Westminster Homecare Limited (Chelmsford) is a domiciliary care agency. It provides personal care to people living in their own home in the community, including older adults and people with disabilities. At the time of the inspection they were supporting approximately 150 people.

This announced inspection took place between 17 and 20 April 2018.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service did not have a registered manager in place. However, a new manager had been recently appointed and were applying to CQC to become the registered manager. They worked closely with the operations support manager, who had until recently been the manager of the service.

At our last inspection in February 2017 we rated the service as requires improvement in all areas. We asked the provider to submit an action plan and monthly reports to show what they would do and by when to improve the service to at least a good rating. At this inspection, we found the provider and manager had taken action as required. However, whilst many areas of the service had improved to good, further time was needed to ensure the improvements were sustainable and so we continued to rate the service requires improvement overall.

The operations support manager had set up extremely good systems which were driving improvement and changing the culture of the service. Senior staff had good oversight of the support staff provided, and the service was better organised than at our last inspection. There were effective checks on the quality of the service with prompt action taken when concerns were found. Although we found some areas still needed improving, we had increased confidence that the systems were in place to continue to resolve concerns.

The provider had enabled senior staff to address the concerns we had found at our last inspection by reducing the pressure to meet targets and increase numbers of people using the service. However, the provider was responsible for the style of care plans staff used and had not ensured the plans presented information about people’s needs and risks in a clear manner.

We found the service had not mitigated the risks to people’s safety when they were discharged back to the community from hospital. The manager assured us they would address our concerns to improve communication with staff and ensure a more coordinated response to the risks around hospital discharges.

New systems had led to the increased safety of people at the service since our last inspection, such as the enhanced checks on the support people received with their medicines. Staff had been retrained in the administration of medicines and, whilst there continued to be some concerns in this area, the measures to drive improvement and safety were proving effective.

Risk assessments had improved, though information about how to minimise risk was not presented to care staff in a clear manner. Staff worked well as a team to support people who were at risk of abuse.

There were enough staff to meet people’s needs. New people only joined the service when there was capacity within the staff team to support them safely. Rotas and visits were better coordinated so that people were supported in a more consistent and structured manner.

Staff had access to improved training and support. They were better skilled to meet the needs of people with complex needs, including people with dementia. People received support to access health and social care professionals where needed. 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, thoug

Westminster Homecare Limited (Chelmsford) provides support to people in their own homes. It does not provide nursing care. At the time of our inspection the service was supporting approximately 236 people.

A registered manager was in post 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. The registered manager had been absent for over 28 days on the day of our inspection. The service was being run by two area managers with the assistance of senior staff from the service, and from a neighbouring branch of the service.

We last inspected this service on 18 and 19 July 2016 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of four regulations, relating to person-centred care, safe care and treatment, staffing and good governance. At our previous inspection we had found there were not enough staff to meet people’s needs in a timely way and people did not consistently receive safe care in line with their preferences. The manager had not adequately carried out necessary checks to ensure that the service met people’s needs. Following the inspection in July 2016, the service sent us a plan to tell us about the actions they were going to take to meet the above regulations.

At this inspection in 21 and 22 February 2016, we found four continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person-centred care, safe care and treatment and good governance. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this inspection we found there had been some improvements since our last visit. There had been a focus on staff recruitment so there were more staff available to meet people’s needs. Training had been improved and staff were being enabled to develop their skills, particularly in the area of dementia care.

As we had found at our last visit, where people had established staff, they received care which was of consistently good quality. However, poor coordination combined with inadequate care plans meant risk was not well managed and staff did not have sufficient information to manage people’s needs safely and in a person centred manner. Unsatisfactory oversight by the manager meant they had not fully addressed on-going concerns.

Poor scheduling of staff rotas meant that some visits were missed and people did not receive the support their required. There were not effective systems to monitor missed visits and the impact on people. Risk assessments were out of date or inaccurate and did not provide staff with the necessary information to reduce risk.

Whilst improved processes for the administration of medicine were being introduced these were not fully established and staff did not have sufficient information about the support people needed with their medicines.

There had been a positive focus on improved training for all staff and this was leading to improvements in overall skills. However, where people had specific needs, staff did not always have access to specialist training and information.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 and report on what we find. The service had started improve measures in relation to assessing people who may lack capacity but this was still at an early stage. Staff offered people choice and had a working understanding of supporting people who lacked capacity, however they did not have adequate information in relation to people’s needs in these instances.

Where staf