We carried out an announced inspection of this service on 19 and 20 December 2018.

J.C.Michael Groups Ltd Redbridge is registered to provide personal care to people in their own homes. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’. Where they do, we also consider any wider social care provided. At the time of our inspection, the service provided personal care to 72 people in their homes.

At our last inspection on 11 October 2017 the service was rated ‘Requires Improvement'. We found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook this inspection to check if the service had made the required improvements. We found that these breaches had not been addressed. As a result, the service continues to be rated ‘Requires Improvement.’

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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

People's risk assessments had failed to identify or address their support needs, which meant staff were not aware of how to keep people safe. Staff did not always arrive on time to see people and systems in place to monitor time keeping were not always effective as people still felt timeliness was a concern. The service had systems in place to oversee safeguarding but people did not always feel safe receiving care from staff, which placed people at risk of potential abuse. People did not feel they were protected from the risk of cross-infection. People did not always feel safe receiving their medicines. Staff were recruited in a safe manner which meant we were assured they were suitable for the role. Accidents and incidents were recorded.

Staff understood the application of the Mental Capacity Act 2005. However, care plans were not recorded in line with the principles of the Mental Capacity Act 2005. Staff received up to date training, supervision and had an annual appraisal to review their work and performance. People were encouraged to live a healthy lifestyle and received support from health and social care professionals.

People and their relatives did not always feel staff were kind and caring. Although people were involved in reviewing their care plans, these reviews were not sufficient and did not change the care provided. People did not always feel staff treated them with respect and dignity. Staff understood how to support people in a manner that ensured people were protected from discrimination. People told us staff promoted a sense of independence.

People knew how to make complaints; however, they didn’t always feel comfortable to do so. Complaints were documented and monitored to ensure appropriate action had been taken. The service worked in a person-centred way. People had their own care plans and gave information about people’s preferences and communication support needs. However, information was not always available in a format that suited individual support needs.

The governance systems at the service were ineffective and failed to identify areas of concern or drive improvements. Previous breaches of regulations had not been addressed and the quality assurance systems in place had not identified the additional concerns we found during our inspection. People and their relatives did not know who the registered manager was, or the role of the management team. People gave feedback about the service; however, this information was not used to make improvements. Staff spoke positively about the management team and felt supported. The registered manager acknowledged the concerns we identified during our inspection and sent us action plan to identify how

Aquaflo Care Ltd is a domiciliary care service providing personal care and support to people living in their own homes in Ilford and Newham. The service provides care and support to people with health and social care needs. At the time of our inspection 65 people were using the service. This inspection took place on 11 October 2017.

We had previously inspected this service on 17 January 2017 and identified a number of areas where improvements were needed, to ensure that people were receiving care that was safe, effective, caring, responsive and well-led.

We found the service to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook this inspection to check if the service had made the required improvements from our inspection in January 2017. We found that although the provider had made some progress, not all the required improvements had been made.

There was a registered manager at the service who told us that they were also registered to manage another location for the same provider. 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.

Staff supported people at home with their care needs and the service had assessed some risks. However, not all risks associated with people’s health care tasks had been assessed to ensure people were safe at all times when staff carried out personal care.

Staff were not always deployed in a way for people to receive care from consistent, punctual staff. People told us that they got along with staff that knew them well.

Staff received up to date training, supervision and yearly appraisals of their work and performance. Staff had a basic understanding of the application of the Mental Capacity Act 2005.

We found recruitment checks were in place to ensure new staff were suitable to work at the service. Staff had positive views about the leadership and culture of the service.

People and their relatives told us they felt safe using the service. Staff knew how to report safeguarding concerns. The provider carried out checks to ensure that staff employed were of good character. Medicines were administered safely by trained and competent staff.

Detailed support plans were in place and records were updated following reviews or changes in people's needs. People were supported by staff if needed, to access support from healthcare professionals where required.

People who used the service and their relatives told us the staff they knew were caring. Staff respected people's privacy and dignity and encouraged them to maintain their independence.

People and their relatives knew how to make a complaint. These were not always satisfactorily handled by the management team. We have made a recommendation about this.

Staff felt supported by management and staff team meetings were used for staff to speak openly and make suggestions that could lead to improvements.

The service had systems in place to monitor the quality of the service provided through seeking people's feedback and carrying out spot checks. However, improvements were needed to identify the issues with an overview of where improvements were required in order to make progress.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We inspected Aquaflo on 17 January 2017. This was an announced inspection. The provider was given 24 hours' notice as they are a domiciliary care provider and we needed to be sure the manager would be available to meet us. This was the first inspection at the service since registration in October 2015. Sixty people were using the service at the time of the inspection.

On the day of the inspection the service had a registered manager in post. However, on 24 January 2017, we received an application from the registered manager to voluntarily cancel their registration. We were informed that an interim manager was in place to manage 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.

People were at risk of harm and poor support because risk assessments did not give guidance to staff about how to manage and mitigate risk for people. Support plans were not personalised and lacked detail. The service had not identified the issues we found at the time of inspection.

Staff did not receive up to date training and yearly appraisal of their work and performance. Staff had a basic understanding of the application of the Mental Capacity Act (2005). We found recruitment checks were in place to ensure new staff were suitable to work at the service. Staff had positive views about the leadership and staff culture of the service.

People and their relatives told us they felt safe using the service. Staff knew how to report safeguarding concerns. However, medicines were not always administered safely by trained and competent staff. The provider carried out checks to ensure that staff employed were of good character.

Staff were not always deployed in a way that people received care from consistent, punctual staff. People told us that they got along well with staff that knew them well.

Detailed support plans were not in place and records were not always updated following reviews or changes in people's needs. People were supported by staff if needed, to access support from healthcare professionals where required.

People who used the service and their relatives told us the staff they knew were caring. Staff respected people's privacy and dignity and encouraged them to maintain their independence.

People and their relatives knew how to make a complaint, however these were not always satisfactorily dealt with by the management team.

The service had systems in place to monitor the quality of the service provided through seeking people's feedback and carrying out spot checks. However, these were not sufficiently robust as they had not identified the issues we did, during our inspection and an overview of where improvements were required was not undertaken in order to make improvements.

Staff felt supported by management and staff team meetings were used for staff to speak openly and make suggestions that could lead to improvements.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.