This inspection took place on 18 December 2017 and was announced. We gave the registered manager notice of our intention to undertake an inspection. This was because Kensington Community Care Birmingham provides personal care for people who live in their own homes and we needed to be sure that someone would be available at the office.

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, people living with dementia, mental health impairments, physical disabilities, sensory impairment, and younger adults.

Not everyone using Kensington Community Care Birmingham Service 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. At this inspection we found that 57 people were receiving this type of support. Where they do we also take into account any wider social care provided.

There was a registered manager in post when we inspected this 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.

The service was last inspected in October 2016, and was rated as requires improvement overall. We found improvement was needed with the training staff received and how the provider recorded people’s capacity to make decisions. We also found people’s care plans were not personalised to ensure staff were aware of people’s individual risks. The systems in place to ensure shortfalls were identified were not consistently effective. We looked at how the service had improved since our last inspection.

People were supported by staff that understood how to keep people safe. We saw examples where safe guarding concerns were raised and acted upon. People had clear risk assessments and were supported by regular staff. Staff understood how to protect people from abuse and protect them from infection through their practice. The registered manager investigated accidents and incidents and took action to ensure people were safe.

People and their relatives told us there was a clear assessment process and people had the support they needed. Staff received appropriate training that maintained their skills. When people needed support with food and drink, staff promoted a healthy lifestyle. The management team worked with other organisations when they needed to, and ensured health professionals were involved as required. People were able to make their own decisions and staff supported them to be as independent as possible.

People were supported by caring staff who listened to people and met their needs. People had support from regular staff that knew them well. Staff encouraged people to be as independent as possible and treated them with dignity and respect.

People said they had their needs met, and staff said they had the information they needed to ensure people had the support they wanted. People were supported in a flexible way and the service was adapted to changes in their needs. Complaints were investigated and actioned and lessons learnt shared with staff.

Systems in place to monitor the quality of the care identified short falls and the management team put in place an improvement plan to ensure quality care was delivered. The registered manager knew people’s needs well and regularly talked to people about the quality of their care. Staff said they were well supported and were supported to share best practice ideas.

This inspection took place on 1 September 2016. This was an announced inspection.

At the time of our last inspection in August 2014, Kensington Community Care Services Birmingham was found to require improvement in three out of the five areas that we inspected them against, including treating people with respect and involving them in their care, providing care, treatment and support that meets people’s needs and the quality and suitability of management. We found that some improvements had been made in these areas.

Kensington Community Care Birmingham provides a domiciliary care service to people living in their own homes. At the time of our inspection, 93 people were receiving the regulated activity, personal care, from the provider.

There was a registered manager in post at the time of our visit. 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 effective because people received care from staff who had not always received adequate training and did not always have the knowledge and skills they required to do their job effectively.

The service was not always responsive because care was not always planned in a person centred way that took in to consideration people’s individual care needs and health related risks.

The service was not always well led because the provider had some quality monitoring processes in place to monitor the safety and quality of the service. However, these had not identified the shortfalls found during the inspection.

The service was safe because people were protected from the risk of abuse and avoidable harm and staff were aware of the processes they needed to follow. People were supported by enough members of staff who knew them well enough to ensure their needs were met. We also found that people received their prescribed medicines as required.

People’s nutritional needs were assessed and monitored to identify any risks associated with nutrition and hydration and they had food they enjoyed. People were also supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

The service was caring because people were supported by staff that were friendly, caring and supportive. People received the care they wanted based on their personal preferences and likes and dislikes because staff took the time to get to know people well. People were also cared for by staff who respected their privacy and dignity.

People were encouraged to be as independent as possible and were supported to express their views in all aspects of their lives including the care and support that was provided to them, as far as reasonably possible.

People received care and support with their consent, where possible and people’s rights were protected because key processes had been fully followed to ensure people were not unlawfully restricted.

People and their relatives felt involved in the planning and review of their care because staff communicated with them in ways they could understand. People were also encouraged to offer feedback on the quality of the service and knew how to complain.

Staff felt supported and appreciated in their work and reported Kensington Community Care Birmingham to have an open and honest leadership culture.

We last inspected this service on 3, 4 September 2013. At that time we found that there were gaps and inconsistencies in peoples care records, and that some people with mental health needs and dietary needs did not have specific care plans. We also found that there was an inadequate system of alerting staff when people’s care needs changed.

During the last inspection we also noted that satisfaction surveys from people were not analysed and that themes resulting from complaints and accidents were not identified. Also there was no evidence that audits of record keeping, including medication records, took place. There were also inconsistences in the process of spot checks that senior staff undertook with care staff.

During this inspection we found that some improvements had been made around people’s care records. We also found that there had not been any improvements in relation to checking and monitoring the service.

On the day of our inspection there were 95 people using the service and 52 care staff employed at the service. We talked with the manager and the nominated individual and looked in detail at the care records for five people. We talked with three staff. We telephoned two relatives and eight people who used the service.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

Staff understood their role in safeguarding the people they supported. There were enough staff and emergency processes in place to make sure that calls were not missed. The manager had a good understanding of issues around safeguarding and their role in protecting people. Staff had been trained in safeguarding and understood how to safeguard people they supported. There were policies and procedures in place to make sure that unsafe practice would be identified and people would be protected. One relative told us, “Dad seems happy with the carers, I’d recommend them.”

We looked at how the Mental Capacity Act 2005 was being applied at the service, and we saw that the manager was operating within this law. The manager had an understanding of the requirements to ensure people’s rights and choices were protected.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. Staff had been provided with up to date training in a range of topics including health and safety and manual handling. One staff member told us, “The training was good, I had a whole day shadowing too. Sometimes I go to new clients and they tell me all about them.”

Care plans were linked to people’s individual needs and wishes. Staff had a good understanding of people’s care and support needs.

One person told us, “I like them pretty well, usually the manager comes out to ask me how things are.” All the people we spoke with told us that the service met their needs. Some people told us they would like to see improvements around communication. One relative told us, “They are usually OK, but there’s a lack of communication, they need to get on top of that and carers need to read the notes.”

Is the service caring?

People told us staff were caring and kind. One person said, “The carers I’ve got now are very good, I only have to say I want some tea or toast and they get up and sdo it. The carers ask me if there’s anything I want.” Staff told us they were clear about their roles and responsibilities and that they had regular supervisions. One person told us, “They are very nice and so far have been prompt.” Another person told us, “They are good and so kind, they come in and get on with it.”

Is the service responsive?

We saw that the manager responded quickly and appropriately to complaints and concerns. One person told us, “I’ve seen the manager once and did complain about my carer. I’ve got a new carer now.” We spoke with the manager who told us other professionals were involved in people’s care when their needs changed. This was so the people’s care could continue to be provided safely and appropriately. Staff we spoke to said they were supported by the office and could phone for advice at any time. One member of staff said, “If you call them they are quick to try and sort things out.”

Is the service well-led?

Staff felt supported and records we reviewed confirmed that staff were appropriately trained and supported to carry out their role safely. Staff told us they were clear about their roles and responsibilities. There was a clear structure of supervision responsibilities within the staff team. One member of staff told us, “It’s ok, everything is alright, the managers seem quite helpful.”

Most people told us they had seen the manager who talked to them about their care workers. One person told us, “I had a person come out and check on how things were going.” Another person told us, “I’m quite happy with them, I like their system. I always know who is coming.”

We saw that systems for checking and monitoring staff and paperwork were not robust.

We gave short notice of our inspection. We did this to enable us to make a judgement about the service provided. At the time of our inspection the service was providing personal care and support to 62 people. We spoke with seven people using the service and three relatives. The registered manager was not available on the day of our inspection. However, we spoke with the operational manager, the care coordinator, and four members of staff. We also looked at five sets of care records for people using the service.

Care plans and risk assessments were in place to support people's needs however, there were some gaps and inconsistencies. This meant that care was not always planned and delivered in a way that was intended to ensure people’s safety and welfare.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse to protect people from the risk of harm. One person told us, "I have no concerns, I am more than satisfied".

Recruitment processes were adequate which gave people using the service some assurances that only suitable staff had been employed.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, "Staff are brilliant".

Systems were in place for the on-going monitoring of the quality of service but a lack of analysis meant that the provider was not identifying themes and trends in order to learn and improve from findings

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