We carried out an announced inspection of Westminster Homecare Limited (North London/Herts) on 7 August 2017. Westminster Homecare Limited (North London/Herts) is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to people of all ages and different abilities. The service provides a range of domiciliary care services which include personal care, domestic support, administration of medicines and food preparation. At the time of inspection the service provided care to approximately 287 people.

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.

At the previous inspection of the service on 21 September 2015 the service was rated as Good with no breaches of Regulation. However, we did find that the service required improvement under “responsive” due to some feedback from people stating that care workers arrived later than their appointed time and this had a detrimental effect on their needs being met. We also found that some support plans were not well organised and lacked details. During this inspection on 7 August 2017, we found that the service had taken action in respect of this and made improvements in respect of these areas.

Feedback from people and relatives was positive in relation to care worker’s punctuality and this is detailed under “Is the service safe?” section of this report. People and relatives told us that care workers were mostly on time and people did not raise concerns regarding this.

People who used the service and relatives informed us that they were satisfied with the care and services provided. People told us they were treated with respect and felt safe when cared for by the service. They spoke positively about care workers and management at the service.

There were safeguarding and whistleblowing policies in place and records showed staff had received training in how to safeguard adults. Care workers demonstrated an awareness of the actions to take in response to allegations of abuse.

Individual risk assessments were completed for each person. These included guidance for minimising potential risks and we saw evidence that risk assessments were reviewed and updated accordingly. However, we noted that some risk assessments we looked at were generic and not personalised and discussed this with the registered manager.

Appropriate arrangements were in place in respect of medicines management.

There were comprehensive and effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by staff who were unsuitable.

The service had an electronic system in place to monitor care worker's punctuality. People told us their care workers turned up on time and they received the same care worker on a regular basis and had consistency in the level of care they received. Management at the service explained that consistency of care was an important aspect of the care they provided.

People were cared for by staff that were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities. Staff spoke positively about their experiences working for the service and said that they received support from the registered manager.

Staff had a good understanding and were aware of the importance of treating people with respect and dignity. They also understood what privacy and dignity meant in relation to supporting people with personal care. Feedback from people indicated that positive relationships had developed between people using the service and their care worker and people were treated with dignity and respect.

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Westminster Homecare Limited is a domiciliary care agency providing a range of services including personal care for people in their own homes. People were either funded by their local authority or were paying for their care. This inspection took place on 21 September 2015 and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available. There had been a previous inspection of the service on 10 June 2014, where the Regulations we inspected were met.

At the time of our inspection Westminster Homecare Limited was providing care for 269 people, of which 77 were funding their own care and 192 were funded by five local authorities.

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.

Feedback from people using the service, relatives and care workers was mostly positive, although some people said that care workers were sometimes late, and some said that they had different carers which made it harder to get to know them. However, all of them said that the care workers were good at their jobs and all followed the same procedures. Comments from people included: "I feel safe with them. They are nice girls", "I would say 95% of the time, they are on time", "they are caring and kind people". Relatives' comments included: "sometimes they are late for some reason", "they never go and leave what needs to be done undone", "these people are brilliant. They are very kind". Care workers told us that they felt supported by their manager. Some of their comments included: "I feel supported by my manager 100%", "the management team is always available" and "My induction was very good".

There were procedures for safeguarding adults and the care workers were aware of these. The risks to people's wellbeing and safety had been assessed. Care workers knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

There were systems in place to ensure that people received their medicines safely, although it was identified that for one person, lateness of care staff had a knock on effect on them receiving their medication on time. This had been identified and was being addressed by the manager at the time of the inspection.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff absence. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.

The service had policies and procedures in place to assess people's capacity to make decisions about their care and support. The provider and registered manager were aware of their responsibilities in line with the requirements of the Mental Capacity Act (MCA) 2005.

People's needs were assessed prior to receiving a service and support plans were developed from the assessment. The registered manager was working with the local authority to improve the support plans and make them more person-centred and detailed.

People's health and nutritional needs had been assessed, recorded and were being monitored. These informed care workers about how to support the person safely and in a dignified way. Care workers received an induction and shadowing period before delivering care to people. They received the training and support they needed to care for people.

There was an appropriate complaints procedure which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

There were systems in place to monitor and assess the quality and effectiveness of the service. These were used to make ongoing improvements.

A single inspector and an Expert by Experience carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

We received questionnaires from 15 people and from seven relatives of people who used the service. We spoke with 25 people who were currently using the service and their relatives, and with 18 members of staff, including the manager.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Assessments were carried out and reviewed regularly for aspects of health and safety.

Risk assessments were completed for the care people required, for example for moving and handling and for the environment in each person's home. Risk assessments addressed risks both for people who used the service and for the staff.

There were sufficient staff to meet people’s needs and keep them safe. Everyone we spoke with had regular care workers. However several people told us that they were not informed of changes in their schedules, and they were not confident that a care worker would arrive when their regular care worker was not available. One person told us a manager had covered a call because there were no care workers available. And a relative said, “One of the care workers didn’t turn up and the agency failed to tell us. It was 24 hours before we realised and my relative may not have had a meal.”

Is the service effective?

Most of the people who used the service who we spoke with and who returned questionnaires felt that their care workers received the training they needed to provide their care. Training records showed that staff completed induction training and regular updates to ensure that their knowledge and skills were refreshed. The care workers we spoke with told us that the training provided them with the skills that they needed, and that additional training was available for specific needs such as dementia care and diabetes.

We saw the care plans for five people who used the service. They contained clear information on each person's personal and healthcare needs to enable the care staff to meet their individual preferences.

Is the service caring?

All of the people we spoke with told us that they were fully involved in planning the care and support that they needed. Relatives of people using the service who returned CQC questionnaires confirmed that they were fully involved in decisions about the person’s care and support needs.

People felt that their privacy and dignity were respected. We saw the care plans for five people who used the service. They contained clear information on each person's personal and healthcare needs to enable the care staff to meet their individual preferences. One person who we spoke with said, “I have been fortunate to have the same lovely carer. It is so important to have someone who understands my condition and my mood changes.”

Is the service responsive?

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Care coordinators contacted everyone regularly either by phone or by visiting them to ask them their views of the service they received.

No-one who we spoke with had made any complaints to the service, but most people felt that their views were listened to and acted on. One person said, "I had a carer who I really didn’t get on with. I spoke with the office and they changed the carer for me." Another person told us that their care plan had been amended as they requested following a review.

Is the service well-led?

The Registered Manager left the service in April 2014 but did not cancel their registration. The new manager had not completed their application for registration.

Staff we spoke with said that managers provided them with good support and they were clear about their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The people we spoke with confirmed that they were able to make their views known and that any concerns that they may have were addressed. Most of the people who we spoke with and who returned CQC questionnaires confirmed that they received regular quality surveys from the agency.

We spoke with seven people who used the service and a relative. They informed us that staff treated people with respect and dignity and they were on the whole satisfied with the services provided. One person however, was not fully satisfied with some aspects of the service.

People who used the service had been assessed and their choices and preferences were noted. Appropriate risk assessments had been prepared. Care plans had been signed and there was evidence of consultation and involvement of people who used the service and their representatives. Care staff we spoke with were aware of the needs of people and the care to be provided. The care provided was closely monitored by the managers and senior staff of the agency.

The agency had an appropriate recruitment procedure and policy. There was evidence that staff had been carefully recruited. The recruitment records contained references, criminal records disclosures, evidence of identity and other essential documentation.

The agency had a policy and procedure for safeguarding adults. Care staff could provide examples of what constituted abuse and knew how to respond to allegations or incidents of abuse.

There were arrangements for quality assurance. Satisfaction surveys, monitoring visits and spot checks had been carried out by the manager. This was confirmed by people who used the service and staff we spoke with. We were provided with a record of compliments received.

We spoke with seven people who use the service and two relatives by phone. They informed us that people had been treated with respect and dignity. Their views can be summarised by the following comment, ”I am satisfied with the care provided. My carers are respectful and they do a good job.”

We spoke with eight staff. They informed us that they had enough travel time and were able to attend to the needs of people. The operations manager and registered manager informed us that the care of people was carefully planned to ensure that people receive care as agreed.

We examined four care records of people. These contained essential information. The care provided had been assessed and care plans were signed by people or their representatives. Risk assessments were in place. People said they had been consulted regarding the care provided and their choices had been responded to. People who use the service indicated that care staff were reliable and competent.

There were arrangements for staff support and we saw evidence in staff files of recent supervision and spot checks on staff to ensure that they were competent.

Effective arrangements for quality assurance were in place. Monitoring visits to people and reviews of their care had been carried out by senior staff. There was documented evidence that complaints had been promptly responded to.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used telephone interviews and home visits to people who use the service and to their main carers (a relative or friends) to gain views about the service. We gained the direct views of 10 people who use services and eight relatives. We also visited three people in their homes.

Most people told us that care staff were respectful towards them. Care staff were variously described as ‘polite’, ‘helpful’, ‘kind’ and that 'they listen.’ Most people felt that staff were capable and knew what to do.

Some people told us that they were involved in decisions about their care and support, for example in how their care plan was drawn up. Most people told us that independence was encouraged by care staff, and that they felt safe with the care staff provided.

Half the people we spoke with told us of having experienced very late or missed calls. Typically, this involved the person or their relative contacting the agency when it was clear that care staff were running late, and rearrangements then being made for someone else to attend. One person explained, “A couple of times, I’ve had to phone the agency to ask if I was going to get a carer today.” They added that at weekends, a replacement was not always provided, which was “difficult for me.” This means that the planning and delivery of care did not always meet people’s individual needs.

Some people had experience of making comments and complaints to the agency. Three people felt that these, mainly around late and missed calls, were acknowledged but not did change practice. As one person said, “I’ve not actually complained, but when I said, “I’ve had nobody this morning” they just say sorry and that’s it.” In conjunction with other evidence, we found that the provider did not have an effective system to identify, assess and manage risks to the health, safety and welfare of people using the service and others, with regard to people’s complaints and comments made.

We were supported by an expert-by-experience during the inspection process. An expert-by-experience has personal experience of using or caring for someone who uses a health, mental health and/or social care service. They sent us a report of their calls to a sample of people who use services, which we have used as part of our evidence. This report includes some direct references to the expert-by-experience’s findings. References to ‘We’ in the report can also include evidence from the expert-by-experience.

People were very positive about how staff treated them. Comments included, “They treat me as an equal rather than talking down to me” and “Staff are very helpful and know what to do.” People felt safe with staff, and felt that their care needs were met.

People were generally happy that there was always someone turning up for their expected calls, although some people felt that carers could be more punctual. Comments included, “They always come. Have never let me down once.” and “No missed calls as I always call them, but they are often late.

We asked people how well the service kept them informed. A slight majority of people felt that improvements could be made here. Comments included, “The office never tell you if there’s a change of carer or if none are available.” Some people were satisfied though.

Whilst the out-of-office-hours service was generally felt to be responsive, calling the office during working hours was difficult for some people. The expert-by-experience was told for instance of the frustration of often having to leave a message which did not always result in a return call.

The majority of people told us that they had not needed to complain. Some of those that had were satisfied with responses. Others explained that complaints were acknowledged but nothing changed.

In summary, the majority of people were happy with the services provided. Some people felt improvements could be made in certain areas, particularly in terms of being kept informed and contacting the office effectively. But comments such as “They’re very good. There’s no problems.” represented the majority viewpoint.