This inspection took place on the 02 and 05 May 2017 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 in. Best Value Care Limited is a domiciliary care service that provides care and support for people living in the London Borough of Greenwich and the surrounding areas. At the time of this inspection 90 people were using the service.

At our last inspection of the service on the 23 and 24 March 2016 we found a breach of legal requirements because the provider had not always obtained appropriate employment references for staff during the recruitment process. At this inspection we found that the provider had obtained appropriate employment references before staff started working at the service.

The service had 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 and associated Regulations about how the service is run.

There were appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. There were procedures in place to support people where risks to their health and welfare had been identified. People’s medicines were managed appropriately and people received their medicines as prescribed by healthcare professionals. People could access health care professionals when they needed them.

Staff had completed an induction when they started work and they had received training relevant to the needs of people using the service. They were supported in their roles through regular supervision and an annual appraisal. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff were aware of the importance of seeking consent from people when offering them support. Where people required support with cooking meals this was recorded in their care plans.

People and their relatives, where appropriate, were supported in making decisions about their care and support needs. Care plans were in place that provided information for staff on how to support people to meet their needs. People told us staff were kind and caring and their privacy and dignity was respected. There was a matching process in place that ensured people were supported by staff that had the experience and skills to meet their needs. People were aware of the complaints procedure and said they were confident their complaints would be acted upon. People using the service and their relatives were provided with appropriate information about the service.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through satisfaction surveys and telephone monitoring calls. They carried out unannounced spot checks to make sure people were being supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the registered manager and office staff. There was an out of hours on call system in operation that ensured management support and advice was always available for staff when they needed it.

This inspection took place on the 23 and 24 March 2016 and was announced. Best Value Care Limited domiciliary care agency was registered with the Care Quality Commission on 26 October 2011. At the last inspection in 2013, the service was meeting the legal requirements at that time.

Best Value Care Limited is a domiciliary care agency that provides care and support for people living independently in the London Borough of Greenwich and the surrounding areas. At the time of this inspection 85 people were using the service.

The service had 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 and associated Regulations about how the service is run.

At this inspection we found a breach of regulations in staff recruitment, relating to concerns around employee references. You can see the action we have asked the provider to take in respect of this breach at the back of the report.

We found the service had appropriate safeguarding adults procedures in place and that staff had a clear understanding of these procedures. People using the service said they felt safe and that staff treated them with kindness and understanding. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

People had access to health care professionals when they needed them and were supported, where required, to take their medicines as prescribed by health care professionals. Staff had completed training specific to meet the needs of people using the service, and they received regular supervision. The manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. People’s care files included assessments relating to their dietary requirements and other essential support needs.

Assessments were undertaken to identify people’s support needs before they started using the service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

The registered manager used a variety of methods to assess and monitor the quality of the service although management oversight of the service required improvement. These included annual satisfaction surveys, spot checks and care reviews. We found people were satisfied with the service they were receiving. The registered manager and staff were clear about their roles and responsibilities and were committed to providing a good standard of care and support to people they were supporting.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe and they did not have any concerns with care staff coming into their homes. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. People said that their care plans were up to date and reflected their current needs.

We found that people’s relatives were involved in their care and supported them with their care planning and delivery. One person told us that their relative, in collaboration with social services and the care agency, arranged their care for them. We also found that other health professionals such as general practitioners (GP) and community nurses were involved in people’s care.

Is the service caring?

All 12 people and their relatives we spoke with told us the staff that supported them were “caring”, “always on time”, “reliable”, “respectful” and “friendly.” One person commented “my carer is very intelligent we have discussions on several topics when she is around, which I very much enjoy.” Three other people we spoke with told us they looked forward to their carer’s visit and two people said they felt their carer was part of their family.

When speaking with staff it was clear that they genuinely cared for the people they supported.

People using the service and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service responsive?

People using the service told us they knew how to make a complaint if they were unhappy. Three people we spoke with told us they had made a complaint in the past and were satisfied with the outcome. We looked at some complaints made in 2013-14 and we saw that the investigations had been completed in line with the provider’s complaints policy. Most people we spoke with told us they had not made any complaints in the past; however, they were confident that they would be investigated and action taken as necessary.

The service worked well with other agencies and services to make sure people received care as required.

Is the service well-led?

We found there were effective systems in place to regularly assess and monitor the quality of service that people received.

Care staff we spoke with told us that office staff were very effective and respond to their emergency calls promptly and provided the required support they needed at the time. Staff had a good understanding of the ethos of the agency and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

At our inspection at Bestvalue Home Care Services UK Limited on 16 December 2013, we followed up a compliance action we had taken following our inspection on 04 and 05 April 2013. We found that the provider had made minimal improvements to records management. We found that one person received care and support that had not been risk assessed or planned for. Another person’s care records were not up to date and fit for purpose. Records could not always be located promptly when required. We found that staff were not always supported to deliver care and treatment safely and to an appropriate standard. For example, staff supervision and training was not always carried out in line with the provider’s policy.

At part of our scheduled inspection of Bestvalue Home Care Services UK Limited on 07 November 2012, we followed up outstanding issues from our inspection on 25 November 2011 including whether people's care assessments covered allergies and whether medical information had been recorded; if the agency had implemented improvements as a result of checks it had done, and if improvements had been made to its record keeping. We also checked how well staff were supported and how the agency had responded to safeguarding incidents.

Overall, people who used the service told us they were very happy with the care they received. One person told us "it's a life-line" and they were "very grateful for the care". People told us they thought their carers were "excellent" and all had a consistent carer. Most people told us they were happy with the cover the agency provided when their usual carer was away. Most people told us they knew about their care plan and they were involved in regular care reviews.

We found the agency carried out care assessments of people and risk assessments, however this sometimes did not take place until after the agency had begun providing a service. We found the provider had followed safeguarding procedures appropriately and provided adequate support and training to its staff. The provider had quality assurance systems in place but it did not always implement changes where issues had been identified. People's care records were stored and located appropriately.

People using the service and family members we spoke to were generally complimentary and positive about the care staff; there was continuity of care, and people had usually been informed of any changes. People said they got on “very well” with their carers and “couldn’t fault” the service they received; carers knew what they wanted and how they wanted it done, were flexible and had time for a chat. People knew how to get in touch with carers directly or with the office if they had any questions or issues; knew how to complain or raise issues, felt that any issues were addressed and felt safe using the service.

Family members told us they were happy with and reassured by the quality of the service and carers.

The results of the agency’s 2011 client satisfaction and feedback survey showed that the majority of respondents felt that they were treated with respect and that their dignity was preserved.

However, a few survey responses indicated that some people did not feel consulted about their care or that they could discuss personal matters with care staff; some also said that language was sometimes a barrier to communication.

Four people and their relatives we spoke with were complimentary about the service. People told us that care was “good” and staff arrived on time and were reliable even in bad whether. One person told us that the care provided was consistent and that they had the same carers for four years. Another person told us that “the care is lovely and staff are very nice people” and that “without them I would be lost”. People told us that they were involved in the care planning and knew how to make a complaint if they were unhappy. One person told us that the agency responded well when they raised a concern about their care worker.

We found that the provider had updated information on people’s allergies and medical histories, staff were aware of their responsibilities to report concerns of abuse and the provider had systems in place to learn from incidents to make improvements to the service provided. We found that the provider had notified CCQ of relevant incidents. However, we found shortfalls with the management of records including staff not being able to locate records promptly when required.