This comprehensive inspection took place on 17, 18 and 19 October 2017 and was announced. We gave the registered manager two working days’ notice as the location provided a service to people in their own homes and we needed to confirm the registered manager would be available when we inspected.

The last inspection took place in August 2016 and the service was rated ‘good’ in all five key questions and overall. However the last inspection took place at Research House and the service had since moved to a new location. This was the first inspection at the new location.

MNA is a domiciliary care agency that provides care to people in their own homes. At the time of the inspection there were 562 people using the service. The service offered support to a range of people, for example, people living with dementia, and the support hours varied depending on people’s need. Services were mainly commissioned by the London Boroughs of Brent, Ealing and Harrow.

The service had a registered manager. 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 registered manager was also one of the directors and owners of the service.

People using the service said they felt safe. Care workers we spoke with knew how to respond to safeguarding concerns. They had the relevant training, supervision and appraisals to develop the necessary skills to support people using the service.

People had risk assessments and risk management plans in place to minimise risks. Incidents and accidents were recorded. Learning outcomes were not recorded on the incident and accident form but the registered manager agreed to update the form to include this information.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However the provider was not always consistent in ensuring every person who required it, had a completed mental capacity assessment to evidence that they did not have the capacity to make decisions about their care. The registered manager said they would address this.

There was a policy and procedure in place for the management of medicines which was adhered to by care workers.

People’s dietary requirements were met and we saw evidence that relevant health care professionals were involved to maintain people’s health and wellbeing.

People’s privacy and dignity was respected and care plans identified people’s cultural needs, how they liked to be addressed and how they wanted their support delivered.

People were involved in their care plans and making day to day decisions. People told us they generally had the same care workers and this provided consistency of care.

People using the service and care workers said the managers were accessible and responded to concerns.

The service had a number of systems in place to monitor, manage and improve service delivery. This included a complaints system, audits, care worker observations and satisfaction surveys.