This inspection took place on 30 January and 12 February 2018. The inspection was announced as the service is a small domiciliary care agency where the manager is often out delivering care; we needed to be sure someone would be in.

In November 2016 we identified breaches of five of our regulations relating to the need for consent, safe care and treatment, staff training and support, recruitment and governance. We asked the provider to complete an action plan to show what they would do and by when to improve the rating of the service to at least good. The provider had improved their risk assessments, medicines management, staff support and supervision and recruitment practice. People were now clearly consenting to their care. However, there remained issues with the governance of the service and there were not enough staff deployed to meet people’s needs.

Help in Newham is a domiciliary care service. It provides personal care to people living in their own homes in the community. It provides a service to older adults. At the time of our inspection they were providing personal care to approximately 20 people. Not everyone using Help In Newham’s services receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks relating to personal hygiene and eating.

Help in Newham had a registered manager 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.

People and staff told us they did not think there were sufficient staff to ensure people’s needs were met. People told us they sometimes missed visits of care, and records showed people sometimes received care from one care worker when two were needed. Records of recruitment had not been appropriately maintained and the provider had not always checked whether or not staff had criminal records.

Staff were knowledgeable about how to support people with their medicines and described safe practice. However, records of medicines administration had not been completed. On the second day of the inspection record keeping had improved.

During the inspection the provider took action to update people’s care plans and risk assessments to ensure they were clear, up to date and reflected people’s needs and preferences. Once updated, they showed that people’s needs had been holistically assessed and care was planned in a personalised and holistic way. They contained clear information about people’s health and care needs and what staff needed to do to ensure their needs were met. Where staff supported people to prepare and eat their meals their preferences were clearly captured. People told us they were confident their regular care workers knew how to support them in a safe way, but did not feel that all care workers read their care plans.

Staff were provided with personal protective equipment to ensure people were protected by the prevention and control of infection.

Staff knew about safeguarding adults processes and were confident about their role in safeguarding adults from harm and abuse. The provider had robust systems in place to respond to incidents and allegations of abuse.

Staff told us, and records confirmed they received the training and supervision they needed to perform their roles.

People’s consent to care was clearly recorded in their care plans. Records showed people’s care was regularly reviewed and they were given the opportunity to provide feedback about their experience of care.

Staff spoke about the people they supported with kindness and compassion. People told us they had established positive relationships with their regular care workers, although they also told us the quality of their experience was affected whe

We inspected Help in Newham Limited on 21 November 2016. This was an announced inspection. We informed the provider 48 hours’ in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. This was the first inspection of the service since it was registered with the Care Quality Commission.

Help in Newham Limited provides support with personal care to adults living in their own homes. The service was providing a service to 16 people at the time of our inspection.

The service had a registered manager in place. 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.

Medicines were not always managed safely. The service was not always recording medicines for people. The service was not assessing the risks for people who were supported with medicines. Risk assessments were not robust. Risk assessments contained minimal information and did not always give clear guidance to staff how to support and protect people. Detailed environmental risk assessments had not been carried out in and around people's homes to ensure the safety of

people and staff.

The registered manager was not clear about their responsibilities in relation to supporting people in line with the Mental Capacity Act 2005.

Recruitment and selection procedures were not always safe. Staff records showed interview records were not completed for new staff members. Recruitment and selection procedures were not always carried out in line with the provider’s policy and procedure and may place people using the service at risk of harm by unsafe recruitment and selection practices.

Formal supervision to provide staff support and development required to carry out their role was not being provided by the service. Staff told us they received induction training. However records showed there was no evidence of new staff receiving suitable induction training. The lack of records with induction and shadowing meant the provider could not demonstrate new staff had the skills and knowledge to support people well. We have made a recommendation about induction being recorded.

Systems were not robust to ensure the delivery of high quality care. During the inspection we identified failings in a number of areas. These included managing risks, medicines, record keeping, consent to care, recruitment and supporting staff. These issues had not always been identified by the provider which showed there was a lack of robust quality assurance systems in place.

Staff had undertaken training in safeguarding adults and had a good understanding of their responsibilities with regard to this. We found there was enough staff working to support people in a safe way in line with their assessed level of need.

Staff received regular training and were knowledgeable about their roles and responsibilities. Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported. Care plans were reviewed regularly.

The registered manager was open and supportive. Staff, people who used the service and relatives felt able to speak with the registered manager.

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