This inspection took place on 15 August 2017 and was announced. College Road is a domiciliary care agency. It provides personal care and support for people who live in their own homes. At the time of this inspection the service provided care for approximately 50 people. The agency transferred to it’s present location in May 2017 from another location in Harrow. It was previously registered as Talbot House.

At our previous comprehensive inspection on 13 and 14 July 2016 we rated the service as “Requires Improvement”. We found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment. The registered provider had not ensured that medicine administration charts (MAR) were properly completed. This may put people at risk. At this inspection we noted that audits and checks had been carried out to ensure that they were properly completed. Where there were unexplained gaps, follow up action had been taken. The service had a policy and procedure for the administration of medicines and care workers had been provided with training.

The second breach was in respect of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing. The provider had failed to provide adequate supervision and all essential training for care workers. This placed people at risk of not receiving appropriate care from care workers who were well supported. At this inspection we noted that care workers had been provided with supervision. This consisted of a mixture of individual supervision and group supervision. However, the group supervisions were not clearly specified in care workers supervision records. We have therefore recommended that this be done.

The third breach was in respect of Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Receiving and acting on complaints. The provider failed to establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints. This means that concerns some people had were not being responded to. At this inspection there was evidence that complaints had been appropriately dealt with.

The fourth breach was in respect of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance. The provider did not have adequate scrutiny and quality monitoring of the service. This may put people at risk of harm or of not receiving appropriate care. At this inspection we noted that the service had the necessary checks and audits for ensuring quality care.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People who used the service and their representatives stated that people had been well treated and people were safe with their care workers. The service had a safeguarding adults policy and care workers had received training in safeguarding people. Potential risks to people were assessed and guidance provided to care workers for minimising these risks. The service had an infection control policy and gloves and aprons were available for care workers. People who used the service and their relatives informed us that care workers observed hygienic practices.

The care records of one person did not contain a risk assessment. The registered manager stated that this was kept at the home of the person concerned. He also stated that this person’s contract was due to be terminated. We recommend that all copies of risk assessments of people be kept in the office so that care workers and senior staff in t

This inspection took place on 13 and 14 July 2016 and was announced. Talbot House is a domiciliary care agency. It provides personal care and support for people who live in their own homes. At the time of this inspection the service provided care for approximately 60 people. The provider met all the standards we inspected against at our last inspection in December 2013.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People who used the service and their representatives stated that people had been well treated and people were safe with their care workers. The service had a safeguarding adults policy and care workers had received training in safeguarding people. Potential risks to people were assessed and guidance provided to care workers for minimising these risks. The service had an infection control policy and gloves and aprons were available for care workers. People who used the service and their relatives informed us that care workers observed hygienic practices.

The service had a policy and procedure for the administration of medicines and care workers had been provided with training. We however, noted that there were unexplained gaps in three medicine administration charts (MAR) and there was no documented evidence of regular audits on the administration of medicines. This deficiency places people at risk and we have made a requirement in this report in respect of this.

We examined the recruitment records. The records indicated that care workers had been carefully recruited. Care workers had received appropriate training to ensure that they had the skills and knowledge to care for people. Care workers said there was a good staff team and the registered manager and senior staff were approachable. We however, noted that staff supervision was irregular and there were long gaps in between sessions and not all staff had received annual appraisals. These deficiencies indicated that care workers were not receiving regular support and opportunities to discuss issues related to their work. Some staff had not received all the required training. The registered manager informed us that these would be provided.

People and their representatives informed us that they mostly got on well with their regular care workers. They stated that their care workers did what was agreed. Care plans were prepared with the involvement of people and their representatives. Reviews of care and telephone monitoring had been carried out to ensure that the care provided was relevant. We however, noted that not all complaints had been promptly responded to and one complaint letter was not dated. Two people we spoke with also made complaints regarding some aspects of their care. The registered manager responded promptly and investigated the complaints.

Social and healthcare professionals informed us that the care needs of people had been met and the service kept them informed of progress. Spot checks had been carried out on care staff to ensure they were carrying out their duties. Visits had been made by the care co-ordinator to people to discuss their care and obtain feedback from them or their relatives. A satisfaction survey had been carried out recently and there was an action plan following the findings. Two social care professionals informed us that the service was addressing deficiencies identified. We however, noted that the service did not have adequate quality assurance measures in place. There was insufficient documented evidence of audits and checks and action taken to address deficiencies. Comprehensive audits and checks are needed in areas such as supervision arrangements, complaints, spot checks, staff logging in