We carried out an inspection of ANA Islington on 8 August 2018. This was an announced inspection. We gave the provider 48 hours' notice because we needed to ensure someone would be available to speak with us. We returned on 9 August to complete the inspection.

ANA service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to adults of all ages that required support and care due to deteriorating health. At the time of our inspection there were 26 people who received personal care from the agency.

The service had a new registered manager in place. 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 previous registered manager had left in January 2018 and the new manager had registered with the Commission in June 2018. The registered manager was supported by the provider, the general director, members of the office team and the care staff. They had appropriate training and experience to manage the regulated activity.

At our pervious inspection on 04 July 2017, we found that the provider's recruitment policy did not include processes if a criminal record check for potential employees came back as positive. At this inspection we found that this had been addressed.

At our previous inspection we found that the agency had not displayed the performance ratings as required by the law. At this inspection we saw that this matter had been addressed and the most current performance rating had been displayed.

At this inspection we found that the agency had not always managed people medicines as they should and there was a risk that people would receive their medicines not as intended by a prescriber. Issues related to medicines management included insufficient practice in transcribing medicines onto people’s Medicines Administration Chats (MARs), the lack of individual PRN (when required) medicines protocols and changes to people’s medicines not being clearly recorded.

The service had not fully assessed all risk to health and wellbeing of people who used the service. Risks related to people’s behaviour that could challenge the service had not always been evaluated. Consequently, staff had not been given sufficient guidelines of how to provide care that was safe to staff and people who used the service. We saw other examples of risk assessment relating to other aspects of care, such us pressure ulcer prevention, manual handling and risk a of falls. We saw that these were sufficient.

We found that the agency had carried out regular quality assurance checks. However, we saw that these checks were not effective in identifying issues highlighted by us during the inspection. Therefore, they needed to improve.

The agency worked within the principles of the Mental Capacity Act 2005. Staff had a good understanding about their role in supporting people lacking capacity. However, more information was required in people’s files about individual people’s abilities to make their own decisions.

There were systems in place to ensure people were protected from avoidable harm. These included appropriate recruitment procedures, adhering to safeguarding procedures and ensuring sufficient staffing levels so all people had been visited and supported as agreed. Staff at the agency also were aware of the provider’s reporting of accidents and incidents procedures and were following appropriate infection control measures.

The agency had assessed people’s care needs and preferences before they started receiving care. This information was then used to formulate people’s individual plans of care.

Newly employed staff had received training and an induction in

We carried out an inspection of ANA Islington on 4 July 2017. This was an announced inspection where we gave the provider 48 hours’ notice because we needed to ensure someone would be available to speak with us.

At our last inspection on 1 June 2016, the service was in breach of Regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found risk assessments had not been updated to reflect people’s current circumstances and did not take into account people’s health needs. Capacity assessments to determine people’s ability to make certain decisions were not being completed in line with the Mental Capacity Act 2005 (MCA). During this inspection we found improvements had been made and the service was compliant with the breaches.

ANA Islington is a domiciliary care service providing personal care to people in their own home. At the time of our inspection there were 23 people who received personal care from the agency. People that received a service were mainly older people that required support and care due to deteriorating health.

The service had a registered manager in place. 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 provider had not displayed the rating of the last CQC inspection carried out on 1 June 2016 at their site and website. This is a requirement under Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. After the inspection, the registered manager confirmed that the ratings had been displayed on the website and at their site.

Pre-recruitment checks had been made to ensure that new staff were suitable to support people in their own homes and maintain people's safety. However, the provider’s recruitment policy did not include processes if a criminal record check came back as positive.

People were protected from abuse and avoidable harm. Staff knew how to report alleged abuse and were able to describe the different types of abuse.

Risks had been identified and assessed that provided information on how to mitigate risks to keep people safe.

Medicines were managed safely. Staff had been trained in medicines and people and relatives had no concerns with medicine management.

Mental Capacity Act 2005 (MCA) assessments had been carried out using the MCA principles. Staff had received training in MCA and were able to tell us the principles of the MCA.

Staff had completed an induction and essential training to perform their roles effectively.

There were systems in place for quality assurance. Spot checks were carried out, which observing staff performance and outcomes were communicated to staff.

There were systems in place for quality monitoring. Feedback had been sought from people and their relative. Results were analysed to make improvements to the service.

Systems were in place to monitor staff attendance.

People told us they were encouraged to be independent and their privacy and dignity was respected. Staff knew how to protect people’s privacy and dignity.

Care plans listed people’s support needs and were person centred. People's care needs had been reviewed and the care plans were updated to reflect any changes in people's needs.

Complaints were recorded and investigated with a response sent to the complainant.

Staff told us that they were supported in their role, the service was well-led and there was an open and transparent culture where they could raise concerns with management and felt this would be addressed promptly

We carried out an inspection of ANA Islington on 1 June 2016. This was an announced inspection where we gave the provider 48 hours’ notice because we needed to ensure someone would be available to speak with us.

ANA Islington is a domiciliary care service providing personal care to people in their own home. At the time of our inspection there were 23 people who received personal care from the agency. This was the first inspection of the service.

The service had one registered manager in place. 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 protected from abuse and avoidable harm. Staff knew how to report alleged abuse and were able to describe the different types of abuse. Two staff were not able to tell us they could ‘Whistleblow’ to external organisations such as the CQC and local authority. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.

Some risk assessments were not updated to reflect people’s current needs and did not take into consideration people’s health needs. When a risk was identified it did not provide clear guidance to staff on the actions they needed to take to mitigate risks in protecting people from risks with choking and falls.

Staff provided support with medicines. Staff were trained in the safe management of medicines. However, staff had not carried out competency assessments to check their understanding of medicines and how to administer them safely.

People’s capacity was being assessed and some people were determined to have lacked capacity. However, the assessments did not specify what areas people did not have capacity and we did not find evidence of best interests meeting being held to make a decision on the person’s behalf. Assessments were not being completed in accordance to the Mental Capacity Act 2005 (MCA). Staff had not been trained in MCA and three staff were unable to tell us the principles of the MCA.

Quality assurance were not being carried out on people’s and staff record to ensure high quality care was being delivered at all time. Questionnaires were completed by people about the service and people's responses were positive. Spot checks were carried out to provide feedback to staff on areas that needed improving.

The number of staff were sufficient to meet people's assessed needs. Staff were employed according to robust recruitment procedures. Pre-recruitment checks had been made to ensure that new staff were suitable to support people in their own homes and maintain people's safety.

People had choices during mealtimes and staff assisted with meals in accordance to people’s preferences.

People were encouraged to be independent and their privacy and dignity was maintained.

Staff knew the people they were supporting, their needs and expectations, and provided a personalised service. Care plans were in place detailing how people wished to be supported. People were involved in making decisions about their care.

The registered manager promoted an open culture where staff, relatives and people using the service could raise concerns.

People knew how to complain and felt their complaints would be investigated and responded to and staff were able to tell us how to handle complaints. Complaints were being handled appropriately.

We identified breaches of regulations relating to consent and risk management. You can see what action we have asked the provider to take at the back of the full version of this report.