This inspection took place on 6 April 2017 and was announced.

At our previous inspection on 10 and 11 February 2016 a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to notifications.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Better Healthcare Services (London)’ on our website at www.cqc.org.uk’

There was a branch manager at the service who was in the process of applying to be a registered manager. The registered manager at the previous inspection was no longer working for the provider. 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.

Better Healthcare Services (London) is a domiciliary care agency which provides live in care for people in their own homes. This service is managed from the head office based in London, but also receives support from its regional offices located throughout the United Kingdom. At the time of our inspection the service was providing personal care and support to 15 people.

At our previous inspection we found that the provider did not always notify the CQC of notifiable incidents.

At this inspection, we found that improvements had been made.

The provider was aware of the type of incidents that they were required to notify the Care Quality Commission (CQC) of and had reviewed their notifications procedure. Records of the notifications were kept with additional information added as investigations were carried out.

This inspection took place on 10 and 11 February 2016 and was announced. The provider was given 24 hours’ notice because we wanted to be sure there would be someone at the office when we called. This was their first inspection since registration with the Care Quality Commission.

Better Healthcare Services (London) is a domiciliary care agency which provides live in care for people in their own homes. This service is managed from the head office based in London, but also receives support from its regional offices located throughout the United Kingdom. The service received support from regional offices in Brighton, Bedford, Cambridge, Colchester and Norwich. At the time of our visit the service was providing support to 15 people.

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 (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 about how the service is run.

People and their relatives told us they felt safe using the service and care workers understood how to protect people from abuse. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. Staff also felt confident that any concerns would be investigated and dealt with.

People’s risks were managed and care plans contained appropriate risk assessments which were updated regularly when people’s needs changed. The service had a robust recruitment process and staff were subject to the necessary checks to ensure they were suitable to work with people using the service. People were given the same care worker for the duration of their live in shift to ensure they received consistent levels of care. The provider could also rely on care workers from their regional offices to cover shifts at short notice if required.

People who required support with their medicines received them safely and all staff had completed training in the safe handling and administration of medicines. When recording errors were identified they were addressed appropriately.

Care workers received an induction training programme to support them in meeting people’s needs effectively and received regular supervision from management. They told us they felt supported and were happy with the supervision they received.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and issues relating to personal choice. Care workers respected people’s decisions and gained people’s consent before they provided personal care.

Care workers were aware of people’s dietary needs and food preferences. Care workers told us they notified the registered manager or a care coordinator from a regional office if they had any concerns about people’s health and we saw evidence of this in the weekly reports. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, speech and language therapists and social services.

People and their relatives told us care workers were compassionate and caring and knew how to provide the care and support they required. Care workers we spoke with knew the people they supported and their life histories due to the amount of time they were able to spend with them.

Staff treated people in a way that respected their privacy and dignity and promoted their independence.

People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. Care was personalised to meet people’s individual needs and was reviewed if there were any significant changes, with health and social care professionals being contacted to support the changes in care received. However t