This inspection took place on 18 and 20 June 2018 and was announced. Bexley is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. At the time of this inspection 40 people were using the service.

There was 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 2008 and associated Regulations about how the service is run.

At our comprehensive inspection on 20 April 2017, we found breaches of legal requirements as risks to people had not always been assessed, identified and did not have appropriate management plans in place. People did not always have care plans in place to ensure the service was meeting all their needs. People’s nutritional needs and preferences were not always documented. Staff recruitment records did not always contain fully completed application forms, references or up to date criminal records checks. We asked the provider to take action and they sent us an action plan which they would complete by 25 August 2017.

At this inspection, we found that the provider had made some improvements however, we found further breaches of legal requirements in relation to safe care and treatment and good governance. We found that people’s medicines were not always managed safely, the systems in place to monitor and assess the quality of the service were not always effective and records were not always accurate, complete, and presented promptly when required.

The provider had a recruitment procedure in place and had updated their application form to include previous employment history. People were protected from available harm because risk had been identified, assessed and had management plans in place. However, information was not always consistent and easy to locate in their care files.

People were protected from the risk of abuse because the provider had systems such as policies and procedures in place and staff had been trained to ensure they knew their responsibility to safeguard people they supported. Staff knew of the provider’s whistleblowing procedure and told us they would use it if they needed to. People were protected from the risk of infection because staff followed the provider’s infection control protocols. Adequate numbers of staff were deployed for each visit to ensure people received safe care and support. Accidents and incidents were reported and recorded and learning was disseminated to drive service improvement.

Before people used the service, their needs were assessed to ensure they would be met by the provider. People were supported to eat and drink sufficient amounts for their health and well-being. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were supported with induction, training, supervision and appraisals to ensure they had the knowledge and skills to deliver a safe and efficient service. People were supported to access health care services where needed to maintain good health and well-being. The provider worked in partnership with health and social care professionals to provide joined-up care.

People were treated with kindness and compassion. People and their relatives were involved in making decisions regarding the care they or their loved ones received. People’s privacy and dignity was respected and their independence promoted. People were provided information about the service to ensure they knew the level of support to expect.

People received support from staff that met their needs and each person had a care plan in place with appropriate guidance to ensure their needs were met. People w

This inspection took place on 20 April 2017. This was the first inspection at the service. We gave the provider 48 hours’ notice that we would be visiting to ensure the registered manager would be at the service.

Bexley is a domiciliary care agency that provides personal care for people living in their own homes. At the time of this inspection 10 people were using the service.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because risks to people had not always been assessed or staff were not aware of how to manage identified risks safely. People did not always have care plans in place to ensure the service was meeting all of their needs. People’s nutritional needs and preferences were not always documented. Staff recruitment records did not always contain fully completed application forms, references or up to date criminal records checks. You can see the action we have asked the provider to take in respect of these breaches at the back of the full version of the report.

There were safeguarding adult's procedures in place which were robust and staff understood how to safeguard the people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. The service had systems in place to manage accidents and incidents whilst trying to reduce reoccurrence.

Medicine records showed that people were receiving their medicines as prescribed by health care professionals. There were enough staff on duty to meet people's needs and there was an out of hours on call system to offer support to staff if needed.

Records confirmed staff training was up to date. Staff received supervision and training appropriate to meet people’s needs and to enable them to carry out their roles effectively. There were processes in place to ensure staff new to the service were inducted into the service appropriately.

People’s consent was sought before care was provided. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and acted according to this legislation. At the time of inspection the registered manager told us people they supported had the capacity to make decisions for themselves. People had support to access health care appointments if needed.

People were treated with kindness and compassion and people's privacy and dignity was respected. People were provided with information about the service when they joined in the form of a 'service user guide' which included the service's complaints policy.

People and their relatives were involved in their care planning and staff respected their wishes and met their needs. Care plans were reviewed on a regular basis. Peoples' care files were kept both in people's home and in the office. People were supported to be independent where possible such as attending to some aspects of their own personal care.

People and their relatives knew about the home's complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

People told us they thought the service was generally well run and that the registered manager was supportive. There were systems in place to carry out staff spot checks to ensure consistency and quality was maintained whilst supporting people in the community. The registered manager was aware of their responsibilities as a registered manager in relation to notifying CQC about reportable incidents.

There were some processes in place to monitor the quality of the service provided, however these have not been operati