We undertook an announced inspection on 4 and 7 December 2017 of Capital Homecare (UK) Limited. This service is a domiciliary care agency. It provides personal care to adults and older adults living in their own houses and flats in the community.

At the time of the inspection, 426 people were receiving personal care and support from this 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 the last comprehensive inspection we carried out on the 27 February 2017 and 01 March 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We received an action plan from the provider which showed what they would do and by when to improve the key questions, is it safe, is it effective, is it responsive and is it well led to at least Good. During this inspection, we found that the service had taken appropriate action to improve on and meet the breaches of regulations we previously identified.

At our previous inspection we found complete records had not been maintained in relation to the support people needed with their medicines. During this inspection we found that the service had taken steps to address this. Records showed Medicines Administration Records (MARs) were completed fully and people’ s care plans clearly outlined the level of support people required with their medicines. There were medicines audits in place which identified any discrepancies and highlighted better practice. Staff had received medicines training and policies and procedures were in place.

At our previous inspection we found consent had not been obtained in line with the requirements of the Mental Capacity Act 2005 (MCA). During this inspection the service had taken steps to address these issues. Records showed where a person lacked the capacity to make a specific decision, people's families were involved in making a decision in the person's best interests. Care plans were signed by people or their representative to indicate that they had consented to the care provided. There was a MCA policy in place and staff had received training on the Mental Capacity Act 2005 (MCA). Staff understood the implications of the MCA and were aware of the importance of obtaining people's consent regarding their care and support.

At our previous inspection, we found systems for monitoring the quality and safety of the service were not always effective. During this inspection, we found that the service had taken steps to address this. The service had updated their quality assurance systems and undertook a range of checks and audits of the service. Spot checks were conducted to assess staff performance and competency. People and relatives spoke positively about the way the service monitored the quality of care they received.

The service also obtained feedback about the quality of the service people received through review meetings, telephone monitoring and satisfaction surveys. Records showed positive feedback had been provided about the service.

At our previous inspection, we found records of staff members' full employment history and consideration of any gaps in employment had not been maintained. During this inspection, we found that the service had taken steps to address this. Records showed any gaps in staff members employment had now been accounted for. Appropriate recruitment checks has been undertaken to ensure people were safe and not at risk of being supported by staff that were unsuitable.

Processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how t

This inspection was carried out on 27 February and 01 March 2017 and was announced. Capital Homecare (UK) Limited is a domiciliary care provider located in the Royal Borough of Greenwich providing care and support to approximately 350 people across a number of London Boroughs.

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 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.

We inspected the service three times during 2016: in February, June and October 2016. We found breaches of legal requirements at all three of these inspections which placed people at risk of unsafe and poor quality care. Medicines were not managed safely, risks to people had not always been adequately assessed and the provider’s systems for monitoring and improving the quality and safety of the service were not effective. Records were not always accurate and the provider had not always obtained consent from people or their representatives in line with the requirements of the Mental Capacity Act 2005 (MCA). We also found the provider did not have an effective system in place for recording and responding to complaints.

These concerns were so significant following the February 2016 inspection that we also imposed a condition on the provider's registration, restricting them from taking on any new service users without prior agreement from CQC. Following the June 2016 inspection we also took urgent enforcement action, placing a condition on the provider's registration, requiring them to submit medicines audits and any actions taken as a result of audit findings to CQC on a regular basis.

At this inspection on 27 February and 01 March 2017 we found the provider had made improvements in addressing the most significant concerns we had previously identified. The improvements made in the management of medicines meant we could remove the condition on the provider’s registration requiring them to submit medicines audits and any actions taken as a result of audit findings to CQC on a regular basis.

However we also identified continued breaches of regulations because records were not always accurate or complete. The provider’s systems for monitoring the quality and safety of the service had improved, but had not always identified issues or driven improvements. Insufficient action had been taken to ensure the service complied with the requirements of the Mental Capacity Act 2005 (MCA), although staff confirmed they only supported people with their consent and in their best interests in consultation with relatives.

We also found a breach of regulations because the provider had not sought and maintained a record of each staff members’ full employment history to help demonstrate that staff were of good character. We therefore decided not to remove the condition on the provider's registration, preventing them from taking on any new service users without prior agreement from the Commission.

Despite these issues, we found on-going improvements had been made in the majority of areas we reviewed in the time since our last inspection. Risks to people had been assessed and staff were aware of how to manage risks safely. People told us they received their medicines as prescribed, and the provider had implemented an effective process for receiving and addressing complaints.

There were sufficient staff deployed by the service to meet people’s needs and staff received safeguarding adults training. However improvement was required to ensure people were consistently protected from abuse because whilst most staff we spoke demonstrated a good understanding of safeguarding practices, two staff members were not aware of the different types of abuse that could occur.

People wer

This inspection was carried out on 05, 06, 07 and 14 October 2016 and was announced. Capital Homecare (UK) Limited is a domiciliary care provider located in the Royal Borough of Greenwich providing care and support to approximately 400 people across a number of London Boroughs. 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 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.

We have inspected the service twice previously in 2016: in February 2016 and June 2016. We found breaches of legal requirements at both of these inspections, and people were placed at risk of unsafe and poor quality care. Medicines were not safely managed, risks to people had not always been adequately assessed and the provider did not have effective systems in place to monitor and manage areas of risk. Records were not always accurate and could not be promptly located. The provider did not have an effective system in place to monitor staff training needs, and the provider’s recruitment practices did not meet the requirements of the regulations. Notifications had not always been made. Our concerns were so significant following the February 2016 inspection that we also imposed a condition on the provider's registration, restricting them from taking on any new service users without prior agreement from the Commission. We also wrote to the provider asking them to take action to improve their recruitment practices and this action has been completed.

Following the June 2016 inspection we also took urgent enforcement action, placing a condition on the provider’s registration, requiring them to submit medicines audits and any actions taken as a result of audit findings to CQC on a regular basis.

At this inspection on 05, 06, 07 and 14 October 2016 we found that the provider had made improvements in some areas. However, we also identified continued breaches of regulations because people’s medicines were not managed safely. Records relating to people’s medicines administration were not always accurate or reflective of the medicines they had been prescribed. Audits of people’s medicines were not always effective in identifying and addressing issues. Risks to people had not always been adequately assessed and there was not always guidance in place for staff on how to manage risks to people safely. Some records were not always accurate or had not been properly completed. The provider had made improvements to the systems used to monitor and mitigate risks to people and we saw examples where this had driven improvements in people’s support planning. However, reviews of people’s care records had not always been prioritised safely and had not always addressed deficiencies in recorded information, placing people at risk.

We also identified breaches of regulations because the provider had not always obtained consent from people or their representatives in line with the requirements of the Mental Capacity Act 2005 (MCA), and because the provider did not have an effective system in place for consistently recording and responding to complaints.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There were sufficient staff deployed within the service to safely meet people’s needs. The provider had appropriate recruitment processes in place but improvement was required to ensure that references received on behalf of new staff were consistently from robust sources. People were protected from the risk of abuse because staff 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 t

We carried out an announced comprehensive inspection of this service on 17 and 19 February 2016 during which we found breaches of regulations. Medicines were not safely managed, risks to people had not always been adequately assessed and the provider did not have effective systems in place to monitor and manage areas of risk. Records were not always accurate and could not be promptly located, and the provider did not have an effective system in place to monitor staff training needs. These issues placed people at risk of unsafe care. We also found that the provider’s whistle blowing policy provided no guidance to staff on how to report concerns externally if needed and that they had failed to submit notifications relating to allegations of abuse as required by the regulations.

Following the inspection we served warning notices on the provider and registered manager requiring them to comply with the regulations. Our concerns were so significant that we also imposed a condition on the provider’s registration, restricting them from taking on any new service users without prior agreement from the Commission.

We undertook this announced focused inspection on 23 June 2016 to check that the provider had met the requirements of the warning notices. At this inspection we looked at aspects of the key questions ‘Is the service safe?’, ‘Is the service effective?’ and ‘Is the service well-led?’ This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Capital Homecare (UK) Limited’ on our website at www.cqc.org.uk.

Capital Homecare (UK) Limited is a domiciliary care provider located in the Royal Borough of Greenwich providing care and support to people across a number of London Boroughs. 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 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 that while a system had been implemented to monitor staff training and the provider had updated their whistle blowing policy, we identified continued breaches of legal requirements relating to safe care and treatment, monitoring the quality and safety of the service, and for failing to submit notifications as required.

Medicines were not safely managed because records relating to the management of people's medicines included conflicting information about the support they required and risks associated with specific medicines had not always been identified. Risks to people had not always been adequately assessed. There was not always sufficient guidance in place for staff on how to safely manage risks where they had been identified. The monitoring system used to ensure people received their visits as planned was not always effective and checks made on people’s care records had not always identified issues or driven improvement. Records were not always accurate and could not always be located promptly when requested. We also found evidence that the provider had failed to submit a notification relating to an allegation of abuse as required, despite these concerns being raised previously. CQC are currently considering the action to take to address these concerns.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

As a result of the findings of this inspection, we have reviewed the rating for the key question ‘Is the service well-led?’ which is now rated inadequate. This was because the provider had failed to make any significant progress in addressing the requirements of the warning notices w

This inspection took place on 17 and 19 February 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure the registered manager was available.

At our last inspection we identified breaches of regulations because the provider did not operate an effective safeguarding quality assurance process and because notifications relating to allegations of abuse had not always been submitted to the CQC as required. At this inspection we found that improvements had been made to the management of safeguarding concerns but the provider continued to be in breach of regulations because they had not always submitted notifications relating to abuse allegations. CQC is currently considering the appropriate regulatory response to address this continued breach in legal requirements. We will report on this at a later date.

Capital Homecare (UK) Limited is a domiciliary care agency located in the Royal Borough of Greenwich providing support for approximately 200 people across greater London. 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 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 a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people had not always been identified or properly assessed, and action had not always been taken to manage risks safely. Risk assessments did not always include areas of risk identified in local authority assessments received by the provider and action had not always been taken to mitigate risks where they had been identified. The provider did not have an effective rostering system in place to allocate calls to staff and this had resulted in missed visits. Medicines were not safely managed by the service because records relating to the management and administration of medicines were inaccurate and some records provided staff with conflicting information.

The provider did not operate effective systems to monitor and mitigate risks to people because audits of people’s care plans and risk assessments were not recorded and had failed to identify a range of concerns that we found during this inspection. Records relating to people’s care were not always easy to locate and could not be provided promptly when requested.

The provider’s whistle blowing policy did not provide any guidance for staff on how to report concerns to external agencies and one staff member told us they would only report concerns externally if given permission to do so by the agency. We also found that the system used to monitor staff training required updating as the information it contained was out of date. Therefore the provider could not assure us that they had an accurate overview of staff training needs at the time of our inspection. CQC is currently considering appropriate regulatory responses to address these breaches in legal requirements. We will report on this at a later date.

We also found a breach of regulations because the provider did not maintain a record of the pre-employment checks undertaken by the service prior to new staff starting work which included details of any gaps in their employment history. You can see the action we have asked the provider to take in respect of this breach of regulations at the back of this report.

There were sufficient staff available to meet people’s needs and staff were supported in their roles through training and regular supervision. People were protect from the risk of abuse because staff were aware of the action to take should they suspect abuse had occurred. Staff sought consent from people when providing them wi

An adult social care inspector carried out this inspection. We spoke with the registered manager, the deputy manager, 60 people who use the service or their families who spoke on their behalf and twelve care staff. We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

Staff were aware of the importance of consent and people were asked for their consent before care was provided. People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support.

The manager and other office staff including the business manager were available on a daily basis to respond to people’s concerns or queries, and to monitor that people were being safely supported, for example in ensuring staff support was provided on time. There had been a number of concerns raised such as about some staff attendance, and these had been reported to local authorities and were investigated, and action taken to ensure continuity of care. Four of these cases were as yet not concluded when writing this report.

There were arrangements in place to deal with emergencies and to make sure people were safe. People's support needs, such as manual handling were included in their care planning to ensure that important health needs were met. The staff and manager were trained in protecting people from neglect or abuse and people told us they felt safe in their home.

Staff wore uniforms and carried photographic identification issued by the agency, to ensure that people who used the service were able to identify them and feel safe. All of the people we spoke with said that the staff always used these items.

All of the 60 people we spoke with who used the service said they felt safe in the way staff supported them. The majority said that staff were well trained and knew how to support them.

Is the service caring?

We spoke with 60 people who used the service or their families and people told us that the staff and supervisors were very caring and supportive. Many said staff always took the time to speak with them and spoke with them in a manner they understood. One person said “they always say what they are going to do before they wash me”, and a person’s family said, “they understand my relative’s religious needs when they wash them and prepare their food.”

Care planning did not include enough specific information about how to support people as individuals, for example what they could do for themselves in order to maintain their independence.

Is the service effective?

We saw from 16 people’s records we looked at that people's needs were assessed and a plan drawn up to meet those needs. People we spoke with told us they were happy with the plan provided. Regular reviews were made of the plan provided and people or their families told us they were involved in the reviews.

There were suitable policies in place for consent to care, assessing and planning care, safeguarding people, medication and quality assurance. The majority of the people we spoke with told us the staff knew how to support them well. People who used the service were consulted for their views on the service they received a regular basis, which involved the person, their family and social services. We saw that any changes they requested were included in a revised care plan.

Staff were provided with adequate support, guidance and training to do their job. They were experienced in supporting people with care needs such as dementia and continence management, and they told us that the training they received equipped them to support people with confidence.

Is the service responsive?

People we spoke with who used the service told us that the staff and manager always listen to their concerns and do something to help sort out any problems they are experiencing. People were asked for their views about their service and action was taken to address any problems, for example in changing a member of staff to one who communicated in the person’s preferred language.

People's support plans were reviewed and changed when necessary in response to changing needs, for example in negotiating higher levels of support when necessary, or in changing the time of visits to accommodate people’s personal preferences.

We were told that the carers were flexible and one person said, “they went the extra mile” when supporting them.

Is the service well led?

There were some concerns raised by social services that the quality of safeguarding investigations needed to be improved and that the investigation information was passed on to them in a timely manner. All of the notifications regarding safeguarding incidents had not been reported to the Care Quality Commission as is required.

The registered manager was qualified and experienced and was involved in the day to day management of the service. There was an out of office hours on call system in operation to ensure that management support and advice was always available. There was a system for doing spot checks on staff working with people to monitor the quality and safety of care provided.

Comments received from people who used the service and families included, “the supervisors are very good and regularly call in to see how the staff are doing”, and “I once had a problem with one staff and it was dealt with immediately”. Most of the people we spoke with reported being in contact with the agency monthly or more. One person said, “the manager will always ask if there are any problems”. Phone monitoring helped to ensure that people received a good quality service.

Staff we spoke with told us that they felt the agency was very well managed and they received direction and training to help them to support people. Regular staff meetings and supervision sessions were held and staff said they felt able to raise any issues with the management openly and honestly, and felt the manager followed up on any issues quickly.