This comprehensive inspection took place on 10 January 2019. We gave the provider three working days’ notice because the location provides a domiciliary care service for people in their own homes and we needed to confirm someone would be available when we inspected.

The last comprehensive inspection took place on 18 May 2017. At that inspection we rated the service requires improvement for the key questions, ‘is the service safe?’ and 'is the service well-led?' We found two breaches of the Health and Social Care Act 2008 (Registration) Regulations 2009 because the provider had not always followed effective recruitment procedures and the systems to monitor the quality of the service that people received and to make improvements were not always effective. We carried out a focused inspection on 18 January 2018. At that inspection we found that the provider had made improvements but we did not see evidence that the registered manager had enabled people to give their views independently or evidence of other checks and audits that enabled them to monitor quality in the service and make improvements. The overall rating of the service was ‘good’ but the rating for the well-led key question was maintained at requires improvement because we wanted to see sustained improvements at the service.

Sipi Care Agency Ltd is the only location for the provider Sipi Care Agency Limited. This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults some of whom might be living with dementia

and adults who have physical or learning disabilities. The provider has moved to a different address at the Crown Business Centre since the last inspection. At the time of the inspection, 18 people were using the service. They lived in the London Boroughs of Harrow and Brent and their care was commissioned by these local authorities.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During the inspection we found arrangements in place for the management and recording of medicines support were not always safe.

The risks to people's safety and wellbeing had been identified, but the provider had not always developed processes to mitigate these risks. For example, care plans were not detailed enough for them to provide safe care and treatment.

The service was not always working in line with the principles of the Mental Capacity Act 2005 which meant people were not appropriately supported to have their views taken into account when decisions about their care were being made.

Staff had not received the appropriate training to ensure that staff always had the skills and knowledge to deliver care safely and effectively.

The provider's quality assurance systems had improved but were not always effective at identifying where improvements were needed.

People told us that they were happy with their care and felt safe with the staff who supported them, but their needs were not always considered in person centred care plans.

People felt that the service was responsive and that their care needs were being met.

There were systems and processes in place to protect people from the risk of harm. The provider recruited staff using safe recruitment processes.

The provider had systems for handling complaints and responding to incidents and accidents.

Staff were positive about the management of the service and felt supported by the registered manager and other senior staff.

The provider displayed their CQC ratings for this service on its website as required by law.

We found the service to be in breach of five regulations of the Health and Soc

This focused inspection took place on 18 January 2018. We gave the provider 48 hours’ notice of our visit as the service provides care to people living in their own homes and we needed to make sure the provider would be available to assist with the inspection.

We carried out an announced comprehensive inspection of this service on 18 May 2017 when we found two breaches of legal requirements regarding staff recruitment and the way the provider monitored quality in the service and made improvements. 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 this announced focused inspection on 18 January 2018 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 those requirements. We inspected the service against two of the five questions we ask about services: is the service Safe and Well-Led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sipi Care Services Ltd on our website at www.cqc.org.uk.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Sipi Care Agency Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and younger disabled adults. At the time of this inspection the service was supporting 10 people. The provider's Nominated Individual was 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.

Not everyone using Sipi Care Services Ltd 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 receive this support we also take into account any wider social care provided.

We found the provider had taken action to improve safety. They had reviewed their procedures for recruiting care workers and ensured they carried out checks on all new staff before they started to work in the service.

The provider had systems in place to provide safe care and support to people using the service.

Where the provider’s assessments identified specific risks, they gave care workers clear guidance on how to mitigate these.

The registered manager told us they would review their medicines management policy and procedures to reflect current guidance from the National Institute for Health and Care Excellence.

The provider had policies and procedures for the control of infection and reporting accidents and incidents and they had reviewed these in February 2017.

We found the provider had taken some action to improve the ways they monitored quality in the service although further improvements were needed. We did not see evidence that the registered manager had enabled people to give their views independently, supported by an advocate or family member or evidence of other checks and audits that enabled them to monitor quality in the service and make improvements.

Where people raised concerns with the registered manager we saw they took action in response.

The registered manager actively engaged with our inspection. They provided the information we needed to make our judgements and accepted that they needed to make more progress to address issues we raised at our inspec

This inspection took place on 18 May 2017. We gave the provider 72 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to assist with the inspection. This was the first rating inspection of the service after it was registered by the Care Quality Commission (CQC) in August 2012. The service was not providing a service to people until September 2016 and we could not inspect it.

Sipi Care Agency Ltd is a domiciliary care service that provides care and support to people in their own homes. At the time of this inspection the service was supporting 11 people. The provider’s Nominated Individual was 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.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not always follow effective recruitment procedures to make sure care workers were suitable to work with people using the service. The provider had systems to monitor the quality of the service that people received and to make improvements but these were not always effective.

You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe with their care workers.

The provider worked within the principles of the Mental Capacity Act 2005 (MCA) to make sure that, as far as possible, people made their own decisions about the care and support they received.

People using the service were cared for by staff who had been appropriately trained and supported.

Care workers gave people the support they needed with their nutritional needs.

The provider supported people using the service to meet their health care needs and where people needed support with their medicines, care workers provided this safely.

People using the service told us they liked their regular care workers and described them as kind, caring and professional. They also told us they were supported to do things for themselves when they were able. People told us their care workers usually arrived on time, stayed the correct amount of time and completed all of the tasks that were included in their care plan.

The provider also recorded people's religious, cultural and communication needs and their care workers were able to tell us about these.

The provider had a complaints policy and procedure in place. People using the service told us they knew how to complain to the provider but they told us this had never been necessary.

People using the service were able to provide feedback on the care they received.

There was an open culture at the service. People using the service, their relatives and care workers told us they felt able to approach the management team and felt valued by them.

The provider actively engaged with our inspection and they provided the information we needed to make our judgements.