This comprehensive inspection took place on 12 December 2018 and was announced.

We gave the provider 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure someone would be available when we inspected.

The service was last inspected on 12 May 2016 when we rated the service good in all key questions and overall.

Westminster Homecare Limited (West London) 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 older adults including those with physical frailty or memory loss due to the progression of age whilst others were living with the experience of dementia or had mental health needs. At the time of our inspection, there were 172 people using the service. Most people using the service were receiving funding from their local authority, either Hounslow or Ealing, and a few people were funding their own care.

There was a registered manager in post at the time of our inspection. 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.

There was a policy and procedures for the management of people’s medicines and staff had received training in this. However, one person who used the service had not received their medicines as prescribed.

There were systems in place to monitor and assess the quality and effectiveness of the service, and the provider ensured that areas for improvement were identified and addressed. However, a medicines audit had failed to identify the issues we found during our inspection.

Compared to the number of calls completed, the number of missed calls was small, but in each case, these were investigated and recorded. The registered manager showed us evidence that a new system had recently been put in place to improve this and prevent further missed visits.

Feedback from people and their relatives was not always positive. Some people said they did not always feel listened to by office staff when they raised concerns. Others told us they were happy and had built a good rapport with the care workers.

There was a complaints procedure in place which the provider followed. All recorded complaints had been addressed appropriately and in line with the provider’s procedures.

The risks to people's wellbeing and safety had been assessed, and there were detailed plans in place for all the risks identified.

Incidents and accidents were recorded and appropriate action was taken. The provider ensured that lessons were learned when things went wrong and put action plans in place.

People and staff were protected from the risk of infection and cross contamination. Staff were issued with appropriate equipment and received training in infection control.

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

The registered manager raised safeguarding concerns to the local authority and worked with them to investigate these and take appropriate action.

People's needs were assessed by the provider prior to receiving a service and care and support plans were developed from the assessments. People had taken part in the planning of their care and received regular visits from the care coordinators or the field supervisor.

Most people we spoke with and their relatives said that they were happy with the level of care they were receiving from the service and found the care workers kind and respectful.

The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act (MCA) 2005 and we saw evidence that staff received training

This inspection took place on 17 May 2016 and was announced.

We gave the provider 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure someone would be available.

The service was last inspected on 1 November 2013 and at the time was found to be meeting the regulations we looked at.

Westminster Homecare Limited (West London) is a domiciliary care agency which provides personal care for people in their own homes. At the time of our inspection, there were 178 people using the service. Most people using the service were receiving funding from their local authority, either Hounslow or Ealing, and a few people were funding their own care.

People who received a service were all older people and included those with physical frailty or memory loss due to the progression of age whilst others were living with the experience of dementia or had mental health needs. The frequency of visits varied from one to four visits per day depending on people's individual needs.

There was a registered manager in post at the time of our inspection. 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 risks to people's wellbeing and safety had been assessed, and there were detailed plans in place for all the risks identified.

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

Feedback from people and their relatives was positive. Most people said they had regular care workers visiting which enabled them to build a rapport and get to know them.

People's needs were assessed by the local authority prior to receiving a service and support plans

were developed from the assessments. People had taken part in the planning of their care and received regular visits from the care coordinators or the field supervisor.

People we spoke with and their relatives said that they were happy with the level of care they were receiving from the service.

The registered manager was aware of their responsibilities in line with the requirements of the

Mental Capacity Act (MCA) 2005 and told us that the newer staff had received basic training in this during their induction. They told us they were planning more in-depth refresher training for all staff.

Records showed that people had consented to their care and support and had their capacity assessed prior to receiving a service from Westminster Homecare Limited (West London). The registered manager told us that all the people currently using the service had capacity.

There were systems in place to ensure that people received their medicines safely and the care workers had received training in the management of medicines.

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.

People's health and nutritional needs had been assessed, recorded and were being monitored.

These informed carers about how to support the person safely and in a dignified way.

Carers received an induction and shadowing period before delivering care and support to people.

They received the training and support they needed to care for people.

There was a complaints procedure in place 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, and the provider ensured that areas for improvement were identified a

We spoke with ten people using the service or their representatives, nine care workers and the agency’s registered manager and Operations Manager. We also spoke with the deputy manager who had recently been appointed to manage the branch and was applying to the Care Quality Commission to become the registered manager.

People told us they were generally happy with the care and support they received. Their comments included “they are very good, they always help with the things I need” and “the carer is excellent, I couldn’t ask for better.”

We looked at the care plans for 6 people using the service. We saw that the care plans detailed people’s needs and the care and support their care workers should provide. The plans were updated regularly and people were involved in reviewing the care they received.

The provider had policies and procedures for safeguarding people using the service. Care workers understood the procedures and were trained to identify possible abuse. The agency cooperated with other agencies to address any safeguarding concerns.

We looked at the personnel files for 6 care workers and saw that the provider had carried out appropriate checks before care workers started to work with people using the service.

There were procedures in place to monitor the quality of the services provided. People told us they were asked about their care and support and they felt they were listened to. People also told us they knew how to make a complaint and they were confident they would be listened to.

We spoke with five people using the service or their relatives and six members of staff to get their views about the quality of the service people received. We also received feedback from one Local Authority that commissions services from the Agency.

People said they were involved in the way their care and support was planned and were able to say how they wanted to be cared for and supported. They were also involved in the review of their care. They informed us that their care workers respected their privacy and dignity. They thought that care workers were well trained and knew how to care for them appropriately. People said they were informed when their care workers were late and alternative arrangements were made if their usual care worker could not visit them.

People reported that they had the necessary information to contact the office if they were not satisfied with their care or worried about their safety and were confident that their concerns would be taken seriously and addressed. Staff however did not always have all the necessary information to enable them to raise concerns if this was needed to safeguard people against the risk of abuse and poor care.

The provider carried out a satisfaction survey, spot checks and telephone surveys of people or their relatives to get feedback about the quality of services provided. The provider however has not ensured that a yearly audit and quarterly audits were completed according to it’s quality assurance procedure.