This inspection took place on 23 January 2019 and was announced. At our last comprehensive inspection on 17 November 2016 the service was rated overall Good. During this inspection we found risk assessment, medicine administration, safeguarding processes and systems for monitoring the quality of the service were not effective in ensuring the safety and wellbeing of people using the service.

Temp Exchange Services Limited 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 children, older adults, younger disabled adults and older people. Not everyone using Temp Exchange Services 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 our inspection there were 64 people using the service.

The service has a registered manager who was appointed in July 2018. 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 said they felt safe with staff and staff knew what constituted abuse and understood their responsibility to report abuse. Staff were aware of the whistleblowing procedures and the authorities to report their concerns to outside of the service. However, people were not always protected from abuse because the provider failed to identify when abuse had taken place. This was corroborated by a number of safeguarding concerns identified by the local authority where these had been proven.

Staff we spoke with understood the potential risks posed to people using the service and what to do to minimise any risks identified. However, risk assessments were unclear and did not provide details of how to manage risks.

Staffing levels were based on people’s individual level of need and the packages of care agreed with the local authority.

Staff supporting people with their medicines received training and competency assessments. Where medicine errors had been identified the provider took immediate action. However, medicines were not always managed safely.

People were protected from the risk of the spread of infection because staff followed infection control practice when providing care. Staff told us that they were provided with the necessary personal protective equipment.

Systems for reporting and recording incidents and accidents were in place. However, records of outcomes and action taken were not always clear. This meant we could not confirm whether there had been any learning from incidents.

Staff received an induction which involved training in mandatory areas relevant to their roles. Staff received supervision which included a review of their performance and training needs.

People were supported with eating and drinking or had their nutritional and hydration needs met where this support was provided.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and staff understood the importance of asking people’s consent before providing care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service worked in partnership with other health and care professionals to meet people’s health needs. However, we received mixed feedback from people using the service, relatives and local authority commissioners about the running of the service.

People and relatives told us that they were treated with dignity and respect and staff encouraged people’s independence.

The inspection took place on 17 November 2016. This was an announced visit because we needed to make sure the registered manager was available and that people’s care records were available in the office for us to review.

Prior to this inspection this service was inspected on 19 February 2014 where all standards inspected were met.

Temp Exchange Ltd is a domiciliary care agency that provides care and support to children and adults with a range of needs in their own homes. At the time of our inspection there were 44 people using the service.

There was a registered manager in post. 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 registered manager and office staff were well informed about people who used the service. There were systems in place for monitoring the quality of the service. People and their relatives were encouraged to contact the office and asked to provide feedback about the service they received.

People’s needs were assessed and care plans were developed to identify what care and support people required. People said they were involved in their care planning and were happy to express their views or raise concerns. When people’s needs changed, this was quickly identified and prompt, appropriate action was taken to ensure people’s well-being was protected. The registered manager told us that copies of care plans were kept in people’s homes.

Staff understood how to recognise the signs and symptoms of potential abuse and told us they would report any concerns they may have to their manager. However, some staff did was not aware of who the authorities they could contact outside of the agency. Assessments were undertaken to assess any risks to the people using the service and the staff supporting them. This included environmental risks and any risks due to people’s health and support needs. The risk assessments we viewed included information about action to be taken to minimise these risks.

Staff were happy to work for the service, as a result staff turnover was kept to a minimum ensuring that continuity of care was in place for most people who used the service.

Staff were respectful of people’s privacy and maintained their dignity. Staff told us they gave people privacy whilst they undertook aspects of personal care, asking people how they would like things done and making enquiries as to their well-being to ensure people were comfortable.

The service followed safe recruitment practices and carried out appropriate checks before staff started supporting people. Care staff received supervision and some had received an appraisal. These processes gave staff an opportunity to discuss their performance and identify any further training they required.

People were supported to eat and drink. Staff supported people to take their medicines when required and liaised with their GP and other healthcare professionals as required to meet people’s needs.

The service had a complaints policy. People and/or their relatives knew how to complain if they were dissatisfied. However, the provider is aware of the importance of following their own complaints policy and procedure.

The registered manager demonstrated leadership and a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service. We saw that visits had been made by the office staff to people using the service and their relatives in order to obtain feedback about the staff and the care provided.

We found that the provider's office based staff were quick to respond to requests from people who used the service and they were supportive to their staff. People were mainly positive about the service they received. One person told us, 'My carers are first class'.

Care files were generally in good order and contained appropriate records, but the format was in the process of being improved. We saw that staff generally had access to training and when we spoke with them they confirmed that they had undertaken a range of relevant courses, including safeguarding. Some staff members had been supported to take professional qualifications.

Systems for monitoring the administration of medicines were in place, although training had not yet reached every member of staff.

The provider had appropriate quality assurance procedures in place and was preparing for an assessment to maintain their ISO 9001:2008 (international quality standards) accreditation on the day of our visit. However, we thought some of their policies and local procedures needed to be updated and amended to better reflect the provision of services within people's own homes.

We did not speak with people who use the service at this inspection, as we visited the service to follow up on concerns raised at our inspection in February 2013 about the recording of medicines given to people, and the auditing of medicines records. Therefore we assessed whether improvements had been made by inspecting medicines records, care plans and staff training records at the provider's office.

At the time of the inspection, the agency was providing carers to approximately 30 people, primarily in the Waltham Forest area.

We spoke to eight people using the service, and all except one person were very positive about the service, indicating that they were provided with the care that they needed, and were given choices about the support they received. They had formed good and supportive relationships with staff and management. One person told us ‘they come up trumps every time,’ others noted ‘they are always on time,’ and ‘they get in touch regularly, and keep us informed of any changes.’ Where concerns were raised by a particular individual, these were passed on to the management, and addressed promptly.

The agency would benefit from improvements to a number of records kept, including records of staff supervision and shadowing, medication administration and some quality assurance recording, to ensure that people are provided with the highest possible standard of care and support.

At the time of the inspection forty-two people were using the service, and we had the opportunity to visit or speak with ten of them or their relatives. People were very positive about the service, indicating that they were provided with the care that they need, and were given choices about the support they received.

In discussing the service people told us “Everything is fine,” “No problems,” “Very good service, “They are usually on time, “They are respectful,” and “I’m satisfied with the service.” People had formed good and supportive relationships with staff and management, and felt able to speak up about any concerns that they might have.

Appropriate staff recruitment procedures were in place and staff received effective support and supervision from management. A training plan was in place to ensure that all staff worked in line with best practice. Quality assurance procedures were in place to ensure that people received a high standard of care and support.

However insufficiently rigorous procedures were in place to monitor the recording of medication administration to people, to ensure that they were protected from the risk of errors being made.