About the service: J.C.Michael Groups Ltd Docklands 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. At the time of the inspection they were supporting 10 people in the London Boroughs of Islington and Tower Hamlets.

People’s experience of using this service:

¿ Relatives told us the regular care workers were kind and caring and knew how to meet their family members needs. Positive relationships had been developed and people were treated with dignity and respect. One relative highlighted the importance of language and cultural requirements in staff being able to meet their family members needs.

¿ We received mixed feedback from relatives about timekeeping and missed visits. Although some improvements had been made since the last inspection, negative comments highlighted the impact this had upon the service people received and their families. Inconsistencies with care worker logging information showed their monitoring system was not always being used accurately.

¿ One relative told us they did not have any concerns with how medicines were managed. However, we continued to see inconsistencies in how records were completed and regular quality assurance checks were not being completed, which the provider acknowledged. We saw the provider had introduced new medicines competency assessments to make staff aware of their responsibilities.

¿ Although the provider regularly reminded staff to complete the appropriate records we found that this was not always being done. Not all of the records we requested were available as they had not been returned to the office. A new monthly audit was in the process of being implemented so we were unable to see how effective it was in monitoring the service.

¿ Care workers supported people to maintain their health and wellbeing and were aware of people’s dietary needs.

¿ Staff spoke positively about the management of the service and felt supported in their roles. They felt listened to and confident any action would be taken if they raised any concerns.

¿ We continued to receive mixed feedback from relatives about the management and organisation of the service, where issues with communication had an impact on the service people received. The manager said they would make contact with the relatives to follow up their concerns.

We found a breach of regulations in relation to good governance. You can see what action we told the provider to take at the end of the full version of this report.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 9 June 2018).

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection. The previous inspection was a focused inspection on 10 April 2018 to check that improvements to meet legal requirements had been made. At this inspection, despite some continued improvements that had been made, we found there were still some inconsistencies. This is the sixth time this service has been rated Requires Improvement.

Follow up: We will ask the provider following this report being published to tell us how they will make changes to ensure they improve the rating of the service to at least Good. 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.

We undertook an announced focused inspection of JC Michael Groups Ltd Docklands on 10 April 2018. This inspection was carried out to check that improvements to meet legal requirements after our last comprehensive inspection on 14, 16 and 20 November 2017 had been made. At the time of the last inspection the provider was registered under the name of AQUAFLO CARE LIMITED and changed their registration in January 2018. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘AQUAFLO CARE LIMITED’ on our website at www.cqc.org.uk’.

We inspected the service against two of the five questions we ask about services: is the service safe and is the service well led? This is because at our previous comprehensive inspection a continued breach of legal requirements was found. The provider was issued with a warning notice in relation to safe care and treatment. The warning notice asked the provider to make improvements within a limited period of time.

No risks or concerns were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At this inspection, we found that the provider had made improvements in how people’s medicines were managed and further improvements with the monitoring of the service were still in progress.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection they were supporting 18 people in the London Boroughs of Islington and Tower Hamlets. Not everyone using JC Michael Groups Ltd Docklands receives a regulated activity; 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.

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.

Improvements had been made to how people’s medicines were managed. Care records had been updated since the last inspection and checks had started to be completed to ensure people received their medicines safely.

We received mixed feedback from people and their relatives about timekeeping and missed visits. Although some comments were positive and highlighted improvements had been made since the last inspection, negative comments said these issues had impacted upon the service people received.

Risks to people continued to be assessed with detailed information and guidance in place for care workers to reduce the likelihood of people coming to harm.

Robust staff recruitment procedures were still in place which minimised the risk of unsuitable staff being employed.

There was evidence of positive action being taken after the last inspection and staff spoke highly of the support they received to make the necessary improvements. Systems to monitor the quality of the service were in place however were still in the process of being fully implemented.

We continued to receive mixed comments from people who used the service and their relatives about how well the service was managed. Negative comments highlighted the impact that poor communication had on the support that people received. Missed visits had not always been documented or followed up appropriately. The provider contacted us after the inspection to update us on their investigations and

This comprehensive inspection took place on 14, 16 and 20 November 2017 and was announced.

At the last comprehensive inspection on 31 January, 1 and 2 February 2017 we found three continuing breaches of regulations relating to safe care and treatment, complaints and notifiable incidents. Two new breaches of the regulations relating to consent and safeguarding people from abuse were also found. For each of the three continuing breaches we served the provider a warning notice and asked them to send in an action plan of how they were going to meet the regulations.

We undertook an announced focussed inspection on 8 and 13 June 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 31 January, 1 and 2 February 2017 inspection had been made. The team inspected the service against three of the five questions we ask about services; is the service safe, is the service responsive and is the service well-led?

We found that the provider had made improvements in relation to two of the warning notices, but were still in progress in relation to the requirements in one warning notice and therefore this had not yet been fully met. At this inspection, despite some improvements, we found that not all improvements had been made.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection they were supporting 24 people in the London Boroughs of Islington and Tower Hamlets. Not everyone using AQUAFLO CARE LTD receives regulated activity; 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.

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.

Appropriate policies and procedures were still not in place to ensure that people received their medicines safely and effectively. People’s records were not always being completed or being checked to ensure they received them safely.

There had not been sufficient improvements in how the provider worked in line with the principles of the Mental Capacity Act 2005 (MCA). Where family members had signed to consent to the care and support of their family member, the provider was unable to demonstrate that the relative had the legal authority to do so and so continued to not work in line with the MCA.

Improvements had been made into how risks to people were identified during initial assessments. Care records had been updated with more detailed information and guidance since the last inspection.

Care workers understood how to protect people from abuse and were confident that any concerns would be investigated and dealt with. Improvements had been made since the last inspection in how the provider responded to safeguarding concerns.

Newly recruited staff underwent 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.

New staff received an induction training programme with regular staff having an annual refresher. Staff received regular supervision and spoke positively about how it helped them in their role.

People were supported to have sufficient food and drink and the provider had made improvements in how this information was recorded in people’s files.

Staff understood the importance of respecting people’s privacy and treating people with

This inspection took place on 8 and 13 June 2017 and was announced.

At our previous inspection on 31 January, 1 and 2 February 2017 continued breaches of legal requirements were found. The provider was issued with three warning notices in relation to safe care and treatment, complaints and notification of incidents. The warning notices asked the provider to make improvements within a limited period of time.

We undertook this focussed inspection to check that they now met the legal requirements in relation to the warning notices. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘AQUAFLO CARE LIMITED’ on our website at www.cqc.org.uk’ At this inspection, we found that the provider had made improvements but these were still in progress in relation to the requirements in one warning notice and therefore this had not yet been fully met.

AQUAFLO CARE LIMITED is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our previous inspection the service was providing support to 132 people in the London Boroughs of Hackney, Tower Hamlets and Islington. The majority of the people using the service were either funded by the local authority or the NHS. At this inspection they were supporting 135 people.

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.

Appropriate policies and procedures were not always in place to ensure that people received their medicines safely and effectively. People’s records had been updated and now included more detailed information about the medicines they took and the support they received. However, medicines records were not always being checked appropriately to ensure people received them safely. The return and auditing of medicines records was still being implemented at the time of the inspection.

People who lived with specific health conditions had been assessed and their risk assessments had been updated, to highlight the risks associated with these conditions. It included guidance for care workers on how manage these risks. However there were inconsistencies in the care records viewed and not all people’s care plans reflected the current level of care being provided.

Improvements had been made in how the provider dealt with people’s complaints and we saw that complaints viewed at the previous inspection had now been investigated and followed up. Learning had taken place since the previous inspection and shortfalls in customer service had been acknowledged and action taken.

The provider had made some improvements regarding notifying the Care Quality Commission (CQC) of serious incidents which they have a legal obligation to do so. Statutory notifications had been received since the previous inspection, recorded and followed up appropriately.

We found one continuing breach of regulations relating to safe care and treatment and asked the provider to submit an action plan to tell us how they were going to make the necessary improvements. We also asked the provider to send us specific documents about people’s care to show us what improvements they had made since the inspection was completed.

This inspection took place on 31 January and 1 and 2 February 2017 and was unannounced.

At the last inspection on 27 and 29 September 2016 we found breaches in relation to safe care and treatment, complaints, staffing, the employment of fit and proper persons and notification of incidents. The service was rated Requires Improvement overall and Inadequate in Safe. The provider sent in an action plan to tell us what they were going to do to make improvements. We found that not all improvements had been made.

AQUAFLO CARE LIMITED is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our previous inspection the service was providing support to 118 people in the London Boroughs of Hackney, Tower Hamlets, Islington and Newham. The majority of the people using the service were either funded by the local authority or the NHS. At this inspection they were supporting 132 people, but were no longer supporting people in the London Borough of Newham. These people were being supported by another branch of the provider.

There was not a registered manager in post at the time of our inspection. We were told that two senior members of staff were in the process of applying for the registered manager’s post. 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 who lived with specific health conditions did not always have the risks associated with these conditions assessed and care plans were not always developed from these to ensure their safety and welfare. Risk assessments lacked detail and did not always provide staff with guidance on how to minimise risk. Risk assessments had not been updated in line with the provider’s action plan.

Appropriate policies and procedures were not in place to ensure that people received their medicines safely and effectively. People’s records were not clear as to what support they received with their medicines and were not being checked to ensure they received them safely.

People were not always protected from the risk of potential abuse because the provider did not always act appropriately to safeguarding concerns or follow them up to ensure people’s safety.

The provider had improved their staff recruitment process and initial interview assessment process to ensure staff were suitable to work with people using the service.

Staff did not have a clear understanding of the principles of the Mental Capacity Act 2005 (MCA). Where family members had signed to consent to the care and support of their family member, the provider was unable to demonstrate that the relative had the legal authority to do so and was therefore not working in line with the MCA.

New staff received an induction training programme with regular staff having an annual refresher. The provider was aware of some of the issues raised regarding the amount of training that was covered in the induction programme and they were in the process of reviewing this.

We saw that more regular supervisions were being carried out by suitably qualified staff. A supervision and appraisal matrix had been developed and information was seen to highlight when staff were due to receive one.

People were supported to have sufficient food and drink. Information had been recorded in people’s files however still lacked detailed information of people’s preferences and nutritional needs.

People and their relatives told us that their regular care workers were kind and caring and knew how to support them. Staff understood the importance of respecting people’s privacy and treating people with dignity and respect.

People and their relatives were not always involved in making decisions about their care and the sup

This inspection took place on 27 and 29 September 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. This was the first inspection since registration.

AQUAFLO CARE LIMITED is a domiciliary care provider, the registered office is based in Tower Hamlets. This location provides personal care and support to people in four local authorities, Tower Hamlets, Hackney, Islington and Newham. There were approximately 118 people using the service at the time of our inspection.

There was a registered manager at the service. 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.

Although the majority of people using the service told us they were happy with the care and support they received, we identified areas for improvement during the inspection.

Staff recruitment checks were not thorough therefore we could not be assured that care workers were suitable to work with people. Staff files were sometimes incomplete and did not contain appropriate references, application forms were not signed or dated or had gaps in their employment history. Staff supervisions were not carried out in line with the provider’s policy on staff supervision. We found evidence that some care workers were being supervised by the office administrator rather than the care co-ordinators as stated in the provider’s policy.

We were not able to verify that all staff were given regular training because the IT systems were not working at the time of the inspection and the registered manager said the latest records were not accessible.

We found the provider’s risk assessments did not adequately identify assessed risks or guide staff about how to mitigate these. There was an over reliance on risk assessments that had been carried out by other agencies and risks identified in those risk assessments were not always captured in the assessments carried out by the provider. The provider’s care plans did not always document identified risks to people.

The initials assessments that were carried out by the provider were not always fully complete. Care plans contained minimal information about people’s care and support needs. They were not person centred and did not identify people’s preferences as to how they liked to be supported in all the records we saw.

Although complaints were documented and responded to, we found examples where the identified actions for the provider to try and learn from complaints and prevent similar events in future did not take place. These included staff having refresher training or additional supervisions.

The registered manager was not a visible presence at the service. She was not always up to date with changes within the service and quality assurance audits did not pick up the concerns we identified during the inspection.

We found five breaches of the regulations in relation to safe care, fit and proper persons employed, staffing, complaints and notifications. You can see what action we have told the provider to take at the back of the full version of this report.