The inspection was carried out on 27 and 29 September 2016, and was an announced inspection. The provider was given 24 hours’ notice of the inspection as we needed to be sure that the office was open and staff would be available to speak with us.

London Care (Rochester) is a domiciliary care agency, which provides personal care to people in their own homes, who require support in order to remain independent. At the time of the inspection it provided a personal care service to approximately 476 people with diverse needs such as dementia, older people, learning disabilities and physical disabilities.

There was a registered manager at the service. The registered manager was also the provider. 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 and associated Regulations about how the service is run.

At our previous inspection on 22 and 25 September 2015, we found breaches of Regulation 9, Regulation 11, Regulation 12, Regulation 13, Regulation 16, Regulation 17 Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of regulation 18 CQC (Registration) Regulations 2009. We asked the provider to submit an action plan by 07 December 2015. The provider submitted an action plan on 07 December 2015 which showed how they planned to improve the service by 28 February 2016. At this inspection, we found improvements had been made and the provider was meeting the requirements of the regulations.

During this inspection, we found that London Care (Rochester) had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

The agency provided sufficient numbers of staff to meet people’s needs and provide a flexible service.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals. All staff received induction training at start of their employment.

The registered manager and staff carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the agency and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People were supported with meal planning, preparation and eating and drinking. Staff supported people, by contacting the office to alert the provider to any identified health needs so that their doctor or nurse could be informed.

People said that they knew they could contact the provider at any time, and they felt confident about raising any concerns or other issues. The provider carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement. This enabled people to get to know the provider.

The agency had processes in place to monitor the delivery of the service. As well as talking to the provider at spot checks, people could phone the office at any time.

The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

We inspected this service on 22 and 25 September 2015. The inspection was announced. The provider was given two working days’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available at the location offices to see us.

London Care (Rochester) is a domiciliary care agency, which provides personal care to people in their own homes, who require support in order to remain independent. At the time of the inspection it provided a personal care service to approximately 495 people with diverse needs such as dementia, older people, learning disabilities and physical disabilities.

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.

Effective systems were not in place to assess and monitor the quality of the service. There were no formal checks in place to ensure that medicines were administered safely. Care plans and assessments were not comprehensive.

London Care (Rochester) had a safeguarding policy dated 2013 in place. However, the policy had not been updated to reflect changes in regulation. The policy and procedure did not provide staff with information about Kent and Medway local authority safeguarding policy, protocols and guidance. This meant that staff did not have up to date information and relevant local guidance on how to recognise and protect people from abuse.

People told us that they felt safe. Staff received ‘prevention of abuse’ training and can recognise the signs of abuse or neglect and what to look out for. However, office staff had not received training to enable them perform their duties accordingly. Therefore, people were not fully protected against the risk of abuse.

The agency had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. However, the risk assessments had not always been completed in detail. Guidance about people’s needs and details of how the risks could be reduced had not been put in place to protect people and staff. There was a risk of people not receiving their medicines as prescribed by their doctor because there were not effective systems in place for the management of medicines.

People told us that they did not think there was sufficient staff to meet people’s needs. People did not always receive the amount of care and support that had had been agreed. Care that was planned for care staff to carry out sometimes overlapped which meant that they were not able to spend the amount of allocated time with each person.

Staff told us that they sought people’s consent prior to providing their care. We saw that there was a section of the care plan regarding consent. However the usage of these was inconsistent and sometimes contradictory. Where people did not have the capacity to consent to their care and treatment there was no record of how the care provided had been agreed in line with the Mental Capacity Act 2005.

People’s needs had not always been assessed and reviewed in detail. Assessments and care planning had been carried out by a person who did not have the required training, level of skill and knowledge to do so and as a result they were not always comprehensive. Some people required specific visit times for assistance with personal care, but this was information was not contained in their care plan. Plans of care did not contain detailed guidance for staff in how to support people safely.

There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. However, all staff had not received training in the Mental Capacity Act 2005. Staff were not able to tell us anything about the Act or its principles, and how it affected their practice. Staff did not have an awareness of Deprivation of Liberty Safeguards.

Staff had not received regular individual one to one supervision meetings and appraisals as specified in the provider’s policy.

People knew how to make a complaint. However, people felt London Care (Rochester) had not been responding to their needs and office staff had not been responding to people’s calls. People told us that the office does not always respond to their complaint. Complaint procedure had not been always followed.

People told us that communication with the office staff was not good. Care staff told us that there was no culture of openness and transparency. We have made a recommendation about this.

The registered manager followed safe recruitment practices to help ensure staff were suitable for their job role. Staff told us that they received induction before starting in their job role. Staff talked positively about their jobs.

People told us that staff were caring and they treated them with respect during visits to their homes. People felt they were involved in their care planning processes.

People were supported to have choices and received food and drink at regular times. People spoke positively about the choice care staff offered daily.

Staff were clear about their roles and responsibilities. The staffing structure ensured that staff knew who they were accountable to.

There was an emergency plan which included an out of hours’ policy and emergency arrangements for people which meant that the service could be operated during severe and adverse weather.