This announced inspection took place on 10 July 2018. At the last inspection in October 2017, the service was rated as Inadequate. 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 service. We did receive a comprehensive action plan within the time allocated to them. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We asked the provider to take action to make improvements in staff training, medicine management, risks to people, care planning, about how specific decisions of people who may lack capacity had been made and how safeguarding processes were managed. During this visit, we found some of the actions had been completed. However, further improvements were needed regarding how risks to people were assessed and information about how to communicate with people.

Affinia Healthcare is a domiciliary care agency that provides personal care to people living in their own homes and some living in supported living in the London Borough of Havering. At the time of our service, there were 13 people using the service, three of whom were receiving personal care in a supported living set up.

There was no registered manager in place as the registered provider was in day to day charge of 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.

We found that the risks associated with people’s support were not always fully assessed, which could have an impact on the safety of people.

Care plans did not mention people’s ability to communicate and how staff should communicate with people. Records showed that some people required information through a communication passport and in an easy read format. This was not available at our inspection.

The service had an efficient system to manage accidents and incidents and learn from them so they were less likely to happen again. The provider had safeguarding policies and procedures in place. Staff had received training about how to safeguard people from abuse.

Systems were in place to make sure people received their medicines safely and for the monitoring and prevention of infection.

The provider employed enough staff to meet the needs of people. There was a recruitment system in place that helped the provider make safer recruitment decisions when employing new staff.

Staff had the knowledge and skills to care for people effectively and responded promptly to their needs. They had a structured induction at the beginning of their employment and received regular supervision and an annual appraisal.

Staff demonstrated a good understanding of the requirements of the Mental Capacity Act 2005. The consent of people was sought appropriately. Referrals were made to health care professionals for additional support or guidance if people’s health needs changed.

An initial assessment of people was carried out before they started using the service. People or their representatives had been involved in writing their care plans. People received care and support in accordance with their preferences, interests and diverse needs.

Staff had a good knowledge and understanding of people's needs. People who required support with meals were provided with food and drinks which met their nutritional needs. People’s privacy and dignity were respected.

People were

The announced inspection took place on 24 and 31 October 2017. At the last inspection on 21 October 2016 the services met the regulations we inspected.

This inspection was completed on 24 October and 31 October 2017. Affinia Healthcare is a domiciliary care agency that provides personal care to people living in their own homes and some living in supported living in the London borough of Havering. At the time of our service there were 55 people using the service nine of which were receiving personal care in a supported living set up.

At the time of our visit there was a registered manager in place. 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

At our last inspection in October 2016 the service met the regulations we inspected. However at this inspection we found several breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

People we spoke with told us they felt safe and that they were treated with dignity and respect. However we found risks were not always effectively assessed reviewed or managed in order to protect people from harm. Safeguarding processes in place were not always followed. This resulted in delayed safeguarding investigations and demonstrated staff knowledge gaps as to what and where to report different types of abuse. The updated electronic policy did not have any local authority contact details.

Medicines were not always administered as prescribed. We found several instances where medicine administration records had not been completed in order to evidence that people had received their medicines as prescribed. We also saw medicine record transcribing errors which resulted in people receiving less that their prescribed medicines.

People were not always supported by staff that had undergone the necessary training to enable them to deliver support effectively. There were shortfalls in the systems in place to monitor and ensure staff attended all relevant training and were kept up to date with practice.

There were inadequate care planning systems in place which did not ensure people’s needs were accurately documented.

Staff demonstrated limited understanding of the Mental Capacity Act 2005 beyond considering consent before care was provided. Capacity assessments were not always completed properly and did not always reflect how specific decisions of people who may lack capacity had been made.

This resulted in decisions being made by people who had no legal delegation to do so.

We found several failings in the current governance systems in place which had failed to identify and address issues we found at our inspection. These included breaches of information governance as staff could still access the service’s records whilst no longer actively requiring access to people's personal information. People’s records were not reviewed in a timely manner and were not completed to reflect a complete an accurate account of care delivered. The provider had failed to ensure an open and transparent culture.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate f