We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive took place on 27 February 2018 and was announced. The inspection site visit started and ended on 27 February 2018. Telephone calls to people using the service and their relatives were carried out on 27 and 28 February 2018.

We gave the service 72 hours’ notice of the inspection visit because the location provides a domiciliary care service. We needed to be sure that they would be in.

Two inspectors and two experts by experience undertook the inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection, we reviewed the information we held about the service including notifications. Statutory notifications include information about important events, which the provider is required to send us by law. We reviewed the Provider Information Return (PIR) form sent to us. A PIR is a document that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information to plan the inspection.

During our inspection, we spoke with 11 people using the service and six of their relatives. We spoke with two members of care staff, a deputy head of service, a human resources manager, two service managers, and a chief executive officer. The registered manager was not available on the day of the inspection due to adverse weather.

We looked at 10 people’s care records, including their risk assessments and five medicine administration records. We reviewed information about the management of the service including safeguarding reports, incident records and policies and procedures. We looked at 15 staff records that included recruitment, induction, training, supervisions and appraisals.

After the inspection, we received feedback from two health and social care professionals.

This announced inspection took place on 27 August 2015. Domiciliary Services provides a range of home and community based services to 32 people with a learning disability in Croydon, Lewisham and Southwark. Domiciliary Services was last inspected on 29 July 2014. It met all the regulations inspected.

The service has 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.

People were supported by staff who understood their health conditions and the related risks. There were support plans in place to guide staff on how to support people with care and in line with their needs and identified risks. People were asked for their consent before they received care.

The service supported people in line with the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People who may lack mental capacity were given appropriate support to understand and make decisions relating to the care and support they required.

Staff told us the registered manager was approachable and supportive. The registered manager ensured staff received regular supervisions and appraisals. Staff used feedback to improve their practice. Staff told us they received training in relation to specific needs of people.

People said staff were polite and treated them with respect. Records showed people and their relatives were involved in planning their care and support. The registered manager carried out risk assessments and put plans in place to ensure sufficient guidance was available for staff to support people safely.

People were supported to access healthcare services as required. People told us they received adequate support with eating and drinking. Records showed staff followed healthcare professionals’ advice in supporting people with their nutrition.

The registered manager carried out surveys to obtain feedback on the way people were supported. The registered manager visited and made telephone calls to people regularly and asked them about their views of the service. People told us the registered manager considered their views and used them to improve their care and support.

People told us the registered manager took action on their complaints. Records showed complaints were investigated and resolved in a timely manner to the satisfaction of people and their relatives.

The registered manager effectively used the audit systems in place to monitor the quality of the service. The registered manager monitored the quality of care plans and risk assessments to ensure staff had sufficient guidance to support people. The registered manager conducted checks on staff competency to administer people’s medicines, record keeping and infection control and gave staff appropriate guidance when needed.

People and their relatives had positive feedback on the service and were happy on how support and care was provided. The registered manager had launched a trial computerised system to monitor how people were supported during visits and to get instant feedback on the quality of care given to people. It was early to assess the effectiveness of this system at the time of inspection.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw the service had infection control procedures which included guidance on hand washing and infection control audits. Staff were aware of the policy and understood their roles in relation to infection control.

We saw the service carried out Disclosure and Barring Service (DBS) checks on all staff who worked in the service to ensure they were suitable to work in the care sector.

People were supported by staff who had the knowledge and skills to deal with foreseeable emergencies. They had received first aid training which was regularly updated.

People were protected from the risk of harm because the provider had ensured staff knew how to recognise and report concerns about abuse or neglect.

The registered manager was able to explain how the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) related to their service.

Is the service effective?

People’s social, health and support needs were assessed with them, and they were involved in reviewing their care plans. People told us the service met their identified needs. One person we spoke with said, “I look at my care plan.” People were given information by staff which enabled them to make decisions about their care and support.

Is the service caring?

People were supported by kind and attentive staff. Staff were able to explain how they supported people to maintain their dignity and deliver services in a caring way. Care plans included details of how people liked to be supported. People told us the staff were “caring” and “friendly”. One person said, “All the staff are very nice to me.”

Is the service responsive?

People’s needs were assessed before they were signed up to the service. We saw checks were made to ensure people had not changed their minds about what they liked to do. People told us staff would make changes to the service they provided at their request. One person said “I am happy with Plus, they do what I want them to do.” Staff regularly asked people’s view of the service and responded to what people told them.

Is the service well-led?

The registered manager was clear about the aims and objectives of the service. Quality assurance processes were in place to check what people thought about the service. We saw the service had sent feedback forms to people who used the service and their relatives.

People expressed their views and were involved in making decisions about their care. We examined the care records for six people using the service. We found people had been asked for their choices, opinions and wishes, and these had been taken into account when planning the care provided.

People using the service told us staff treated them with respect and kindness, and they were well cared for. One said “I get to go out. I have my own room and a key to it. There are lots of good things to do."

We reviewed the care documents for six of the people using the service. The records contained up to date care, or support plans. The plans were written in conjunction with the person, and were based on individual needs. One of the people using the service said, "Everything is OK. There is nothing I don't like. Staff treat me well." Another person told us, "So far everything is OK. Staff are OK and the food is alright."

Staff we talked with demonstrated they understood signs of abuse and knew how to raise concerns of abuse. They also received annual safeguarding training. People using the service did not raise any concerns. One person said, "I feel safe here."

Staff told us they received regular training, supervision and support. They said they were enabled to gain further qualifications appropriate to their work.

The provider had effective systems in place to monitor the quality of the service being provided.

People told us that they received information about the services provided by the organisation.

Some people told us that they had received assessments and care plans, but these were outdated and people were not aware when they would be reviewed. Some family members of people who received services told us that the needs of the people had changed and appropriate assessments had not yet taken place, so as to reflect people’s current needs.

Some people told us that sometimes they got different staff who did not know what their needs were.

Some people told us that staff were caring and friendly and helped them with their daily lives and supported them to do activities in which they were interested.

They said that staff did a good job and were satisfied by the service they provided. They said that staff were attentive and caring.

People told us staff helped them to participate in activities in which they were interested. They said that if they were concerned about something, they felt able to speak with staff.

People who used the service and their relatives told us that the care and support they received was good. They said that the care workers were friendly and treated them with respect. One relative said, "My son is very happy with the service, I have no complaints". Another relative told us, "The carer is always on time and we are very happy. The care workers usually arrived on time and stay for the time they should."

We found that care was reviewed on a regular basis, and that people using the service and their relatives were involved in these reviews.

People were protected from abuse as staff had undergone safeguarding training.

Care workers told us that the agency was supportive. They said that they had regular supervision and annual appraisals.

We found that the agency had a number of systems in place to review care plans and risk assessments. However, it did not have systems in place to carry out spot checks to monitor the quality of all parts of the service.