This inspection took place on 21 November 2017. We gave the provider two days’ notice of the inspection as we needed to make sure the manager and staff would be available. At our last comprehensive inspection of the service on 10 and 11 October 2016 we made recommendations to the provider on the safe management and administration of medicines. This was because medicine records were not always completed appropriately by staff in line with best practice. There were no systems in place to seek and assess people’s consent and capacity and to act in accordance with the requirements of the Mental Capacity Act 2005 when required and risk management required improvements as risk assessments did not provide staff with detailed guidance on managing or reducing highlighted risks. At this inspection we found the provider had taken appropriate actions to address the areas requiring improvement and to ensure best practice.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service mainly to older adults. Not everyone using Bromley Mind - Mindcare receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. Bromley Mind - Mindcare is a carers’ respite and sitting service which provides support and some personal care to people living with dementia within their own homes. At the time of our inspection there were approximately 83 people 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 2008 and associated Regulations about how the service is run.

There were safeguarding and whistle-blowing procedures in place and staff knew what actions to take to protect adults and children from harm. Any safeguarding concerns were reported appropriately to the local authority and CQC. There were robust recruitment checks in place before staff started work at the service. People told us that there were regular staff and there were enough of them to safely meet their needs. Risks to people were assessed, managed and reviewed regularly to ensure people’s needs were safely met. Where incidents and accidents occurred these were reviewed regularly to ensure that the risk of them re-occurring was reduced. Staff were knowledgeable about risks to people as care plans gave detailed guidance to them. Medicines were managed and administered safely and appropriately and audits conducted to ensure that medicines practice was safe. People were protected from the risk of infections and staff had received training in respect of infection control.

Assessments of people’s care and support needs were conducted to ensure that the care they received was suitable. Staff were competent and had received an appropriate induction before they started work and had regular training relevant to the needs of people that they supported. Staff also received regular supervision where any training needs or concerns could be discussed as well as an annual appraisal. People were supported to meet their nutritional needs, and staff were aware of any specific dietary requirements people may have. People were supported to access health and social care professionals when necessary. Staff were aware of the importance of seeking consent from people they supported and demonstrated good knowledge of the Mental Capacity Act 2005. There were arrangements in place to comply with the Mental Capacity Act 2005.

People told us staff were caring and respectful when they provided care. People had been consulted about their care and support needs and wer

This announced inspection took place on 10 and 11 October 2016. We told the provider two days before our visit that we would be coming, as we wanted to make sure the office staff and registered manager would be available. At the last inspection, on 10 July 2013, the service was meeting all the legal requirements we inspected.

Bromley Mind - Mindcare is a carers’ respite and sitting service which provides support and some personal care to people living with dementia within their own homes. The service is situated within the London borough of Bromley and provides services to people living within the borough. At the time of our inspection there were approximately 76 people 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 this inspection we made a recommendation to the provider on the safe management and administration of medicines. This was because medicine records were not always completed appropriately by staff in line with best practice. There were no systems in place to seek and assess people’s consent and capacity and to act in accordance with the requirements of the Mental Capacity Act 2005 when required. This required some improvement. Risk management required improvements as risk assessments did not provide staff with detailed guidance on managing or reducing highlighted risks. We will check on these issues at our next inspection of the service.

There were policies and procedures in place for safeguarding adults from abuse. Appropriate recruitment checks took place before staff started work and staffing levels were appropriate to meet the needs of people using the service. There were suitable arrangements in place to manage foreseeable emergencies.

Staff received supervision, appraisals and training appropriate to their needs and the needs of people who they supported 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 nutritional needs and preferences were met and people told us they were treated with dignity and respect. People were provided with information about the service when they joined.

People told us the support they received was personalised, respected their wishes and met their needs. People’s support and care needs were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint and who to refer to if they were unhappy with the outcome.

Although the provider had procedures and systems in place to evaluate and monitor the quality of the service, we found that these were not always followed or were not effective in ensuring the quality of some aspects of care people received. People told us they thought the service was well run and staff told us they received good support that enabled them to do their jobs effectively. There were systems in place to carry out staff spot checks to ensure consistency and people were provided with opportunities to provide feedback about the service.

We spoke to ten people's relatives as the people who used the service had dementia and were unable to effectively communicate with us. Everyone we spoke with was complimentary about the service. One person told us "the service is invaluable, without it I couldn't cope". Another person told us the service "is a real life saver" and they were "very happy" with the service. People told us that staff tried to promote their family members independence and they provided them with stimulation and company. People said staff were reliable and always on time. We heard that when cover for staff was needed people were notified and they were happy with other staff provided. Some people received an overnight sitting service and one person told us they felt very comfortable leaving their relative in the care of the provider.

We found the provider had made the required improvements identified at our inspection on 04 February 2013. People's care and support needs had been reviewed and assessments, care plans and risk assessments had been updated. People's care was delivered in line with their care plans. We found staff had received supervision meetings and their performance had been observed. Staff also had received an appraisal. The provider had systems in place to monitor the quality of the service and receive feedback from people. We found the provider had made improvements to the way in which records were maintained.

People who used the service and their relatives we spoke with were very complimentary of the respite service. People told us it was "an invaluable service", and "I don't know what I would do without it". Another person told us "it has made quite a difference to us". People told us the staff were always friendly, polite and respectful, and that staff had a very good understanding of dementia. One person's relative told us "it is so helpful to have a service you can trust". People told us they enjoyed good communication from the provider including checks to see how they were finding the service.

People were involved in planning their care and they were able to state their choices and preferences. People were treated with dignity and respect, and care staff promoted their independence. People's needs were assessed, however, some assessments were out of date and did not reflect people's current needs. In addition, specific care plans were not in place to provide support where it was needed, and some people's risk assessments required reviewing. Staff were adequately trained and were aware of their responsibilities to report concerns. Staff felt adequately supported through supervision and team meetings, however, we found some shortfalls with the frequency of supervisions and appraisals. The provider had adequate quality assurance systems in place. The provider's records sometimes increased the potential of people receiving unsafe or inappropriate care.