This inspection took place on 29 May 2018 and was announced. 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. The service was last inspected on 30 March 2017, where we found the provider to be in breach of four regulations in relation to need for consent, staff care and treatment, staff recruitment and good governance. 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 Safe, Effective, Responsive and Well-led to at least good. At the inspection on 29 May 2018, we found that the provider had made some improvements but they were not sufficient and they remained in breach of Regulation 12 and 17.

Tottenham Town Hall is a domiciliary care service run by DCAS Direct Personnel Limited. This service provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Not everyone using Tottenham Town Hall receives 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 inspection, the service was providing personal care to 13 people with physical disabilities and older people in their own homes.

The service had 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.

The provider did not always identify all risks associated to people’s healthcare and mobility needs. People’s risk assessments lacked information for staff on how to mitigate risks to provide safe care. People’s medicines administration records had some gaps and errors. Staff were not provided with additional health specific training and did not receive regular supervision to do their jobs effectively.

People’s needs assessments did not always reflect their needs and abilities. People’s care plans lacked information on their likes and dislikes. We have made a recommendation regarding personalising people’s care plans. Staff did not always accurately record how they supported people in their daily care notes. The management did not keep records of telephone monitoring calls and had not carried out any spot checks since the last inspection. Spot checks are home visits carried out by the management to check if staff are providing care as per the agreed care plan. The provider had not sought formal feedback from people and their relatives since the last inspection.

People told us they felt safe with staff and relatives told us they found the service safe. Staff knew the safeguarding procedure and were able to describe types and signs of abuse. The provider employed sufficient and suitable numbers of staff to meet people’s needs safely. Staff followed correct infection control procedures whilst supporting people. The provider had processes in place to learn lessons from accidents and incidents.

Staff told us they felt supported in their role and found training useful. People’s nutrition and hydration needs were met. Staff asked people before supporting and encouraged them to make decisions. People’s care plans made reference to their capacity to make decisions around their care and treatment.

People told us they were supported by staff who were friendly and treated them with dignity and respect. Staff were trained in equality and diversity and told us they treated people equally. People were encouraged by staff to remain independent.

The provider had introduced new care plans that gave information on people’s

The inspection took place on 30 March 2017. This was an announced inspection. We gave the provider 48 hours’ 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 us. This service has not been inspected since its registration on 22 February 2016.

Tottenham Town Hall is a domiciliary care service run by DCAS Direct Personnel Limited. At the time of inspection the service was providing personal care to nine people with dementia, physical disabilities and older people in their own homes.

The service had a registered manager 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 using the service and their relatives were happy with the service and provided positive feedback. They told us staff are caring and friendly, and listened to them and treated them with respect and dignity. People’s health and nutrition and hydration needs were met. People were happy with staff’s punctuality and told us they mostly received same staff.

The service risk assessed the care and support provided to people. The risk assessments gave sufficient information and instructions to staff on the safe management of identified risks including medication. We found medication administration records were not maintained for everyone and the ones we looked at were not appropriately completed.

The service did not always follow appropriate recruitment procedures, some staff did not have updated criminal record checks and their references were not sought as per the provider’s policy. Staff demonstrated a good understanding of protecting people against abuse.

Staff were well-trained and able to demonstrate their understanding of the needs and preferences of the people they cared for by giving examples of how they supported people. Staff did not receive regular supervision to do their job effectively. The service was in middle of scheduling staff supervision dates.

People’s care records did not make reference to people’s capacity and did not include information on how should staff support people if they lacked capacity to make decisions.

At the time of the inspection, the service did not maintain care plans and care task plans were incomplete and not personalised. People felt comfortable in raising concerns and complaints to the management but the service had not received any formal complaints.

The service lacked robust systems and processes to assess, monitor and improve the quality and safety of the care delivery. The service had recently sent out feedback survey forms to people and was awaiting their responses.

We found four 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.