This inspection took place on 16 January 2019. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection.

Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. Nwando Domiciliary Care is owned and managed by Mrs. Ifeoma Nwando Akubue. Hence, there is no requirement for a separate registered manager. We have referred to her as the provider.

Not everyone using Nwando Domiciliary Care receives a 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. At the time of this inspection, the service was providing personal care to 21 people.

The service was last inspected on 6 August 2018, where we found the provider to be in breach of the regulations in relation to safe care and treatment, safeguarding, staffing, fit and proper persons employed, good governance, and notifications of incidents. We also made three recommendations in relation to the Mental Capacity Act 2005, personalised care plans and end of life care. The service was rated Inadequate and was therefore in ‘special measures’. We served the provider with Warning Notices where we specified actions that the provider was required to take by a set date. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least Good.

At the inspection on 16 January 2019, we found the provider had made some improvements and were no longer in ‘special measures’. We found that the provider had followed their action plan, based on our Warning Notices, which was to be completed by the 16 November 2018, and we found that the provider had addressed the breach of the regulations in relation to safe care and treatment, safeguarding, staffing, fit and proper persons, good governance and notification of incidents. However, we found the service was still in the process of implementing effective systems and processes to assess, monitor and improve the quality and safety of the service and hence, the service was rated Requires Improvement. This is the third time the service has been rated Requires Improvement or Inadequate.

Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. Nwando Domiciliary Care is owned and managed by Mrs. Ifeoma Nwando Akubue. Hence, there is no requirement for a separate registered manager. We have referred to her as the provider.

Not everyone using Nwando Domiciliary Care receives a 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. At the time of this inspection, the service was providing personal care to 21 people.

People told us they felt safe with staff and that staff mostly arrived on time. The provider was in the process of reviewing and updating people’s risk assessments to ensure all risks to people were assessed and mitigated. People’s medicines needs were met by appropriately trained staff. However, not all staff had their medicines competency assessed every year as required by the National Institute for Health and Care Excellence. Staff were knowledgeable about risks to people and how to provide safe care. The provider had systems and processes in place to safeguard people against abuse. The

This unannounced inspection of Nwando Domiciliary Care was undertaken on 6 August 2018 and was carried out by two inspectors.

We carried out an unannounced comprehensive inspection of this service in July 2017. The Care Quality Commission (CQC) recently received anonymous concerns in relation to hiring illegal staffing, missed visits, providing personal care to children which the service is not registered for, and governance.

As a result of these recent, anonymous concerns we undertook this responsive comprehensive inspection. At our last inspection, this service was rated 'good' overall with Well-led being rated as 'requires improvement'. At this inspection, Effective and Responsive had been rated as 'requires improvement' and Safe and Well-led as 'inadequate'. The overall rating for this service has changed to 'requires improvement'.

Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. At the time of this inspection the service was providing personal care to 58 people. Nwando Domiciliary Care is owned and managed by Ifeoma Nwando Akubue. There is no requirement for a separate registered manager. We have referred to her as the provider.

The provider did not follow appropriate procedures to safeguard people against avoidable harm and abuse. The provider did not raise a safeguarding alert with the local authority in relation to a person at risk of neglect, psychological and financial abuse from their relative. The provider failed to notify us about three safeguarding concerns without delay. The provider did not always identify, assess and mitigate risks to people in a timely manner. There were gaps in staff recruitment checks and we could not be assured if they were safe to work with vulnerable people. The provider lacked systems to ensure the safe management of medicines.

People were not always supported by staff who were appropriately trained, competent and skilled. Staff were not provided with regular supervision to do their job effectively. People’s care records were not always as per the requirements of Mental Capacity Act 2005 (MCA). Not all people’s care plans were person centred. The provider did not discuss people’s end of life care wishes and did not train staff in end of life care. People told us different staff supported them and there was a lack of continuity of care.

The provider lacked robust and effective systems and processes to ensure the quality and safety of service. Not all people were asked for their feedback and the provider did not analyse and evaluate the feedback that was received. There were gaps in internal audits and the provider did not fully implement the agreed improvement action plan that was developed following the local authority monitoring visit.

People told us they felt safe with staff and were generally happy with staff timekeeping. Staff knew safeguarding and whistleblowing procedures and how to escalate concerns and abuse. Staff were provided with appropriate personal protective equipment to prevent spread of infection.

People told us their individual needs were met and they were happy with nutrition and hydration support. Staff gave people choices and encouraged them to make decisions.

People told us they were supported by staff who were caring, friendly, and treated them with dignity and respect. People’s cultural and religious needs were recorded and met by staff.

People and their relatives were encouraged to raise concerns and were happy with the complaints process. There were accurate records of complaints and written correspondence to complainants.

Staff and their relatives told us they were happy with the service and found the management approachable. Staff told us they felt supported and enjoyed working with the provider.

We found six breaches of regulations during the inspection. Th

The inspection took place on 25 July 2017. This was an announced inspection. We gave the provider a notice of the inspection as this is a domiciliary care agency and we wanted to ensure the manager was available in the office to meet with us. We last visited this service on 17 and 23 January 2017 when we carried out a focused inspection to check if the service had followed their action plan to meet the legal requirements where we found them to be in breach of one regulation in relation to safe care and treatment. At the last comprehensive inspection on 15 June 2016 we found the provider was in breach of four regulations in relation to the need for consent, staff supervision and training, safe staff recruitment practices and good governance.

Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. At the time of this inspection the service was providing personal care to 20 people. Nwando Domiciliary Care is owned and managed by Ifeoma Nwando Akubue. There is no requirement for a separate registered manager. We have referred to her as the provider.

At the inspection on 25 July 2017, we found that the provider had made sufficient improvements and were no longer in breach of legal requirements.

People using the service and their relatives were happy with the care provided and found staff reliable and trustworthy. They were happy with staff punctuality and had never experienced missed visits. Staff understood people’s individual needs. People told us their needs were met by staff and they felt safe with them. Staff treated people with dignity and respect. Care plans were personalised and regularly reviewed, they recorded people’s needs, likes and dislikes. Staff were provided with instructions on how to support people to meet their needs and preferences.

Staff demonstrated a good understanding of safeguarding procedures and knew how to report abuse and poor care. The provider carried out safe recruitment procedures and staff were vetted appropriately before providing care. Risk assessments were detailed and provided sufficient information and instructions to staff on the safe management of identified risks. However, the service did not always maintain health specific risk assessments.

Staff received regular supervision and induction and mandatory training to do their jobs effectively. However, not all staff were provided specialist skills training and were not competency assessed for medicines administration. Staff sought people’s consent before providing care and gave them choices. People’s nutrition and hydration needs when requested were met. Staff maintained daily care records but did not always detail care visit times and a clear account of how people were supported. The service worked with health and care professionals in improving people’s physical health.

The provider regularly sought feedback from people but did not always keep records of this. The service visited people’s homes to observe staff whilst supporting people with their care needs to ensure they were supported as per their care plans but these were not carried out regularly. The service had systems and processes to assess, monitor and improve the quality and safety of the care delivery however, did not always identify gaps in the record keeping.

We carried out an announced comprehensive inspection of this service on 15 June 2016. At which breaches of legal requirements were found. This was because the service did not have effective systems and processes to assess, monitor and improve the quality and safety of the service. Staff did not receive one-to-one supervision and training, lack of information on people's care records regarding their capacity to make decisions.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 17 and 23 January 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Nwando Domiciliary Care’ on our website at www.cqc.org.uk’.

Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. At the time of this inspection the service was providing personal care to three people. Nwando Domiciliary Care is owned and managed by Ifeoma Nwando Akubue. There is no requirement for a separate registered manager. We have referred to her as the registered person.

At our focused inspection on the 17 and 23 January 2017, we found that the provider had followed their plan which they had told us would be completed by the 16 August 2016 and overall, we found that the provider had addressed the breaches of these regulations.

People’s risk assessments were reviewed. They detailed risks to people and how to safely manage them. Appropriate action had been taken to induct staff in their roles and appropriate security and references checks were carried out to confirm staff’s suitability to work with vulnerable people. New systems had been introduced in relation to staff training and supervision, and staff told us they found training and support provided helpful. Regular staff meetings were taking place.

Staff showed understanding of the Mental Capacity Act 2005 (MCA) and the implications of this legislation and how they sought consent from the people before supporting them.

The care plans were reviewed and were personalised and captured people’s needs, likes and dislikes. The daily care records were in place but were not consistent and did not always include information on nutrition and hydration intake.

There were records of spot checks, care plans and staff personnel files audits. People using the service and their relatives were asked for formal feedback. The service was in the process of seeking formal feedback from staff and professionals.

The inspection took place on 15 June 2016. This was an announced inspection. We gave the provider 24 hours notice of the inspection as this is a domiciliary care agency and we wanted to ensure the registered provider was available in the office to meet us. This service has not been inspected since its registration on 19 June 2015.

Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. At the time of this inspection the service was providing personal care to three people.

Nwando Domiciliary Care is owned and managed by Ifeoma Nwando Akubue. There is no requirement for a separate registered manager.

At the time of the inspection, the service did not maintain care plans and risk assessments. Following the inspection, the service provided us with care plans and risk assessments for people using the service. However, risk assessments were incomplete and care plans not personalised.

People using the service and their relatives told us they found staff caring and friendly. People’s relatives told us that staff listened to them and their health and care needs were met. They told us their family members were treated with respect and staff engaged with them in a friendly and considerate manner.

There were safeguarding policies and procedures in place. Staff were able to demonstrate their role in raising concerns.

Staff files lacked records of reference checks. There were no records of staff supervision and staff told us they did not receive one-to-one formal supervision. There were no records of staff induction training and the service did not offer any training to their staff.

The service did not have effective systems and process to assess, monitor and improve the quality and safety of service.

We found that the registered provider was not meeting legal requirements and there were a number of 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.