This service is a domiciliary care agency. It provides personal care to people living in their own homes in the Aylesbury area. It is registered to provide a service to older adults, younger disabled adults and children. One hundred and fourteen people were receiving support from the service at the time of the inspection, none of these were children.

This inspection took place on 7 and 8 January 2019. It was an announced visit to the service.

We previously inspected the service in September 2017. The service was not meeting all the requirements of the regulations at that time. 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’. The action plan was completed and sent to us.

There had been changes to management of the service since the last inspection. A registered manager was in post. This 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 spoke positively about their care workers. Comments included “Staff are friendly and kind. Some carers are exemplary,” “Lovely staff, very charming, friendly,” “Good service and very good carers,” “I’ve had nothing but kindness from all of them” and “The carers are always very pleasant and we chat.”

Staff described improvements to the culture of the service. They told us they received good support. Improvements had been made to staff training. None of the staff had any concerns about the practices they were asked to undertake as part of their duties. They understood about safeguarding people from abuse and said they would report any concerns. People who were supported by the agency told us they felt safe.

Each person had been assessed before they received a service from Westminster Homecare Limited (Aylesbury). Care plans had improved and recorded people’s preferences and support requirements in detail. Risk assessments had been written to assess the likelihood of people experiencing any harm or injury. Measures were put in place where risks were identified, to reduce the likelihood of harm.

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.

Some people were supported with their medicines. These were handled safely and appropriate records were kept.

Staff were recruited using robust procedures to make sure people were supported by care workers with the right skills and attributes. Staff received appropriate support through a structured induction, which included all the training the provider considered mandatory.

People told us there were inconsistencies in when their care workers arrived to support them. For example, some of the feedback we received included “Arrival times can fluctuate within two hours and they never call to say they’re going to be delayed,” “Forever late with calls” and “Staff arrive at different times, you never know where you are. Always more than half an hour late.” We have made a recommendation to improve this area of practice.

People knew how to make a complaint. Their experiences of doing this varied. We have made a recommendation about monitoring responses to people’s complaints and concerns.

There were improvements to monitoring of the service, to ensure people received appropriate care and support. This included spot checks of care workers’ practice, care reviews and audits.

Records were maintained to a good standard and staff had access to policies and procedures to guide their practice.

We undertook an announced inspection of Westminster Homecare Limited (Aylesbury) on 14, 15 and 16 September 2017.

Westminster Homecare Limited (Aylesbury) provides care and support to people in their own homes with personal care needs. The agency provides support and personal care to children, younger adults and older people. At the time of our inspection 128 people were 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.

Care delivery was not always effective as some people experienced delays in their care calls as people did not receive their care at the agreed time. This put people potentially at risk. One person commented; “As far as it goes, the care workers I get are managing well. But I don’t get the same care workers all the time”.

People told us they felt safe when staff delivered their care. Staff knew how to keep people safe, for example, trip hazards. Staff understood their responsibilities in relation to safeguarding people.

We saw staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. Staff were confident their training on how to protect people from harm prepared them to protect people from abuse.

The service had systems in place to notify the appropriate authorities where concerns were identified. People received their medicine as prescribed.

The service had safe recruitment procedures and conducted background checks to ensure staff were suitable for their role. Where risks to people had been identified, risk assessments were in place.

Although we saw care worker training had taken place, some people were not confident staff had received the right training to look after them. Staff also said they would like more training to ensure they knew how to look after people.

Staff told us they had adequate induction prior to them looking after people and they had regular supervision and overall felt supported.

Staff knew their responsibility under the Mental Capacity Act 2005. People were supported with their nutrition and their health needs and their preferences were respected.

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.

People told us care staff were very friendly, caring and attentive to their needs. They said they benefitted from caring relationships with the regular care staff and their dignity and respect was maintained when staff delivered care. Comments included; “They are kind and caring. They are excellent” and “The care workers are very pleasant”.

People said they were mainly involved in their care and their independence was actively promoted. Staff sought people’s consent and involved them in their care where possible.

We saw people’s care files were maintained with the necessary information in the office. However, people’s care files in their own homes did not contain the same level of information, were incomplete or in one case, the care file was absent.

Although systems were in place to record complaints. We saw complaints had been raised about the poor delivery of peoples’ care calls. People we spoke with knew how to raise concerns, but comments received demonstrated people were not always confident their concerns would be actioned or the complaints policy followed. One person commented; “I have spoken to the agency regarding the care workers, but they don’t listen to you in the office. You are just a number to them, not an actual client”.

People and staff were not confident the service was well managed. They said communic