We carried out an announced inspection of Mooncare Limited (Domiciliary Agency) on 24 April and 4 May 2018. Mooncare Limited (Domiciliary Agency) provides the regulated activity of ‘personal care’ to people living in their own houses and flats in the community. At the time of the inspection six people with a learning disability were receiving a personal care service. The service is located within a day resources service operated by the provider and all of the people who used Mooncare Limited (Domiciliary Agency) lived with their relatives and also attended Rosy Care day centre.

At the previous inspection in January 2018 the provider was rated as ‘Good’. At this inspection we have rated the service as ‘Requires Improvement’. Safe, effective, responsive and well-led have been rated as ‘Requires Improvement’ and caring rated as ‘Good’.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered managers 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 present on both days of the inspection.

Staff understood how to safeguard people who used the service from abuse, however necessary risk assessments were not in place in order to guide staff how to safely deliver care and minimise the risk of accidents and potential injury and harm occurring.

Systems were in place to safely recruit staff. The staff we spoke with told us that they felt well supported and they received regular supervision from their line manager; however we found that the mandatory training to update staff to safely support people had fallen behind schedule, which placed people at risk of receiving inadequate care and support.

Relatives told us that they received a reliably delivered service and there were sufficient staff deployed to enable their family members to develop good relationships with their regular care staff. People who used the service were also able to spend additional time with the care staff they knew and trusted, as care staff also undertook some shifts at the provider’s day centre. This continuity and the small size of both the domiciliary care agency and the day centre enabled people to benefit from the provider’s relaxed family orientated approach.

The care and support plans provided basic information about how to meet people’s needs. The registered manager addressed this during the inspection and updated three out of the six care plans so that they provided a more detailed level of information for care staff to follow. People were supported to meet their nutritional needs where this formed part of their care package. None of the care and support plans we looked at indicated that people needed support from the care staff to adhere to any guidance from external professionals to meet their health care needs.

Relatives told us that their family members were supported in a very caring and kind manner. Care staff told us that they had worked with people who used the service for several years and the warm interactions we observed between people and the staff team showed that both parties genuinely enjoyed spending time together.

There was a lack of documentation to evidence that the provider had considered how people who used the service gave their consent to care, although relatives told us that they felt staff acted in accordance with the wishes and aspirations of their family members. The provider did not have a clear system to demonstrate that they ascertained whether people’s representatives held the appropriate legal powers to sign documents on behalf of their family members.

Relatives told us that they knew how to make a complaint and felt confident that any complaints would be sensitively managed. Relatives reported that they felt consulted by the provider

The inspection was conducted on 28 January 2016 and was announced. We gave the provider short notice of the inspection to make sure the key staff we needed to speak with were available.

Mooncare Limited (Domiciliary Agency) provides personal care services to people with a learning disability living with their relatives in their own homes. It is situated within a day centre owned by the provider, and some of the people who received a personal care service also attended the day centre. At the time of our inspection there were eight people using the domiciliary service.

At the previous inspection in January 2015 we found two breaches of regulation and made three recommendations in relation to improvements the provider needed to implement. The breaches of regulation were in regards to the provider not demonstrating safe recruitment and inadequate record keeping. Recommendations were made for the provider to improve the quality of guidance for staff about how to support people with prescribed medicines, improve staff training to meet individual needs and improve the quality of person-centred care planning. At this inspection we found the provider was no longer in breach of regulations and had achieved sustained improvements in regards to the recommendations.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered managers 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 relatives of people who used the service told us their family members were provided with safe care, delivered by kind and trustworthy support staff. The provider had clear systems in place to protect people from abuse and the support staff we spoke with understood their responsibilities in relation to safeguarding people. Effective recruitment practices were in place to ensure that staff were appointed with suitable knowledge and skills to meet people’s needs.

People were not ordinarily supported with their medicines, as this aspect of their care was provided by their relatives. However, staff had received medicines training and the provider’s medicines policy advised staff about how to safely support people with prescribed medicines, if required.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA). Staff had received applicable training and showed they understood how to ensure their practice was in line with MCA legislation.

Staff received training, support and supervision in order to meet people’s needs. Staff told us they could always speak with the registered manager or the care co-ordinator if they needed professional advice and guidance. Relatives told us that the standard of care and support was good, and staff were very reliable, punctual and polite. People were supported by staff to meet their needs in relation to nutrition and hydration, and were encouraged to develop their culinary skills if they wished to.

People’s social care and health care needs were assessed and the care planning records showed that their needs were addressed in an individual and sensitive manner. The staff knew how to meet people’s cultural preferences including religious practices, food and activities. Risk assessments had been conducted and risk management plans developed to support people to be as independent as possible and participate in community activities, while promoting their safety.

People and their relatives were provided with straight forward information about how to make a complaint, which was produced in written and pictorial formats. Relatives expressed their view that the registered manager would respond to any complaints or concerns in a prompt and professional manner.

There were systems in place to assess and monitor how the service performed, in or

We carried out this inspection to check that the provider had taken action following our previous inspection of 2 May 2013. We found that the provider had taken appropriate actions.

The agency had made changes to their record keeping. The care plans had been updated with specific information for staff on how to manage any identified risks associated with people's care. The manager was able to locate all the records we asked to see. We reviewed the care workers' log sheets, detailing the care they provided to people at each visit, which had been unavailable at the previous inspection. These records showed that people were receiving the care they needed. The agency had obtained independent references for all care workers since our previous inspection. The agency carried out appropriate recruitment checks to ensure that staff members were suitable for the role of care worker.

Mooncare Limited was providing care to six young adults with learning disabilities. We spoke with the relatives of four people who use the service. They were all pleased with the service. One person said, "I'm happy and [my relative] is happy with them. The service is very good." Relatives praised the care workers as friendly and reliable. One person said, "we waited for a long time [with other agencies] to find better care. Mooncare understands our needs very well so I'm happy, yes."

We saw that the agency assessed people's needs including their cultural needs. It also monitored people's progress in achieving goals such as improved social skills and greater independence. But we found that the information for staff in some care plans did not fully reflect identified risks and needs.

The agency had improved its procedures to protect vulnerable adults and children. We spoke with one care worker who had a good understanding of the signs of abuse and how to report concerns. The care workers were well supported with access to training, appraisal and supervision.

The manager monitored the service, investigated complaints and had sent structured feedback forms to people using the service. However, some of the agency's care and recruitment records could not be located on the day of the inspection which made it difficult to check that people were receiving safe and appropriate care.

The agency was providing care to four young adults with complex learning disabilities who were unable to communicate with us verbally. We spoke to the relatives of these four people for their views of the service. We also spoke with the registered manager and one care worker.

People's relatives told us that they had enough information about the service and had been involved in making important decisions. All the relatives we spoke with were happy with the service and praised the care workers. One person said "they are already doing everything. They can not do any better". The agency assessed people's individual needs, the care to be provided and undertook individual risk assessments to ensure that the care provided was appropriate and safe.

The agency had clear recruitment procedures to ensure all workers were recruited safely. The staff received training and regular supervision with the manager. We spoke with one care worker who confirmed they were well supported to carry out their role. The relatives of people using the service also felt that their care workers were skilled and experienced.

Relatives said they felt that their family members were safe with their care workers and we saw that the agency had a clear safeguarding adults policy. However, the agency did not provide information or guidance for staff on the local safeguarding arrangments and contacts in Tower Hamlets.

The inspection was carried out on the 16 and 19 January 2015 and was announced. We gave 72 hours’ notice of the inspection to make sure that the staff we needed to speak with were available.

Mooncare Limited (Domiciliary Agency) provides personal care services to people with a learning disability living in their own homes, with their relatives. At the time of our inspection there were six people using service. The service is located in a day centre owned by the provider. Some of the people receiving a personal care service also attend the day centre.

Recruitment records showed that staff had only one reference each, which was not always checked by the provider to guarantee its authenticity. This meant the provider did not demonstrate a robust enough approach to ensure staff were suitable for employment at the service.

Staff were aware of how to protect people from abuse, but did not understand the principles of the Mental Capacity Act 2005 (MCA), in regard to ensuring people’s rights to make choices were protected.

Staff did not support people with taking their medicines as they received this support from their relatives. However, the provider’s medicine policy and procedure did not address staff responsibilities if an event arose in which staff needed to administer medicines to ensure a person’s safety or wellbeing.

Assessments were carried out to identify people’s care and support needs. Risk assessments were in place to enable people to take part in activities and access community resources, whilst ensuring that their safety was maintained. However, some people’s risk assessments were generic and not applicable to their needs and wishes.

Staff received support and supervision but there was a lack of specific training to meet the needs of people with a learning disability.

People received support with their nutritional needs, including support to develop cooking and baking skills. The service understood how to meet people’s cultural preferences in regard to food, activities and practising their religion.

Relatives told us that people received personalised care but this was not consistently reflected in the care plans. People’s care plans were reviewed annually or more frequently if necessary.

Relatives told us they were confident that any complaints would be properly listened to and acted upon. People were given pictorial complaints guides; however, the complaints procedure was not made as clear and straight-forward as possible.

People’s views and the views of their relatives were sought through surveys, which showed that they were happy with the quality of the service. Relatives told us they received regular visits and telephone calls from the registered manager to check if they were pleased with how their family member was being supported. Staff told us they felt well supported by the registered manager.

The auditing of staff documents, and policies and procedures was not thorough enough. We found policies which were conflicting and inappropriate terminology recorded in supervision notes had not been addressed.

We made recommendations in regard to the limitations of the medicines policy and procedure, the training needs for staff and the care plans not reflecting the personalised care provided to people.

We found two breaches of regulations, relating to the safe recruitment of staff and the accurate keeping of records and documents. You can see what actions we told the provider to take at the back of the full version of this report.