This inspection took place on 29 March 2017 and was announced. We told the provider two days

before our visit that we would be coming, as we wanted to make sure the office staff and registered manager would be available.

At our last inspection on 08, 09 and 12 February 2016 we found a breach in legal requirements in that people were not always asked to give their consent to care and treatment. When people lacked the capacity to make a decision, the service did not have a system in place to assess the level of capacity. The provider sent us an action plan telling us how they would address these issues and when they would complete the action needed to remedy these concerns. At this inspection we checked to see if these actions had been completed and found the that the provider had taken action to make sure that capacity assessments were carried out and people’s consent was gained before carrying out treatments.

Age UK – Bexley provides personal care to people in their own homes. At the time of our inspection the provider delivered care and support to approximately 326 people and employed two members of staff. The service supports older people some who are living with dementia. The care and support provided involved visits by staff to people’s homes where people’s feet were cared for by nail cutting and other non-invasive foot care procedures.

The service had a registered manager. 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.

People told us they felt safe and were happy with the care, treatment and support they received. The service had safeguarding adult's procedures that were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Risks to people using the service were assessed and risk assessments and care plans provided clear information and guidance for staff. People were protected from the risk of infection.There were systems in place to manage accidents and incidents. There were enough staff deployed to meet people’s needs and the provider conducted appropriate recruitment checks before staff started work. At the time of our inspection people using the service were not receiving any support with medication.

Staff had completed induction training when they started work and mandatory training for staff was up to date. Staff were supported by receiving regular supervisions and annual appraisals. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and acted according to this legislation and people’s consent was gained. People had access to health care professionals in order that they maintain good health.

People told us that staff were kind, caring and supported them in a manner which protected their privacy and dignity. People were provided with information about the service when they joined.

People were involved in their care planning. Care plans and risk assessments provided clear information for staff on how to support people using the service with their needs. Care plans were reviewed on a regular basis. People were aware of the service's complaints procedure and said they felt confident their complaints would be investigated and action taken if necessary.

There were effective processes in place to monitor the quality and safety of the service and the registered manager recognised the importance of regularly monitoring the quality of the service provided.

Regular staff meetings took place and people were provided with opportunities to provide feedback about the service. Staff and people and staff told us they thought the service was well run and that the registered manager was supportive.

This inspection took place on 8, 9 and 12 February 2016 and was announced. This was so we could be sure that management would be available in the office as this is a domiciliary care service. We last inspected this service in June 2013 where we found the provider was meeting all of the regulations that we assessed at that time.

Age UK – Bexley provides personal care to people in their own homes. At the time of our inspection the provider delivered care and support to approximately 300 people and employed five members of staff. The service supports older people some who are living with dementia. The care and support provided involved short visits by staff where people’s feet were cared for by nail cutting and other non-invasive foot care procedures.

The service had a registered manager. 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.

People were happy with the care and support they received and they spoke highly of the staff who assisted them. They said their needs were met safely and they felt involved and informed about their care. Communication between staff within the service was good.

The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the registered manager, or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as where a person collapsed) to protect people from harm.

Although the registered manager and staff had received training about the Mental Capacity Act 2005, when people lacked the capacity to make decisions about their care, the service did not have robust systems in place to ensure that the care that was provided was in people’s best interests. Sometimes there was a failure to seek the views of next of kin and health care professionals in these circumstances.

People’s needs were assessed, documented and regularly reviewed and appropriate care records were maintained and reviewed

the service’s recruitment processes were thorough and included checks to ensure that staff employed were of good character, appropriately skilled and physically and mentally fit. Staffing levels were determined by people’s needs and the number of people using the service. We had no concerns about staffing numbers.

Staff told us and records confirmed that training in a number of key areas such as safeguarding and dementia awareness and care was up to date. Staff told us they had the skills they needed to meet the varying care needs of the people using the service. Refresher training was provided at regular intervals. Supervisions and appraisals took place. Staff told us they felt supported by management and could approach them at any time. Staff meetings took place monthly and provided an avenue through which staff could feedback their views.

People reported that staff were very caring and supported them in a manner which promoted and protected their privacy and dignity. People said they enjoyed kind and positive relationships with staff and they had continuity of care from the same members of the care staff team whenever possible, which they appreciated.

People were informed about their right to complain and about how to do so, if they wished. Records showed that historic complaints were handled appropriately and records were kept of each individual complaint received and any associated paperwork or correspondence with the complainant. People’s views were gathered through annual telephone surveys.

Care records demonstrated that the provider was responsive when people’s needs cha

People we spoke with told us they were very happy with the service they received. One person told us the foot care assistant was "friendly, polite and professional" and "always on time". Another person told us that visits were arranged at a time that was convenient to them and that the service was "very good".

We found that people's foot care needs were assessed and treatment provided in such a way as to ensure their safety and welfare. The provider had made appropriate arrangements to ensure that people were protected from the risk of abuse and had undertaken checks to ensure the foot care assistant was suitable for their role prior to their employment. Most records were accurate and fit for purpose, were stored securely and could be located promptly when requested.

We spoke with some people who used the service and each were complimentary about the service provided to them. One person described the service as a “hugely useful service”. People told us the foot care assistant turned up on time and ensured treatments were carried out with dignity. People told us they were happy with the information provided to them about the service which included how to raise any concerns or complaints.

We found people were provided with relevant information prior to them receiving a service and people's privacy and dignity were maintained. People's care needs were assessed and people told us their care was delivered in line with their individual care plan. The provider had policies and procedures in place for safeguarding vulnerable adults and these were available to staff. Staff knew how to report any concerns including making referrals to the local authority. Training had not been delivered in line with the provider's policy, however staff were adequately experienced and supported. People's records were adequate and fit for purpose however, some information relevant to people's needs had not been completed and some relevant records were not available at the provider's office. Despite this people told us they received the care that was planned for them.