This inspection took place on 1 and13 August 2018 and was unannounced. At the comprehensive inspection of this service on 19 September 2016 we rated the service as good overall in each of the five key questions.

Immaculate Healthcare Services Ltd Croydon is a service which is registered to provide personal care to adults in their own home. At the time of our inspection there were 190 people using this service.

The registered manager remained 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 service was not always well-led because the provider’s auditing process did not consistently or effectively identify issues where the service was not meeting their own quality standards. This meant that the service had not been improved or developed where it needed to be and we have made a recommendation the provider comprehensively reviews their auditing processes.

Some people told us they felt safe with the services they received and other people told us they experienced late or missed calls on occasions that meant their care was not provided as agreed with them. The provider had not regularly assessed staff competencies to administer medicines safely to people they supported.

There was a recruitment process in place for the selection of staff. This included checks with the Disclosure and Barring Service (DBS) to ensure potential employees were suitable to work with vulnerable people. Access to some of the staff file information was difficult and we were only fully enabled to see the correct information when the registered manager was present on the second day of the inspection.

Our inspection found that medicines were managed safely. Records relating to the administration of medicines were accurate and complete. The registered manager told us they were reviewing the process for ‘spot checks’ to ensure staff had the skills and knowledge to prompt medicines safely.

Staff were aware of the provider’s policies and procedures to do with safeguarding people and they knew how to identify and report concerns about potential abuse.

There were appropriate numbers of staff on duty to support people. Most people were supported by a regular staff member or group of staff who they knew. People were provided with the care and support they required by staff who were trained and supported to do so.

Risk assessments for people, their home environment’s and staff were carried out to ensure risks were identified. There were appropriate plans in place to minimise and manage these risks and to keep people and staff safe from injury and harm.

Staff we spoke with were motivated, passionate and enthused about helping people where they needed it.

Staff ensured people consented to the care they received. Staff were aware of how to respect people's choices and rights. People and their relatives were involved in decisions about their care and support. People and their relatives knew how to complain and felt confident their concerns would be addressed.

The provider dealt with complaints in a timely and thorough way. Staff felt confident in their roles and were aware of their responsibilities. Systems were in place to ask people their views about their care.

Immaculate Healthcare Services Croydon is a domiciliary care agency that provides personal care and support to people living in their own homes in the London Borough of Croydon. This inspection was undertaken in response to concerns raised about the operation of the service. The last inspection was July 2015 and at this inspection we found the service met all the regulations we inspected.

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 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 majority of people using the service and their relatives spoke positively about the care provided by the service and said that they felt safe with care staff. Staff recognised how to identify the signs of potential abuse and knew how to respond appropriately to keep people safe. There were sufficient numbers of trained care staff available to enable the service to deliver care at the times preferred and to provide for any staff absences. The agency office was suitably staffed to coordinate services.

People found that the majority of delays in care staff arriving on time were mainly due to unavoidable factors such as public transport and road works. Office staff were working hard to improve the service delivery by assigning care staff to work in specific geographic areas to reduce travelling time. Staff had recruitment checks to ensure they were suitable for their role; we made recommendations to strengthen recruitment procedures.

Risks to people and the environment they lived in were assessed, and management arrangements were put in place to promote the safety and welfare of people and staff providing the service. The care arrangements and support needs were reviewed regularly to ensure the care delivered remained appropriate for people’s needs. People were supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent and risks were mitigated in the least restrictive way possible.

Most people were supported by a regular staff member or group of staff who they knew. People were provided with the care and support they required by staff who were trained and supported to do so. People who required support to take their medicines received assistance to do so. People who received support with their medicines were satisfied with arrangements but improvement were recommended to ensure people who required full assistance with taking medicines was in line with safe medicine guidance.

Staff ensured people consented to the care they received. Staff were aware of how to respect people's choices and rights. People and their relatives were involved in decisions about their care and support.

People and their relatives knew how to complain and felt confident their concerns would be addressed. The provider dealt with complaints in a timely and thorough way.

People felt the service was well run and the management team approachable. Staff felt confident in their roles and were aware of their responsibilities. Systems were in place to ask people their views about their care. Quality audit processes were in place to monitor the quality of the service provided. There were signs the service was working hard in making improvements. When required action plans were developed to address areas which needed to be improved.

Management arrangements had improved and were becoming more robust. The service cooperated fully in working with external professionals and participated in training to help them develop their skills.