This announced comprehensive inspection took place on 23 and 24 November 2016. At our last comprehensive inspection on 5 and 6 April 2016 we had found serious breaches in relation to the safe management of medicines, the identification of possible risks to people, arrangements to monitor the quality of the service and risk management. We had also found a breach of regulations in relation to recruitment records. We had taken enforcement action in respect of the more serious breaches of regulatory requirements and served two Warning Notices. These required the provider to take action to address the concerns. We undertook a focused inspection on 24 and 25 August 2016 to check that the provider had taken the action required in relation to the serious breaches. We found improvements had been made and found that regulatory requirements were being met.

We carried out this comprehensive inspection in line with our guidance to provide a new rating for the service and to check that the provider had addressed the less significant breach in relation to recruitment records identified at the last comprehensive inspection on 5 and 6 April 2016.

Care Outlook (West Wickham) provides support and personal care to people in their own homes. At the time of our inspection approximately 115 people were receiving care and support from this service. The service operates in the Croydon and Bromley local authority areas and provides packages of care for people commissioned by the local authorities and people who make private arrangements.

There was a registered manager in place. 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 registered manager was being supported to deliver the service by the branch manager.

People told us they felt safe and well cared for. Care workers and office staff had received training on safeguarding adults. They knew the signs of possible abuse and were aware of how to raise any concerns. Possible risks to people were identified and plans were put into place to reduce risk. Care workers and office staff knew how to deal with any emergencies.

People were asked for their consent before care was provided. People told us they were involved in making decisions about their care wherever possible and were supported to be as independent as they could be. Care workers were reliable and people told us that their dignity and individuality was respected. Where people were supported to eat and drink they were asked about their food and drink choices and any concerns were notified to family members or the GP.

An assessment of people’s needs was completed before they started with the service and individual plans detailed the care or support to be provided. We saw these were detailed and provided guidance for care workers on how to meet people’s needs. Care workers told us these were up to date and were amended if people’s needs changed. People knew how to make a complaint if they needed to and we saw responses were made in line with the provider’s policy.

There was effective communication between office staff and care workers. Care Workers told us the service was well led, the office staff were reliable and the management team was approachable and supportive. The provider sought the views of people about the service through direct contact by phone and visits. We found considerable improvements had been made at the service. However, there were aspects of the quality monitoring of the service that required some improvement to be judged as consistently good.

We carried out a comprehensive inspection of this service on 5 and 6 April 2016. Breaches of legal requirements were found in respect of risks to people were not always identified, assessed or plans were not in place to guide care workers on how to reduce them. Medicines were not always safely managed and there were ineffective systems to monitor the quality of the service in relation to risks. Staff recruitment systems were not always managed in line with the regulations. We took enforcement action and served two Warning Notices against the more serious breaches that we found.

We gave the provider until 20 June 2016 to ensure they complied with the regulations in respect of risks, managing medicines and the quality monitoring aspects of the service. We carried out this focused inspection on 24 and 25 August 2016 to check that the service was now compliant with these regulations. We will follow up on the breach of legal requirements in relation to staff recruitment at a later date.

At this focused inspection we looked at aspects of the key question Safe and 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 ‘Care Outlook (West Wickham)’ on our website at www.cqc.org.uk.

Care Outlook (West Wickham) provides support and personal care to people in their own homes. At the time of our inspection approximately 156 people were receiving care and support from this service. The service operates in the Croydon and Bromley local authority areas and provides packages of care for the local authorities and people who make private arrangements.

There was a registered manager in place. 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 action had been taken to improve the identifying, assessing and recording of risks to people. Risks to people were individually identified and assessed and monitored although some improvement was still needed to ensure this was consistent across the service. Improvement had been made to the management of medicines but some improvement was still needed to ensure records were consistently accurate.

In view of the changes made we have therefore changed the rating of the key question Safe to Requires Improvement in line with the characteristics for each rating. We will check for improvements at our next inspection.

There had been improvements to the monitoring of quality at the service. Regular medicines audits were completed to monitor quality across the service. However these changes were relatively recent and we were not able to judge consistency or the reliability of these improvements at this inspection. Audits of the daily care records were not always routinely checked to ensure care and support was delivered as planned.

We have therefore not changed the rating for the key question Well Led. The overall rating remains the same. We will check on improvements at our next inspection.

This announced inspection took place on 5 and 6 April 2016. At the last inspection of the service on 2 June 2015 we had found breaches of legal requirements in respect of staff recruitment, quality assurance and arrangements to obtain people’s consent.

Care Outlook (West Wickham) provides support and personal care to people in their own homes. At the time of our inspection approximately 192 people were receiving care and support from this service. The service operates in the Croydon and Bromley local authority areas and provides packages of care for the local authorities and people who make private arrangements.

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 that although the provider had made improvements to the recruitment system and quality assurance processes there were continued breaches of these regulations. We also found breaches of regulations in respect of safe care and treatment as risks to people were not always identified in respect of their care and treatment. Guidance was not always available for care workers on how to reduce risk. Medicines were also not always managed safely. You can see the action we have asked the provider to take at the back of the full version of this report.

People and their relatives told us they felt safe and well cared for. Staff had received training on safeguarding adults. They knew the signs of possible abuse and were aware of how to raise any concerns. There were enough staff to meet people’s needs in a safe way. Care workers told us they had enough time to travel between calls and people told us carers stayed the full length of the call.

Staff received training and told us they received enough support but some improvements were required to the arrangements for training and care workers knowledge of their responsibilities under the Mental Capacity Act 2005. People told us they were asked for their consent before care was provided. They were involved in making decisions about their care wherever possible and were supported to be as independent as they could be. They said care workers were caring and kind and that their dignity and individuality were respected. Where people were supported to eat and drink they were asked about their food and drink choices and their preferences were recorded. The registered manager told us any concerns were notified to family members. People were supported to have access to a range of health professionals if needed.

An assessment of people’s needs was completed before they started with the service and individual support plans detailed the care or support to be provided. Care workers told us these were regularly updated if there were changes in people’s needs. People knew how to make a complaint if they needed to and these were investigated in line with the provider’s policy.

The provider had addressed most of the issues identified at the last inspection. Regular spot checks on care workers were carried out to ensure care was provided as agreed. The previous branch manager had been absent from the service for long periods since the last inspection. There was a new branch manager who had recently joined the service. The provider, registered manager and branch manager showed a commitment to address the issues we identified. Care workers told us the service was well run and the new branch manager was approachable and supportive. The provider sought the views of people using the service through direct contact, by phone and visits and an annual survey.

This inspection took place on 2 June 2015 and was announced. We told the provider two days before our visit that we would be coming as we wanted to make sure the registered manager would be available. This was the first inspection of this service.

Care Outlook (West Wickham) provides support and personal care to people in their own homes. At the time of our inspection approximately 190 people were receiving care and support from this service. The service operates in the Croydon and Bromley local authority areas and provides packages of care for the local authorities and people who pay privately.

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.

While most aspects of safe recruitment practices were in place, for example police identity and character checks, the provider did not ask for a full employment history to protect people from the risk of being supported by unsuitable staff. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Arrangements to comply with the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were not in place. These protect the rights of people who may not be able to make some decisions. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems to monitor the quality of the service were in place but were not consistently used and records related to the management of the service and staff records were not always available or recorded. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked the provider to take in respect of those breaches at the back of the full version of the report.

People told us they felt safe and well cared for. Staff were aware of how to raise any concerns and had received training on safeguarding adults so they knew the signs of possible abuse. Possible risks to people were identified and plans were put into place to reduce risk. There were arrangements to deal with emergencies and staff had first aid and fire safety training.

People were asked about their food and drink choices and staff supported them with their meals when required. People were supported to take their medicines when needed. People were involved in making decisions about their care wherever possible and were supported to be as independent as they could. Care plans were set up that reflected people’s individual needs and wishes, and guided staff on the care and support to be provided. Checks were carried out to ensure people got their calls when they were needed. Most people confirmed this was the case; although a small number of people, seven out of 30 reported late calls on some occasions.

People were supported by a small team of carers to try and maintain consistency in the support provided and this enabled staff to get to know people’s needs well. Most people described staff as kind and caring and that they had a sense of humour as well although two people described two staff member as having a more abrupt manner than other staff. Staff were trained and supported to carry out their work.

Staff told us the service was well led and the branch manager and registered manager were approachable and supportive. The provider sought the views of people about the service through a system of checks and an annual survey. People knew how to make a complaint if they needed to.