We undertook an announced inspection of Care Outlook (Hillingdon) on 25th and 26th May 2017. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and as staff might be out visiting people, we wanted to be sure someone would be available to assist with the inspection.

Care Outlook (Hillingdon) is a domiciliary care agency that provides personal care for approximately 250 people. The London Borough of Hillingdon funded the majority of care packages.

We previously inspected Care Outlook (Hillingdon) on 23rd and 24th November 2016 and we identified issues in relation to the recording of the administration of medicines, recruitment processes, complying with the requirements of the Mental Capacity Act 2005, care worker induction and training, people receiving care that reflected their needs by having visits at the same time each day, accuracy of records and quality assurance. We issued a warning notice in relation to quality assurance and records requesting the provider resolve this issue by the 28 February 2017. Following the inspection in May 2017, we found improvements had been made in relation to all issues that were identified at the previous inspection.

At the time of the inspection, the service had 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.

Improvements had been made in the recording of the administration of medicines. The provider had a procedure in place for the management of medicines.

The provider had made improvements in the recruitment process to ensure information was obtained regarding the previous work experience of new care workers.

People now received care that reflected their needs or met their individual preferences as times for visits had been reviewed and the arrival times of care workers were now being monitored to ensure they were in line with the agreed care plans. The electronic monitoring system (EMS) had been updated to indicate the accurate time for care visits.

The provider had a policy in place in relation to the Mental Capacity Act 2005 and now out carried assessments to identify if a person using the service was able to make decisions about their care and ensure the appropriate actions were taken to support them.

Improvements had been made in relation to the induction and assessment of new care workers.

Improvements had also been made in relation to a range of audits to enable the provider to monitor the quality of the service.

The daily records of care completed by the care workers were more focused on the person receiving care and not on the support tasks completed during the visit.

The provider had systems in place for the recording and investigation of incidents and accidents.

People using the service said they felt safe when they received support in their own home.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care.

The care plans identified how the care workers could support the person in maintaining their independence.

Each person’s cultural and religious needs were identified in their care plan.

An initial assessment was carried out before the person started to receive care in their home to ensure the service could provide appropriate care. Care plans were developed from these assessments and were up to date.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns.

People using the service and care workers felt the service was well-led and effective. Care workers felt supported by their managers.

We undertook an announced inspection of Care Outlook (Hillingdon) on 23 and 24 November 2016. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Care Outlook (Hillingdon) is a domiciliary care agency that provides personal care to around 248 people in their own homes in the London Borough of Hillingdon.

We previously inspected Care Outlook Hillingdon on 3 May 2016 and we identified issues in relation to people not always receiving care that reflected their needs or met their individual preferences, because the care was not delivered at the same time each day and sometimes people had to wait for food or care without knowing when the care worker would arrive. During the inspection in November 2016 we found some improvements had been made but further action was required to resolve the issues fully.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

There was a procedure in place for the management of medicines but care workers were not recording the administration of medicines accurately.

The provider had suitable recruitment practices but information was not always accurate in relation to the previous work experience of new care workers.

People did not always receive care that reflected their needs or met their individual preferences, because the care was not delivered at the same time each day and sometimes people had to wait for food or care without knowing when the care worker would arrive.

Daily records were focused on the tasks completed and not the person receiving the support.

The provider had a policy in place in relation to the Mental Capacity Act 2005 but they did not undertake assessments to identify if a person using the service was able to make decisions about their care and ensure the appropriate actions were taken to support them.

Some new care workers completed their induction training a number of months before they started to provide care. Care workers had received the training identified as mandatory by the provider, supervision and appraisals they required to deliver care safely and to an appropriate standard.

The provider had a range of audits in place but the audits in relation to the administration of medicines, recruitment and other records relating to care did not provide appropriate information to monitor quality.

People told us they felt safe when they received support and the provider had policies and procedures in place to deal with any concerns that were raised about the care provided.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns.

People using the service told us they felt the service was well-led. We received both positive and negative comments from care workers when asked if they felt the service was well-led and if they received enough support.

We found breaches 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.

The inspection took place on 3 May 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be available.

This was the first inspection of the agency at their current address. Care Outlook (Hillingdon) previously operated out of one of the provider's other branches and was included in their registration.

Care Outlook (Hillingdon) is a domiciliary care agency providing personal care and support to people living in their own homes in the London Borough of Hillingdon. The majority of people using the service were funded or part funded by the local authority and the agency was one of the four main agencies contracted by the local authority to provide care within the borough. At the time of the inspection there were 219 people using the service, although the manager told us the number of people changed regularly as they took on new people and others no longer needed care.

Care Outlook Limited is a private family run business. They provided care and support to people in their own homes in London and the South East of England. At the time of the inspection the provider had seven branches including the Hillingdon branch.

There was a registered manager in post. This person was the provider's operations director and their role involved overseeing other branches. There was also a branch manager, who had been in post since October 2015. The branch manager told us they were in the process of applying for registration with the Care Quality Commission. They had not submitted their application form for this at the time of the inspection, but they had started gathering evidence for the application. 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 and associated Regulations about how the service is run.

The majority of people were happy with the service they received and they felt the care provided was good.

However, people did not always receive care which reflected their needs and preferences because the care workers did not arrive at the same consistent time each day and were sometimes late when supporting people with their meals and personal care.

People using the service told us they felt safe with the agency workers and with the care provided. The provider's procedures for safeguarding adults were designed to protect them from the risk of abuse and to act swiftly when abuse was identified.

The risks to people's safety had been assessed and recorded.

People received their medicines as prescribed.

People had consented to their care.

The staff were appropriately trained and had the information they needed to carry out their roles and responsibilities. The staff felt supported and their work was regularly assessed.

People who required support with eating and drinking received this from the agency.

The staff supported people so they stayed healthy.

People were cared for by staff who were kind, considerate and polite. They had good relationships with their care workers. They were treated with dignity and respect.

Care plans were clear, detailed and regularly reviewed.

People were able to make a complaint and felt these were listened to and acted upon.

The majority of people felt the service was well-led. The staff also felt the service was well managed. Some of the people using the service and staff had concerns about specific aspects of the service. There were opportunities for people to voice these concerns through the provider's quality monitoring, complaints procedure and staff supervision.

Records were appropriately maintained. The provider was auditing records and identifying areas where improvements were needed.