We undertook an announced inspection of Mears Care – Richmond on 6 and 7 August 2018. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. They also provided short term care and support alongside the treatment and support provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return as far as possible to the lifestyle they had previously. The number of people who used the service changed regularly because the agency was one of the main providers used by the local authority

Until just before the inspection this service also provided care and support for people living within two extra care schemes in the borough as part of their contract with the local authority. These two extra care schemes have been registered as a separate location from 10 August 2018 so the care provided was no longer managed by Mears Care - Richmond. At the time of the inspection the agency was delivering an average of 6500 visits per week of around 2600 hours of support for approximately 469 people. Not everyone using Mears Care - Richmond 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. Where they do we also take into account any wider social care provided. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Mears Care - Richmond branch was based in an office with a number of other branches.

We previously inspected the service on 18 July 2017 where we rated it requires improvement in the key questions of ‘is the service safe? ’is the service responsive?’ and ’is the service well-led?’ as well as overall. The key questions of Effective and Caring were rated good.

At the time of the inspection the registered manager had left the service four weeks earlier and a new manager had started at the service the week before the inspection. The new manager was in the process of applying to become registered with the CQC when the inspection was undertaken. 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 were not receiving care which met their assessed needs because the provider was not deploying care workers to ensure that visits took place at the stated times and care workers stayed for the agreed length of time.

The provider had a policy for the management of medicines but care workers were not always provided with guidance on how to administer people’s medicines and records were not always completed clearly.

Risk management plans were not in place where specific issues had been identified to provide care workers with the information to enable them to mitigate these risks when providing care.

We have made a recommendation in relation to the recruitment process which not robust as information had not been recorded and appropriate references were not always in place before assessing applicants’ suitability for the role.

The provider had a procedure to assess a person’s mental capacity to consent and make decisions about their care but this was not always completed in a way that ensured people’s care was provided in l

This was a comprehensive inspection which took place on 18 July 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to make sure the manager would be available.

The last inspection took place on 21 March 2017, when we rated the service as Requires Improvement, with an inadequate rating for the key question of Safe. We found breaches of five Regulations in relation to person-centred care, need for consent, safe care and treatment, good governance and staffing. We issued a warning notice for breaches in safe care and treatment telling the provider they must make improvements by 30 April 2017. We issued requirement notices in respect of the other breaches. At the inspection of 18 July 2017 we found that all the breaches had been met. However, some areas of the service still required improvements to make sure people were always cared for in a way which reflected their needs and preferences.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. As part of the provider's contract with the local authority they provided the care and support to people who lived within two extra care schemes in the borough. They also provided short term care and support alongside the treatment provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return to the lifestyle they had previously. The number of people who used the service changed regularly because the agency was one of the main providers used by the local authority. At the time of the inspection the agency was delivering approximately 3,000 hours of support a week. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with a number of other branches.

There was a manager in post. They were registered to manage a different branch of Mears Care Limited. They had changed role to manage this location and were in the process of transferring their registration for the management of Mears Care – Richmond. 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.

There had been improvements at the service and the previous requirements and warning notices we issued had been met. Most people using the service, their representatives and the staff told us they had experienced improvements. However, some people still felt the service did not meet their needs. In particular some people were not happy with the times care visits took place because these were not always consistent and did not always reflect when they needed care. Another concern was about the changes in the care workers who visited them. Whilst some people had regular care workers and they were happy with this, others told us they did not always know who would be caring for them and they did not like this. The third main concern people raised with us related to communication with the agency. They told us

The inspection took place on 21 March 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.

The last inspection took place on 15 November 2016 when we found breaches of Regulation in relation to safe care and treatment, person centred care, receiving and acting on complaints, staffing and good governance. We rated the service requires improvement. We found that the service was not safe and rated this domain inadequate.

At the inspection of 21 March 2017 we found the provider had made improvements. In particular there had been improvements in the way in which the service was managed leading to some improvement in all areas. However, we found that the provider was not always keeping people safe. We noted improvements in other areas but these were not always enough to meet the Regulations.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. As part of the provider's contract with the local authority they provided the care and support to people who lived within two extra care schemes in the borough. They also provided short term care and support alongside the treatment provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return to the lifestyle they had previously. The number of people who used the service changed regularly because the agency was one of the main providers used by the local authority. At the time of the inspection the agency was delivering approximately 3,000 hours of support a week. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with a number of other branches.

The registered manager left the organisation in 2016. Since this time three different service managers had been employed to run the service. The current service manager was appointed in February 2017. They had not yet applied to be registered for the Mears Care – Richmond branch, but had previously been the registered manager at another one of the provider's locations. They told us they would be applying to add the Richmond branch to their registration with the Care Quality Commission. 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.

People did not always receive their medicines in a safe way and the provider had not taken sufficient steps to ensure medicines were managed safely in the future.

People were sometimes placed at risk of harm and the provider had not taken enough action to minimise this risk.

There had been improvements in the way in which the staff were deployed but there were still instances where people did not receive the care and support they needed because the systems for deploying and organising staff were not always sufficient.

The provider had not always acted within the principles of the Mental Capacity Act 2005 because they had not assessed people's capacity to make decisions or followed the correct processes for making decisions in people's best interests.

People did not always receive care visits at the time they were planned and expected, or for the amount of time planned, and this resulted in some of their needs not being met.

Records were not always up to date, accurate or well maintained.

The provider's systems for monitoring the qua

The inspection took place on 15 November 2016. We gave the provider 48 hours' notice because they provide a domiciliary service and we wanted to make sure someone would be available.

The last inspection took place on 17 November 2015 when we found the provider was meeting all the Regulations we inspected.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. As part of the provider's contract with the local authority they provided the care and support to people who lived within two extra care schemes in the borough. They also provided short term care and support alongside the treatment provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return to the lifestyle they had previously. At the time of the inspection approximately 280 people were using the service, although the number of people changed regularly because the agency was one of the main providers used by the local authority. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with a number of other branches.

The registered manager had left the organisation earlier in 2016. A new manager was in post and they were in the process of applying to be registered with the Care Quality Commission. 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.

There were not always enough suitably qualified staff deployed to meet the needs of people using the service and keep them safe. The way in which care visits were planned meant that neither the care workers nor the people using the service knew in advance who would be carrying out the visits. People did not always have the same regular care workers and they were sometimes late or visits did not take place.

People did not always feel safe with the agency. In 2016 there had been a high number of allegations of abuse where people had not received their care visits or care had not been delivered in a safe way.

People did not always receive their medicines safely and as prescribed.

People did not always receive care which met their needs or reflected their preferences.

There was a complaints procedure but people using the service and their relatives did not always feel confident that their complaints would be investigated and acted upon.

The service was not always well managed and the communication within the agency was not effective. Records were not always appropriately maintained and the systems for auditing and monitoring the service did not always lead to improvements for people.

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

Not all of the staff understood their responsibilities under the safeguarding procedures.

The senior staff working at the agency did not always get opportunities for support or training. We have made a recommendation in respect of this.

Not all the staff had a good understanding of the Mental Capacity Act 2005 and we have made a recommendation in respect of this.

Although we found a number of concerns, some of which were breaches of Regulation, we also found that improvements had been made at the agency within the four weeks preceding our inspection. People using the service confirmed this and over

The inspection took place because the Home Office Immigration Enforcement Department had found that some of the staff employed at the location were working illegally in the UK. This had resulted in a number of staff leaving the employment of the agency without any notice impacting on the service being provided. We wanted to make sure people’s needs were being met and the agency had plans in place to recover from this.

The last inspection of the service was on 12 May 2015 when we found no breaches of Regulation.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with four other branches. There was a manager in post who had worked at the branch since May 2015. He had applied to be registered with the Care Quality Commission. 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

The agency had experienced a sudden loss of staff and this had impacted on the care provided meaning some people had received visits later than planned. However, most people felt safe with the agency. The agency had employed additional resources from other branches of Mears Care Limited and had recently recruited new staff to make sure care was delivered to everyone as planned.

People told us their care workers were kind, caring and considerate.

The provider had followed their contingency plans to manage the changes in staffing level and make sure people’s needs were met. They had contacted people using the service, staff and other stakeholders to make sure they were involved in planning how care would be provided and to inform them about how the agency was recovering from the situation.

The inspection took place on 12 May 2015 and was announced.

We last inspected the service on 3 July 2013. At the last inspection there were no breaches of Regulation.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. At the time of the inspection 130 people were receiving a service. The majority of these people had their care funded and organised by the local authority. The provider worked closely with the local authority to monitor the service people received. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with four other branches. There was a registered manager in post. This person had been promoted to the role of operations manager overseeing a number of branches. A new manager had been appointed to the service and they told us they were in the process of applying to be registered. 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.

There were procedures for safeguarding adults and the staff were aware of these. The risks to people’s wellbeing and safety had been assessed and there were plans to reduce the likelihood of harm.

The agency employed enough staff to meet people’s needs safely.

People were given the support they needed with medicines The staff had the training and support they needed to care for people.

People had consented to their care and support. Where people had been assessed as lacking capacity, decisions were made in their best interest by people who were important to them.

People’s health and nutrition needs had been assessed, recorded and were monitored.

Some people felt the service was not caring and they were not happy with the way they were treated by the agency’s staff. We talked to the provider about the things people told us. They took immediate action by contacting people using the service to ask if they had any concerns, by addressing the concerns with staff and taking further action where necessary. Other people told us the care staff were kind, polite and caring.

People’s individual needs had been assessed and recorded in care plans. The care plans reflected their preferences and views. People’s needs were regularly reviewed and they contributed to these reviews. Some people felt their care was not personalised and did not always meet their needs.

People knew how to make a complaint and complaints were responded to appropriately. Some people felt concerns were not always acted upon, whilst others were satisfied with the response to these.

Most people felt the service was well-led and staff felt supported by the manager. There were systems to assess and monitor the quality of the service and risks. The agency worked closely with the local authority to assess the service. People were asked for their feedback.

We previously inspected Mears Care - Richmond on 28 January 2013. We found the provider was not meeting the essential standards in care and welfare of people who use services and requirements relating to workers. On our inspection of 3rd July 2013 we found that Mears Care – Richmond had made improvements and was meeting the required standards in care and welfare of people who use services and requirements relating to workers. On the 5th and 8th August 2013 we contacted people who use the service and their relatives, to ask them for their views on the care provided by Mears Care - Richmond.

People who use services said they were treated with dignity and respect. People said carers promoted their independence. People had complained to Mears Care and their complaints had been resolved. People had complained about carers being ‘unsuitable’. Once this was reported Mears Care always provided an alternative carer. However, overall people said they were satisfied with the care they received from Mears Care - Richmond.

During the inspection we talked with four people using the service, one relative and four members of staff to get their views about the service provided.

People we spoke with were satisfied that their care workers treated them kindly and respected their privacy. One person said “the staff are not too bad, they treat me well”. People confirmed that they could choose the gender of their care workers according to their preferences and that their choices were respected. They also told us staff called them by their preferred names. However we noted that recruitment processes were not robust enough to demonstrate that only suitable applicants were employed to care for people.

We found that staff assessed people’s individual needs and prepared appropriate care plans and risk assessments that were reviewed six monthly. People were involved in making decisions about the care and support they needed and had access to their care records.

People had the agency’s contact details and said they would speak with the office staff if they had any concerns. Many also said they would involve their relatives if they were worried about their safety. Some said they were sometimes concerned they would not get the care they needed because the agency did not keep them informed when their care workers changed or when they were late for visits. The provider’s own quality system had identified these areas for improvement but they had not been able to make the necessary improvements.

Everyone we spoke to said that they were happy with their regular care workers and gave us positive feedback about them. People told us that their regular care worker knew their needs well and how they liked things to be done. Many people said they had had the same care worker for a long time and had developed a good relationship with them.

All the people we spoke to said that the agency arranged a replacement care worker when their regular care worker was away. Some people said that the agency gave them little or no notice when a replacement care worker would be attending and that they found this unacceptable.

None of the people we spoke to, or their friends and families, said that they had ever had any concerns about the treatment they received from care workers. People told us that the agency telephoned them from time to time and occasionally visited them at home to check they were happy with the service they received.