This inspection took place on 4 October 2018 and was announced. We gave the registered manager two working days’ notice of the inspection because the service is small and we wanted to be sure they would be available to meet with us. Business Services Bromley 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. Eight people were using the service at the time of our inspection.

At our last inspection in August 2017 we asked the provider to take action to make improvements in order to keep people safe because risks to people had not always been adequately assessed. This action had not been completed. Identified risks to people had not always been assessed and people’s care plans did not always contain sufficient information for staff on how to manage identified risks safely. This amounted to a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection in August 2017 we asked the provider to take action to make improvements in order to keep people safe because the provider’s systems for monitoring the quality and safety of the service were not effective in identifying issues or driving improvements, and records at the service contained inaccurate information. This action had not been completed. Whilst improvements had been made to address the recording issues we had previously identified, the provider’s systems for monitoring the quality and safety of the service remained ineffective. This amounted to a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection in August 2017 we asked the provider to take action to make improvements to ensure they followed safe practice when recruiting new staff. This action has been completed. The provider followed safe recruitment practices.

At this inspection we found the provider’s induction and training programme was not robust and the registered manager was not always able to demonstrate that staff had received training in the areas considered mandatory by the provider. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection in August 2017 we found improvement was required to ensure people’s medicines were consistently managed safely. At this inspection we found the administration of people’s medicines had not always been accurately recorded and there was no guidance in place for staff on the support they should give to people who had been prescribed medicines to be taken ‘as required’. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

At this inspection we found improvement was required to ensure that the registered manager was aware of the responsibilities of their role and had a better understanding of the legal requirements associated with the provision of domiciliary care. We also found further areas requiring improvement because people’s needs had not always been holistically assessed when they started using the service, and to ensure that people received effective, joined up care when supported by different services. We have made a recomme

This inspection took place on 14 August 2017 and was announced because we wanted to ensure that the registered manager would be available. AA Nursing Care Limited – Business Services Bromley is a domiciliary care agency providing care and support to people in the London Borough of Bromley. At the time of our inspection there were five people using the service.

The service had a registered manager in post who had registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, registered managers 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.

At this inspection we found breaches of legal requirements because risks to people had not always been assessed to ensure they were minimised, the provider’s quality assurance and recording systems were not always effective in driving improvements, and because recruitment practices were not always robust. You can see the action we told the provider to take at the back of the full version of the report.

People were supported to take their medicines as prescribed by trained staff, where this was a part of their agreed plan of care. Medicines records were up to date and accurate, although improvement was required to ensure people’s care plans included details of any specific requirements people had with regard to the administration of individual medicines.

There were sufficient staff deployed by the service to safely meet people’s needs. People were protected from the risk of abuse because staff had received safeguarding training. They were aware of the types of abuse that could occur and the action to take if they suspected abuse. Staff were supported in their roles through training and supervision and people told us they considered the staff supporting them to be competent.

People received support to eat and drink in sufficient amounts where this was an agreed part of their care plan. Staff confirmed they supported people to access healthcare services if and when needed. People confirmed staff sought their consent when offering them support. Staff told us, and records confirmed that people were able to make decisions around the support they received for themselves. The registered manager was aware of their responsibilities with regard to the Mental Capacity Act 2005 (MCA). None of the people receiving a service from the provider were deprived of their liberty.

People told us that staff treated them with kindness and consideration, and that they were treated with dignity. Staff respected people’s privacy and involved them in decisions about the support they received on a daily basis. People had been involved in developing their care plans which reflected their individual needs and preferences.

The provider had a complaints policy and procedure in place and people told us they knew how to raise concerns. The registered manager told us the service had not received any complaints since registering in 2016 and this was reflected in the discussions we had with people.

The provider had systems in place to seek feedback from people about the service they received, although these were informal due to the small size of the service. People confirmed their views had been sought on a regular basis and told us they were happy with the service they received. Staff told us they worked well as a team and spoke positively about the support they received from the registered manager and management team.