This comprehensive inspection took place on 28 December 2018 and 11 January 2019 and was announced. The Borough of Lewisham is also known as First Choice Social Care & Housing Ltd.

The service is registered to provide personal care for people living in their own homes. It provides a service to older adults and younger disabled adults. At the time of the inspection there were 43 people using the service.

At the previous inspection on 14 April 2016, we rated the service ‘good’. At this inspection we found the service did not meet the standards we inspected. We found that medicines were not always managed safely, records were not always kept up to date, recruitment of staff was not always safe, staff did not always have opportunities to meet with colleagues and people did not always receive their assessed care.

The service has a registered manager. The registered manager was away on holiday at the time of this inspection. The registered manager did provide us with information and sent us documents to support this inspection, remotely. An operations manager was providing interim leadership and management of the service in the registered manager’s absence. 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.

There was a recruitment process in place, but some pre-employment checks were not returned before staff worked with people.

There were systems in place for the management of medicines that staff were familiar with and followed. However, medicine administration records were not always completed as required and therefore we could not be assured that people always received their medicines as prescribed.

People’s care records and staff recruitment files were not always accurate or up to date.

Staff told us that although they felt supported by the registered manager they did not have many opportunities to meet with colleagues.

Staff did not always provide care and support for people in line with their assessed care requirements.

Staff followed the provider’s safeguarding processes to protect people from harm and abuse. Appropriate actions were taken by staff to report and manage allegations of abuse.

Potential risks to people were identified, and a plan was put in place to manage and mitigate them.

There were established systems in place for staff training, supervision and appraisal. There was enough staff deployed to support people and meet their assessed needs.

People had enough food and drinks available. Staff prepared meals they enjoyed which met their nutritional needs and preferences.

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.

People gave staff their consent to care and support and to make decisions about how they wanted their care carried out.

People received appropriate care and treatment from health care professionals when their needs changed.

Staff were described by people as kind, caring and compassionate. People said that staff protected their privacy while supporting them. People attended activities and social events as they chose.

Each person had an assessment of their needs and had a care plan that detailed the individual support they needed.

People could make a complaint about the care and support they received through the service’s complaints process.

At the time of the inspection, no one required end of life care. Staff had training in end of life care to give them the knowledge and skills to care for people when this support was required.

There were systems in place for monitoring and reviewing the quality of care. People were supported to provide

This inspection took place on 14 April 2016 and was announced. Borough of Lewisham is also known as First Choice Social Care & Housing Ltd. This service is registered to provide personal care and support for people living in their own homes. At the time of the inspection there were 36 people using the service.

The service has 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.

The last time we inspected this service in September 2014, we found a number of breaches in the 2010 regulations. This included care and welfare of people who use services and in records. People did not have their care needs reviewed regularly to ensure care received was in line with their current needs. Some people did not have risks to their health and well-being identified or a plan in place to manage them. People’s care records were either incomplete or had missing information regarding their care needs. We asked the provider to send us a plan about how they will improve the service to meet the regulations. The provider sent us the improvement plan as requested.

During this inspection, we saw evidence of improvements. We found people’s care records were reviewed regularly and risk assessments identified risks to people and plans were in place to manage them. Records we viewed were updated and accurate.

Staff knew how to protect people they cared for from harm and abuse. The registered provider had safeguarding policy and procedures in place to guide staff to raise and manage an allegation of abuse. Risks to people’s health and well-being were regularly assessed and managed by staff. Staff managed people’s medicines safely and as prescribed.

People received support from sufficient numbers of staff to ensure they received their care safely. The registered provider had a robust recruitment practice in place.

Staff obtained skills through training to enable them to care for people effectively. Staff had regular supervision and appraisals that provided them with the opportunity to discuss their training and professional practice needs.

Staff received training and had an awareness of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA supports people who lack the ability to make specific decisions for themselves. Staff were aware of how to care and support people that protected their rights within the principals of MCA. People consented to care and were supported to make choices and decisions about the way they wanted to receive care.

Staff treated people with kindness and compassion while their dignity and privacy was respected. People’s care and support needs were managed by staff who knew them and their preferences well. People’s health care needs were managed by staff effectively. Staff sought advice and support from appropriate healthcare services when needed. People had access to meals which met their individual preferences and nutritional needs. Staff prepared meals which people requested and enjoyed.

People had assessments of their needs and they contributed to and were able to develop care plans to meet those needs. People were able to make choices in the care they received. The registered provider had a process in place for people to make a complaint.

There were systems in place for the registered provider to monitor, review, and make improvements to the quality of care provided. People and their relatives gave feedback to the registered manager and records showed people rated their care as good or excellent. The registered manager was aware of their responsibilities as registered manager with the Care Quality Commission.

Two inspectors carried out this visit. They considered all the evidence gathered under the outcomes inspected and used the information to answer the five questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People who used the service were protected from the risk of abuse. Staff had received training in safeguarding adults. The registered manager could describe the signs of abuse, the strategies in place for preventing abuse, and what steps they took to escalate concerns. They co-operated with the relevant local authorities to investigate any allegations of abuse.

Appropriate checks were undertaken before new staff began work. For example, the service carried out Disclosure and Barring Service (DBS) checks and followed up on people's references.

Care was not always planned and delivered in a way that ensured people’s safety and welfare. Some care records were incomplete, records were missing, and risk assessments had not always been carried out. Not all of the care records had received a timely review to ensure care was being provided in line with people's current needs.

Is the service effective?

Before people received any care they were asked for their consent and the provider acted in accordance with their wishes. The provider acted in accordance with legal requirements where people did not have the capacity to consent.

Is the service caring?

Some of the people using the service and their relatives were satisfied with the care they received. One relative we spoke with told us, "The care workers are lovely. They have a chat. I'm comfortable leaving [my relative] with them."

However, some people were not satisfied with the quality of the care. They told us staff arrived late, did not stay for the correct length of time, or did not complete tasks in accordance with their care needs. One relative said, "Staff are not thorough. They just do the absolute minimum." One person told us, "They don't do their job properly and are regularly late."

Is the service responsive?

There was a complaints policy in place. The details of this policy were included in the guide given to people when they started to use the service. The provider had recorded three complaints since the last inspection. In all cases the registered manager had carried out an investigation and made changes to the service, as required.

Notes of incidents were kept in each individual's communication book. The registered manager told us they reviewed these and made appropriate changes in response.

Is the service well led?

The provider had systems to assess and monitor the quality of service that people received. This included obtaining feedback from people using the service in an annual survey and engaging staff in supervision and meetings. However, the majority of the people we spoke with told us they had little or no contact with the management staff and were not asked to review or otherwise give feedback about their care.

Borough of Lewisham had a training programme for staff. Staff told us "There is training available throughout the year which I always do”. Staff had supervision every three months, appraisal on an annual basis and informal meetings. We spoke with one member of staff who told us, "I have worked here for many years and enjoy my job”. The provider had appropriate arrangements in place for supervision, training and appraisal of staff.

People who used the service said they felt involved in the care planning and were aware of their care choices available. People who use the service and their representatives were satisfied with the care delivery of the service and they felt their changing needs were managed by staff. The provider had identified individual training needs offered training opportunities for staff. The provider had completed regular two monthly supervision with staff and records were kept and updated. The provider does not have in place a system for appraisals. The provider received feedback from people who use the service and their relatives from yearly questionnaires. The provided completed telephone spot checks to ensure carers provided quality care.

People we spoke with who used the service said they had been asked by the agency about the support they needed. They said they knew there was a care plan for them, and that they were happy that we examined it as part of the inspection. They said they were able to ask staff when they needed help or advice and staff listened to them. They said the staff would do extra jobs if they asked them to.

People who used the service told us the same staff usually supported them and said that they knew their care needs well. They said the staff were respectful and friendly, and they felt they were in safe hands when being supported. Only two people we spoke to who received a service said they knew the manager, or had personal regular contact with anyone other than the staff they received support from.

People who received support from the agency said they felt staff supported them in they way they wanted and were caring and helpful. All were aware of their care plan, and they told us a copy of which was in their home. However, most people said they could not recall being asked formally by the agency’s supervisors about any changes needed to their care plan in the past 12 months.