Kingston Domiciliary Care Agency (DCA) provides care and support for 15 people with learning disabilities, who live in their own homes in the boroughs of Kingston, Hillingdon and Greenwich. This service includes assistance with bathing, dressing, eating and medicines, shopping, meal preparation and household duties and support to access community activities. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by CQC.

This inspection took place on 7 and 9 November 2017 and was announced. We told the provider one day before our visit that we would be coming. At the last Care Quality Commission (CQC) inspection in November 2015, the overall rating for this service was Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards

The service did not currently have a registered manager. The previous registered manager left at the end of August 2017 and a new manager had been appointed but was not yet in post. During this interim period the deputy manager and the providers’ operations manager were managing the day to day running of the service.

People remained safe in their homes. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with people’s homes, to help keep people and staff safe. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. Staff told us they encouraged people to make their own decisions and gave them the time and support to do so. Staff were providing support in line with the Mental Capacity Act 2005. People were supported to eat and drink sufficient amounts to meet their needs. When required staff supported people to access a range of healthcare professionals.

Relatives and local authority quality assurance reports stated staff were caring, kind and efficient and staff respected people’s privacy and treated them with dignity.

People’s needs were assessed before they started to use the service and support was planned and delivered in response to their needs. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

People were supported to access the community and activities of their choice.

Staff we spoke with described the management as very open, approachable, positive and easy to get on with. Systems were in place to monitor and improve the quality of the service. The provider had effective quality assurance systems to monitor the scheme’s processes. These systems continue to help ensure people received the care they needed as detailed in their support plans.

This inspection took place on 10 November 2015 and was announced. We told the provider one day before our visit that we would be coming. At our last inspection on 25 November 2015 we found the provider was meeting the regulations we checked.

Kingston Domiciliary Care Agency (DCA) provides care and support for 12 people with learning disabilities, who live in their own homes in the boroughs of Kingston, Hillingdon and Greenwich.

Since the previous manager left in January 2015 the service has had two temporary managers.. On the day of our inspection the provider had appointed an experienced interim manager from within the company, who had managed the service since June 2015. A new permanent manager was due to start on the 23 November 2015 and we were told they will apply to register as a manager with the Care Quality Commission (CQC).

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 told us they felt safe with the support they received from staff. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place to inform people who used the service and staff how to report potential or suspected abuse. Staff we spoke with understood what constituted abuse and the steps to take to protect people.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe.

The provider and interim manager ensured there were safe recruitment procedures in place to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Appropriate arrangements were in place in relation to administering and the recording of medicines which helped to ensure they were given to people safely.

Staff received training in areas of their work identified as essential by the provider. We saw documented evidence of this. This training enabled staff to support people effectively.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. Staff supported people to make choices and decisions about their care wherever they had the capacity to do so. Where people did not have the capacity to make their own decisions, other professionals and families were involved in making decisions for people that were in the person’s best interests.

People chose their meals and were supported to have a varied nutritious diet, to eat and drink well and stay healthy. Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

People were involved in planning the support they received and their views were sought when decisions needed to be made about how they were supported. The service involved them in discussions about any changes that needed to be made to keep them safe and promote their wellbeing.

Staff respected people’s privacy and treated them with respect and dignity. Staff supported people according to their personalised care plans, including supporting them to access activities of their choice.

The provider encouraged people to raise any concerns they had and responded to them in a timely manner. The complaints policy was provided in an easy read format.

Staff gave positive feedback about the management of the service. The interim manager was approachable and fully engaged with providing good quality care for people who used the service.

The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions and action plans were developed where required to address areas for improvements.

At our previous inspection of the service on 20 and 21 August 2014 we observed that care had not been taken to protect people who used the service against financial abuse. This was because the policy and procedures that were in place for protecting people against financial abuse had not been followed.

We also found that the provider did not have an effective system in place to regularly assess and monitor the quality of service that people received. Although the provider sent out yearly surveys the number of surveys returned was very low. The provider had not made any other provision to gather people's views about the service delivered.

Following that inspection we asked the provider to take action to achieve compliance with the appropriate regulation. The provider sent us an action plan in September 2014 setting out the steps they had taken to do this. During this visit we checked these actions had been completed.

We spoke with the manager and asked the deputy manager to send us information about staff supervision and team meetings. We looked at financial and auditing records.

This announced inspection was carried out by a single inspector. We considered all the evidence gathered under the outcomes inspected and used the information to answer two of the five questions we always ask: is the service safe, caring, responsive, effective and well led.

Is the service safe?

The provider had taken most of the steps that they had told us about towards ensuring peoples finances were kept safe. We saw that receipts at one supported living scheme were now being obtained for all purchases. These had been checked and listed on a finance record sheet and signed by two staff members and also checked by senior staff on a daily basis. However at another supported living scheme where one person lived, the new procedure was not being followed appropriately. Staff had obtained and checked all the receipts on the finance record sheet but they were not being audited by senior staff. The manager told us that they would now ensure these sheets were audited on a monthly basis.

Is the service responsive?

The service was responsive because the manager and deputy manager had telephoned all the people who used the service and their families to gain their feedback on the service they received. Results showed that the majority of people were happy with the care they or their family member received. A survey was also sent to staff. Actions had been recorded and where appropriate fed back to the provider.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? The summary describes what families of people using the service and the staff told us and the records we looked at.

On the day of our inspection ten people were using the services of Kingston Domiciliary Care Agency. All the people using the service had a learning or physical disability; some people were unable to express themselves verbally. We looked at the care records of ten people, spoke with three family members, two local authority care managers and three members of staff.

Below is a summary of what we found.

Is the service safe?

The provider had a safeguarding vulnerable adults policy in place and staff had also received recent training. We saw that the policy and procedure for protecting people against financial fraud was not being followed.

Care plans were individually written and included comprehensive information about the person using the service. This helped staff to understand a person's needs. Risk assessments relating to the care and support being provided were regularly reviewed to ensure people's individual needs were being met safely.

Is the service effective?

People using the service had agreed and signed a contract detailing the hours and days that staff would work with them. Including a choice of the gender of staff that would help them and the type of support required. Care plans were reviewed annually with the person using the service.

Staff were trained and supported by the manager. Staff received a range of training and regular one to one supervision and yearly appraisals.

Is the service caring?

The service was caring. Families told us their relatives were supported by staff to achieve their goals of independent living. Families that we spoke with said "The staff are very helpful and we are very happy with them.” Another family said “They make our relative happy.”

Is the service responsive?

The provider sent out yearly surveys to people using the service, their families, staff and other professionals. The number of surveys returned was very low. The provider had not made any other provision to gather people’s views about the service delivered.

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs.

Is the service well-led?

The service employed a manager and a deputy manager who knew their staff and people well. Records showed that staff received an induction programme that included mandatory training and shadowing more experienced staff. Team meetings, supervision and appraisal were held.