About the service: Standard Care Limited is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection, the service was supporting approximately 60 older adults living in the boroughs of Westminster, Hammersmith and Fulham and Kensington and Chelsea.

Why we inspected:

This was a planned inspection based on our routine scheduling programme.

People's experience of using this service:

¿ People were supported by kind and caring staff.

¿ People using the service told us they felt safe and trusted staff members providing care and support.

¿ People's needs were recorded in support plans. However, support plans did not always provide sufficient detail about people’s medical histories and current health status.

¿ Risk assessments were in place. However, these were often generic and did not always consider the specific needs of each person using the service.

¿ People were reminded to take their prescribed medicines. However, the recording of this task did not provide sufficient information as to whether people had actually been observed taking their medicines and medicines administration records (MAR) were not in use within the service.

¿ Quality assurance systems required further development to ensure the service provided to people was consistently safe and effective.

¿ People were supported to eat and drink enough where this formed part of an agreed care package.

¿ Systems in place to track and monitor all visits to people’s homes were currently ineffective.

¿ Staff records contained relevant documentation to demonstrate appropriate checks had been undertaken prior to new staff members commencing employment.

¿ Staff completed an induction period that included shadowing more experienced members of staff before working with people on their own.

¿ Staff understood the provider’s safeguarding policies and were familiar with reporting procedures including whistleblowing.

¿ Staff told us they were well supported by the management team and received training relevant to their roles and responsibilities.

¿ The service was working in partnership with other agencies, services and providers.

¿ When incidents had taken place or complaints had been received, the registered manager acted on these and investigated what had taken place.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (Report published 28 April 2018).

Why we inspected:

This was a planned inspection based on our routine scheduling programme.

Enforcement: We found breaches of the regulations in relation to safe care and treatment and good governance. Please see the ‘action we have told the provider to take’ section towards the end of the report. We also made a recommendation about medicines management systems.

Follow up: We will speak with the provider following the publication of this report to discuss how they will make changes to ensure the rating of the service is increased to at least Good. We will continue to monitor intelligence we receive about this service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We conducted an inspection of standard Care Limited on 30 January 2018. We previously inspected the service on 30 November 2015 and found a breach of regulations in relation to consent. At our previous inspection this service was rated good.

This service is a domiciliary care agency. It provides personal care for people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection they were supporting 40 people using the service in the London Boroughs of Hammersmith, Fulham, Kensington and Chelsea. Not everyone using Standard 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.

There was a registered manager at the service. 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’s care records did not always contain enough information about their medical histories. People were supported with their nutritional needs where this formed part of their package of care.

The provider’s quality assurance systems supported the delivery of good care. However, the registered manager had not identified the issues we found in relation to people’s care records. She assured us she would rectify these issues as soon as possible.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005 (MCA). Care records were signed by people using the service to demonstrate that they consented to their care.

People and their relatives gave positive feedback about care workers. Care workers were passionate about promoting people’s independence and ensured people's privacy and dignity was respected and promoted.

Risk assessments and support plans contained a sufficient level of information about how care workers were expected to mitigate known risks.

Care staff understood people’s personal preferences and had a good understanding of their life histories. Care records included information about people’s hobbies and pastimes.

Safeguarding adults from abuse procedures were in place and care workers understood how to safeguard people they supported. Care workers had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

People we spoke with and their relatives told us they were involved in decisions about their care and how their needs were met.

Recruitment procedures were thorough and ensured that only staff who were suitable worked within the service. The service also ensured there were sufficient numbers of suitable staff to support people.

The provider had an appropriate complaints procedure in place. Complaints were investigated and responded to in a timely manner.

Staff had the skills, knowledge and experience to deliver effective care and support, and received support for their roles. There was an induction programme for new staff which prepared them for their role.

The provider had a clear vision to deliver high-quality care and support. Staff demonstrated that they were clear about the values of the organisation and said these guided their work.

We conducted an inspection of Standard Care Limited on 30 November 2015. The service provides care and support to people living in their own homes. There were 26 people using the service when we visited. This was our first inspection of the service since the provider’s registration with the Care Quality Commission (CQC).

There was a registered manager at the service. 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.

Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Risk assessments and support plans contained clear information for staff. All records were reviewed within six months or where the person’s care needs had changed.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard people they supported. Staff had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. However, records did not always contain details of people’s capacity and how they should be supported to make specific decisions.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs and where two care workers were required for one person, this was accommodated.

People were supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs and were supported to access a range of healthcare professionals.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

The organisation had adequate systems in place to monitor the quality of the service. The registered manager reviewed all care records and daily notes completed by care workers. We saw evidence that feedback was obtained by people using the service and the results of this was positive.