This inspection took place on 05 April 2017 and was unannounced. Our last inspection of the service was in February 2017 when we rated the location as Good for all five questions. Following the February 2017 inspection we received information of concern regarding staff recruitment practices at the provider’s location in Exeter. We carried out this inspection to reassure ourselves that the service operated robust recruitment procedures to ensure staff were suitable to work with people using the service.

Northolt is an agency providing personal care and support to people in their own homes. At the time of this inspection, the service employed 85 care workers and was supporting approximately 180 people. 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.

We found that the provider had a clear policy and procedures for the recruitment of new care workers. They carried out checks to make sure all care workers were suitable to work with people using the service. If required, the provider sought advice from the Home Office before employing people to work in the service.

This inspection took place on 8 and 9 March 2017. We gave the provider one week’s notice as the service provides a domiciliary care service and we needed to make sure the registered manager was available to assist with the inspection. At our last inspection in September 2015 we identified one breach of the Regulations as the provider had not assessed the possible risks to people using the service. At this inspection we found the provider assessed risks to people and gave care staff clear guidance on how to mitigate the risks they identified.

Northolt is an agency providing personal care and support to people in their own homes. At the time of this inspection, the service was supporting approximately 180 people. 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 provider had improved the ways they reviewed and updated assessments of possible risks to people using the service. People and their relatives told us they felt people were cared for safely. Where people needed support with their medicines they received this safely.

Most people told us their care workers usually arrived on time, stayed for the amount of time allocated in their care plan and gave them the care and support they needed.

The provider had systems in place to carry out checks on new staff to make sure they were suitable to work with people using the service.

People told us they felt their care workers had the training and skills they needed to provide them with care and support. Staff records showed that the provider arranged for care workers to receive regular, formal supervision with a senior member of staff.

The provider assessed and recorded people's healthcare needs as part of their care plan. Where people lacked capacity to make decisions about their care, consent was obtained in their best interests by people who knew them well.

Most people and their relatives told us their care workers were caring and treated them with dignity and respect. Care workers told us they usually worked with the same people and this helped them to establish relationships and provide continuity of care. Care workers completed a daily record of the care and support they provided on each visit. We saw examples of these and care workers wrote in a respectful and caring way.

People told us they had met staff from the service before they started to receive care and support to talk about the care and support they needed. People had a care needs assessment completed by the local authority and the registered manager told us they used this information to inform their own assessment and the person’s care plan. Most people told us they received the care and support detailed in their care plans and that they were satisfied with their care workers.

Most people using the service and their relatives told us that staff from the service carried out regular checks to make sure they were happy with the care and support they received. The service had a clear management structure and the provider had appointed additional staff since our last inspection, including two supervisors and a quality monitoring officer. The provider and registered manager carried out checks to monitor standards in the service and make improvements.

People using the service were involved in discussions about the care and support they received and their needs and risks were assessed. Each person using the service had a tailored care plan that reflected their needs and preferences and provided a schedule of care. Daily records were maintained to monitor care provided and there were regular reviews to check that it was suitable and current to people’s needs.

The provider had procedures to ensure continuity of care and the safety and welfare of people using the service. Staff had the necessary training and contacts to manage risks and emergencies.

The provider had appropriate policies and procedures to manage the administration or supervision of medicines when required. Suitable records were kept and were complete and up to date. Staff had received relevant training on administration of medicines and this was up to date.

The provider cooperated with a variety of different services and health care professionals to ensure a continuous and well-rounded package of care. Staff had access to suitable and safe equipment to support people they cared for.

The provider had an appropriate complaints procedure which was communicated to people using the service, although complaints were not well documented.

We spoke to six people using the service who were satisfied with the quality of care received. One person using the service told us, "they're excellent", while another said, "They are good - I have no complaints."

People we spoke to told us that the agency asked their views when deciding what support they wanted and they had been fully involved in their care planning. People said they were treated with respect and dignity. One person said “ Whenever I ring the agency I am always treated with respect, the office staff are very friendly and supportive”.

People we spoke to said they were happy with the staff, one said “I am very happy with the care received” and another said “the staff are brilliant and I wouldn’t want the staff to change”. One person said “ the carer is absolutely fabulous” People we spoke to said they were always helped to take their medication at the correct times.

People had a care plan which reflects their physical, emotional and social needs and ensures care is delivered safely. People were involved in the planning of their care. Key procedures were in place for staff on safeguarding vulnerable adults and dealing with emergencies.

A recruitment procedure was in place and checks were being made on staff before they started working with people. Staff were receiving skills training and supervision by a line manager.

We spoke with staff and with representatives who had been involved with arranging the care for their relatives, where the person was not able to speak with us themselves.

Some representatives said that they and their relative had been asked about the care needed and this had been recorded. Others said the information had been provided by the local authority or hospital. Representatives told us a copy of the care plan was available in their relative’s home. Most people said they were ‘very happy’ with the care being provided to their relative, that staff got on well with their relative and cared for them in a respectful manner. Some people said they had chosen the agency and others said they had asked to move from another agency to this one.

Representatives commented that the ‘regular carers’ were ‘very good’, ‘excellent’ and ‘provided care over and above our expectations’. They told us that the carers mostly arrived on time, and if not there was usually a genuine reason such as public transport delays. Some said that the care provision was best when the ‘regular carers’ attended their relative. Most representatives said they had been informed when a different carer was going to attend their relative. They told us the manager and care coordinator were always available to discuss any issues and carried out regular checks. These were done by telephone and by attending the home, to ascertain that people’s care needs were being met. One representative said ‘the manager and care coordinator are always available and are excellent’. Others said it was easy to contact the management.

Representatives said they knew who to contact if they had any concerns. They said they could contact the agency at any time and when issues had been raised they had been dealt with promptly and properly.

Representatives said staff were ‘good’ and understood their relative’s needs and how to care for them effectively.

Representatives said they and their relatives had received telephone calls from the agency to ask them if they were satisfied with the care being provided and to give them the opportunity to express their views.

This inspection took place on 15 and 16 September 2015 and was announced. We gave the provider short notice of the inspection to make sure they and the branch manager would be available. At the last inspection on 8 and 9 April 2015, we asked the provider to take action to make improvements to care planning, care recording and the way they notified the Care Quality Commission (CQC) about significant incidents affecting people using the service. We issued two Warning Notices that required the provider to improve care planning and the management of the service. We found at this inspection the provider had taken action to meet one of these Notices and partially meet the other.

Lean on Me Community Care Services Ltd is registered with the Care Quality Commission to provide personal care. Lean on Me Northolt is a domiciliary care service providing personal care to people in their own homes. 105 people were using the service when we carried out this inspection. Most people using the service were aged over 65.

Mrs Agbor-Baxter, the Nominated Individual for Lean On Me Community Care Ltd, is also the 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 provider needed to review people’s assessments regularly, to make sure people were cared for safely.

The provider did not always ensure enough staff were deployed to meet individual’s care needs.

The provider had improved the ways they assessed and recorded people’s care and had reviewed their procedures for supporting people with the medicines they needed.

The provider operated effective recruitment procedures to make sure staff were suitable to work with people using the service.

People told us their regular staff were skilled and knew how to support them and they had consented to their care and treatment.

Training records showed staff were up to date with their training and staff told us they felt well supported. The provider had arranged dignity and respect training for staff and staff had improved the way they wrote about the care and support they provided to people.

People using the service told us the staff, particularly the ones who visited them regularly, were kind and caring.

People told us staff were punctual and always stayed the correct amount of time.

People were receiving care that met their individual needs and reflected their preferences.

The provider and branch manager had worked to review the audits they carried out on the day-to-day operation of the service and delegated responsibility to other members of staff. The audits we saw were clear and up to date.

The provider had also completed monthly reviews of most people’s care plans and risk assessments and ensured they kept a record on each person’s file to highlight when the next review was due.

We found one breach 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.

Following our last inspection, we placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five questions, it is no longer in special measures.