This inspection took place on 28 March and 5 April 2018 and was announced. We gave the provider 48 hours’ notice of the inspection visit because the registered manager could be out of the office supporting staff or providing care. We needed to be sure that they would be available.

At the last comprehensive inspection on 3 February 2016 the service was rated as Good.

Southwark African Family Support Services is registered as a domiciliary care agency. The service provides personal care to people living in their own homes. The Care Quality Commission (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 the inspection 15 people in the boroughs of Southwark and Wandsworth were using the service. All of the people using the service were funded by the local authority and were able to choose their service provider through the use of personal budgets.

The service had a registered manager in post who was available during both days of our inspection. 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.

People told us they felt safe. Staff understood how to recognise and report signs of abuse in line with safeguarding procedures. The provider did not always follow safe recruitment processes to make sure that the staff employed to work in the service were suitable to do so. There was enough staff deployed so that people were provided with sufficient care and support.

People's medicines were not always managed safely. Staff had received the required medicines training, however their competency had not been regularly assessed to ensure they were supporting people safely.

Risk assessments had not been always been reviewed and lacked guidance for staff to follow. Some people’s care plans needed to be reviewed to ensure the provider could be responsive to any changes in their needs. People’s care records did not always contain sufficient information about people’s individual needs and preferences.

People and their relatives told us they were treated with dignity and respect and were supported by kind and caring staff. People were involved in the decisions and choices they made about their care. People’s cultural and individual needs were identified during their assessments and met by the provider. Records demonstrated the provider was working within the principles of the Mental Capacity Act 2005 (MCA).

Staff had received on going supervision, however there were gaps in their annual appraisals to support them with any learning and development needs. Staff had received sufficient training to further develop their skills. Changes to people’s healthcare needs were identified and people had access to healthcare services. People were supported with their nutritional needs however their records did not always contain sufficient information about how staff supported them.

People knew how to raise a complaint and told us they were satisfied with their care. However, one person told us they felt their concerns would not be acted on. Staff arrived for their care visits on time and people were kept informed if they were running late for their care calls. There was enough staff deployed to support people with their care and support.

The provider did not always have effective systems in place to assess, monitor and improve the delivery of the service. The provider had not routinely sought feedback from people to check on the standards of care delivered to people in their homes. We received mixed views about how the service was run. Staff spoke favourably about how the service operated.

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This announced inspection took place on 3 February 2016. Southwark African Family Support Services provides personal care to people living in their own homes. At the time of this inspection, the service was providing support to 15 people in the London boroughs of Lambeth, Southwark and Wandsworth.

Southwark African Family Support Services was last inspected on 16 June 2014. The service met all the regulations we inspected at that time.

The service has 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.

People in the service received safe care and support. Staff had identified people’s needs and risks to their well-being and had up to date plans in place to keep them as safe as possible. People were safe from the risk of abuse and neglect. There were sufficient staff available to meet people’s needs.

The services assessed people’s individual needs and planned the delivery of their support. Staff carried out reviews with people and their relatives to ensure their support reflected their current needs. Staff knew people’s hobbies, interests and preferred routines.

The service complied with the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) when supporting people. People were asked for their consent to the care and support they received.

Staff told us the registered manager was approachable and supportive. Staff received regular supervisions and appraisals. Staff used feedback from these sessions to improve their practice. Staff received training to equip them to meet the needs of people.

People told us staff were polite and treated them with respect. People were treated with dignity. Staff involved people and their relatives in assessing and planning for their care and support. People received care that reflected their preferences and choices.

People received support to access the healthcare services they required. Staff supported people with their eating and drinking.

The registered manager obtained people’s views about the service and used their feedback to make improvements. People and their relatives gave positive feedback about the service. People felt confident to raise a concern and understood how to use the service’s complaints procedure. The registered manager investigated and resolved complaints as appropriate.

The provider had effective audit systems in place to monitor the quality of service provided to people. The registered manager conducted regular checks on the support and care provided to people and made improvements if necessary.

This inspection was carried out by an inspector who gathered evidence to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and staff supporting them and from looking at records. We spoke to three of the of 14 people using the service at the time of our inspection, three relatives and two members of staff.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were trained to support people safely. There was a safeguarding policy in place and staff understood the types of abuse that could happen and how to report any concerns they had. Risks were assessed for people; and actions were always taken to address any risk promptly. There was a plan for how staff should respond to unforeseeable emergencies. Incidents and accidents were recorded and reviewed.

Is the service effective?

People’s care was planned and delivered in a person centred way. The provider involved other healthcare professionals in the planning and coordination of people’s care and treatment. Staff followed care plans and responded to changes in people’s needs and they were flexible in meeting the needs of people. People were involved in the planning their care and support.

Is the service caring?

Staff understood the needs of people they supported. People using the service told us that they were treated with dignity and respect. People told us that staff encouraged them to do as much as possible for themselves and gave them choice. One person said, “Staff are nice and caring.” Staff knocked on people’s doors before entering. Staff communicated with people in the way they understood.

Is the service responsive?

The provider liaised effectively with other health and social care professionals to ensure the service responded to people’s needs. Care plans and risk assessments were reviewed and updated as required. People’s views, needs were taken into account when allocating the time of their visits. People were matched with staff that had skills, experience and understanding of their needs including cultural and religious requirements.

Is the service well-led?

The provider worked well with other agencies in meeting the needs of people using the service. There were quality assurance systems in place to identify, assess and monitor the quality of service provided. We saw records of complaints and actions taken to address them. People using the service and their relatives told us that management take complaints and comments seriously and sort things out quickly.

During our inspection in April 2013 we found that Southwark African Family Support Services (SAFSS) was not supporting staff by providing regular training and supervision. We did not find evidence that the quality of the service was regularly assessed and monitored. The provider told us of the actions they were taking to address the findings of our inspection. During our recent inspection in March 2014 we found that the provider had implemented these actions.

People using the service had the same care worker or workers who knew what they needed and how they liked things done. One of them said “She’s like a daughter to me; she respects me”. Another person said “They’re very gentle. They don’t rush you.” People said the care workers were reliable and polite and talked kindly to them. However, some people had received no review of their service for several years and risk assessments had not been reviewed or updated.

There were effective recruitment and selection processes in place and appropriate checks had been made of staff when they started working for the provider.

Care staff said they were able to talk to the care coordinate if they had any concerns, but we found no evidence that they had regular individual meetings with a line manager or that they had received recent training.

We found no evidence that the provider was monitoring the service as set out in their quality assurance policy. There were no regular reviews of care to assess whether the service was meeting people’s needs or to check that the care worker was carrying out the tasks set out in the care plan. They were not regularly finding out the views of people using the service or their representatives.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who had personal experience of using or caring for someone who used this type of service.

We used telephone interviews and home visits to people who use the service to gain views about the service. We spoke on the telephone with five people and visited two people in their own home.

The people we spoke with were very positive about their care workers and said they were very kind. One person said “she’s the most brilliant person I ever found”, and another person referred to the care workers as “angels”. Everyone said that the care workers would do things if they asked them. They said they could contact the service if they needed to.