We carried out this unannounced inspection of London Care (South London) between 10 -13 December 2018. This was carried out as we had received information of concern about the service.

London Care (South London) is a domiciliary care agency which provides care and support to 430 people in the London Borough of Southwark. At our last inspection in October 2016 we rated this service ‘Good’. At this inspection we rated the service ‘Requires Improvement’.

People were put at unacceptable risk of neglect due to missed visits. There had been a failure to plan visits in advance which lead to office staff struggling to cover calls at the last minute. People frequently had one care worker attend when they needed two. Care workers were often unable to meet people’s basic needs as a result. People and their families spoke of their extreme frustration at the situation and were unable to contact the office for help. Care workers also reported being unable to contact the office if they needed crucial information.

There were failures in the management of the service. This included key care co-ordinator roles falling vacant and being covered by supervisory staff. The service had taken on additional people’s care packages that they were unable to manage. The service had a registered manager, but they had resigned. 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 provider had recruited a new branch manager and care co-ordinators, but these staff were yet to start work. There had been a breakdown in the regular functioning of the service which impacted on the supervision of care workers and audit processes. There were failures in the management of medicines and important records relating to medicines, care and handling people’s money were not checked for mistakes. The provider was aware of the failings of the service and had an action plan in place to address these. This did not fully prioritise the highest risks to people using the service and at the time of our inspection this had not yet been fully implemented.

People told us their regular care workers were kind and caring, but the consistency of staff had deteriorated due to recent events. The provider had good processes to assess risks and plan people’s care. There were sometimes missing and incomplete records of the support people received to manage risks and equipment was not checked to ensure it was safe to use.

People had good quality care plans which reflected their needs and preferences for care. Until recently care workers had been recording how they had provided support which met people’s needs, but often staff had to record how they had been unable to care for people. The provider lacked systems to assess people’s capacity to make decisions about their care.

We found breaches of regulations concerning consent to care, safe care and treatment, staffing and good governance. Following the inspection, we requested an urgent action plan from the provider on how they would address these breaches. This described in more detail what would be done to address the most serious failings we identified and safeguard people from missed visits.

We issued two warning notices regarding staffing and good governance. The provider is required to be compliant with these regulations by 31st January 2019. We will carry out a further inspection of this location within six months of the publication of this report.

This inspection took place on 19, 20 and 24 October 2016 and was announced. The provider was given 48 hours' notice because the location provided a domiciliary care service and we needed to be sure that someone would be in.

London Care South London is a domiciliary care service that provides personal care and support to people in their own homes. At the time of the inspection there were 805 people using the service. 19 people were privately funded and 786 funded by local authorities.

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.

London Care South London were registered on 2 March 2016 and this was the first inspection. However, the service had previously been registered at a different address and inspected on 8 February 2016. During that inspection we found three breaches of regulation. During this inspection the service had made improvements. This report looks at our findings from the inspection carried out on 19, 20 and 24 October 2016.

People were not always protected against the risk of safe medicine management. Staff did not always clearly record if people received their medicines in line with good practice. One medicine administration record [MAR] sheet was unclear as to whether a person had received their medicines and if this was administered by staff or the person’s relative. Prior to the end of the inspection, the service had resolved this issue and action taken to address our concerns.

People were protected against the risk of harm and abuse. Staff received on-going safeguarding training and were aware of the correct procedures in raising their concerns of suspected abuse. People were protected against known risks. The service identified risks to people and put management plans in place to enable staff to keep people safe.

People were supported to live in a safe environment. The service carried out regular risk assessments of people’s homes to ensure the environments were safe and identified risks addressed and managed.

People received support from staff that understood their responsibilities in line with the Mental Capacity Act 2005 [MCA] legislation. Staff were aware of how to respond should they suspect someone’s mental capacity was fluctuating and unable to make decisions about their care and support. Records showed where concerns were raised this was then shared with the funding authority to carry out a MCA assessment.

People received sufficient staff to meet their needs. The service had robust recruitment procedures in place to ensure suitable staff were employed. The service carried out Disclosure and Barring Service [DBS] checks and other checks which allowed them to make safe recruitment decisions. Staff underwent regular supervisions and appraisals with their senior colleagues to reflect on their working practices.

People’s consent to care and treatment was sought prior to care being delivered. People were encouraged to make decisions about their care and support and have their decisions respected. People’s dignity was maintained and encouraged. Staff were aware of the importance of respecting people’s dignity and privacy needs.

People were supported to access sufficient amounts of food and drink that met their preferences. People had their health and wellbeing monitored and where concerns about their health were identified, these were then shared with health care professionals for further investigation.

People received care and support that was person centred and tailored to their needs. Care plans were regularly updated to reflect people’s changing needs and preferences. Care plans gave staff clear guidance on how to support people in keeping with their w