and drink of their choice. Staff were required to support people to prepare simple meals of their choice or reheat and serve food prepared by family members. Most staff had completed training in food hygiene and preparation. Staff had guidance about how to support people with known healthcare needs, such as diabetes although we saw evidence that staff were not always following these guidelines.

Staff were required to record arrival and departure times and all tasks completed in people’s daily log books. We saw evidence that daily logs were completed. However, information around medicines prompting was inconsistent and medicines administration charts were not available or not completed meaning we were unable to check whether staff were completing this task appropriately.

There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being. However, the administrative person managing the service on the day of our visit seemed unfamiliar with the provider’s policies and procedures as to how to respond to an emergency situation.

We received positive feedback from family members about the registered manager and staff.

People told us they were aware of how to make a complaint. There was a complaint’s log and procedures for managing complaints were evident.

There were arrangements in place to assess and monitor the quality and effectiveness of the service and use these findings to make ongoing improvements. However, we found shortfalls in this process relating to medicines.

We made a recommendation in relation to meeting people’s nutritional and health needs.

We made a recommendation in relation to meeting people’s nutritional and health needs.

We spoke with three out of four people using the service (or their families). They told us they were able to make choices about how care and support was provided and that care workers completed their tasks according to people's wishes. Staff we spoke with stressed the importance of providing care and support in the way that people using the service wanted.

The people we spoke with said that they were happy with the care and support being provided and that staff were "helpful". They said that care workers arrived on time. When people were first referred to the service they were visited by senior staff who would conduct a full assessment of their needs. This included any health needs as well as any support needed with activities of daily living. This information was then used, with the support of people and their families, to draw up a list of individual tasks of what care and support people wanted and needed.

Staff knew how to spot signs of possible abuse and how to report their concerns to the appropriate authorities.

There was a suitable recruitment process in place. Appropriate checks, such as seeking references and checking with the Disclosure Barring Service, took place before a person started work.

There was an appropriate complaints policy and procedure in place. People using the service and their families told us they would be happy to raise any concerns they had with staff.

When people first started using the service they and their families were asked about the care and support they wanted and how it was to be provided. The families of people using the service told us that they were involved in making these decisions and that staff carried out the duties that people wanted them to.

The families of people who use the service told us that they were asked about how they wanted care and support to be provided to their relative. However, full risk assessments were not completed for people which meant that their needs were at risk of not being met.

The families of people using the service told us that they felt "comfortable" around staff. Staff had been trained in safeguarding. They knew how to recognise signs of abuse and how to report any concerns, including to the local authority.

Staff undertook training in relevant areas before they started working at the service. They kept in regular contact with senior staff at the agency about the care and support they were providing in the community. There was a policy in place for them to undergo an annual appraisal to discuss their performance when they had completed their first year working for the agency.

The families of people using the service told us that they kept in regular contact with senior staff at the service about the quality of care and support that they were providing. They said that they would be happy to raise any concerns they had with staff.

This inspection took place on 16 and 17 December 2014 and was unannounced. At our last visit in November 2013 the service was meeting the regulations inspected.

Hope Care Agency provides support and personal care for adults and children. At the time of our inspection 11 people were using the service.

The service had a registered manager. 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’s needs were assessed and care plans were developed to identify what care and support people required. However, some assessments and care plans were incomplete and provided insufficient guidance to staff about the needs of people using the service. Therefore people were not protected from unsafe and inappropriate care.

Staff understood how to recognise the signs and symptoms of potential abuse and told us they would report any concerns they may have to their manager. However, the registered manager had failed on more than one occasion to report safeguarding matters to the Care Quality Commission. This meant that people using the service could not be confident that important events effecting their health, safety and welfare were reported and appropriately responded to.

The registered manager told us that staff were required to record arrival and departure times and all tasks completed in a people’s daily log books. However, during our visit the registered manager was unable to provide us with copies of daily log sheets for any of the people using the service. The registered manager was therefore unable to demonstrate the quality and consistency of daily recording including documentation relating to people’s medicines. This meant that the registered manager could not be assured and neither could we that people were receiving safe and appropriate care.

People were supported at mealtimes to access food and drink of their choice. Staff were required to prepare simple meals or reheat and serve food prepared by family members.

Most of the people using the service and their relatives told us they were happy with the care they received. Care staff told us they enjoyed the role of caring for people and always tried to make sure people were comfortable.

People told us they were aware of how to make a complaint. Health professionals we spoke with told us they had received a number of complaints in the past six months from people using the service. One relative told us that they had complained three times before a situation had been rectified satisfactorily. Records we looked at did not accurately document these complaints. Therefore we were unable to assess how the provider had managed these complaints and/or whether appropriate investigations had taken place.

Staff told us they received supervision every three months but we were unable to locate any records demonstrating that supervision was taking place on a regular basis.

The registered manager had failed to identify service inadequacies and appeared to be unaware of the importance of accurate and consistent quality monitoring. This meant that people using the service were not always protected from the risks of unsafe care due to ineffective decision making and inadequate risk management.