This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults of all ages, including people with dementia or physical disabilities. This was an announced inspection of the service.

Not everyone using the service receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the start of our inspection there was one people using the service in this respect.

The service had a registered manager, which 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 our previous inspection of this service in October 2017, a breach of legal requirements was found. This was in respect of both record-keeping and effective governance, particularly around supporting people with medicines. The provider completed an action plan to show what they would do and by when to improve the rating of key questions of 'Is it Safe?' and ‘Is it Well-led?’ to at least ‘Good.’

At this inspection, we found the service was no longer providing anyone receiving regulated activity with medicines support. However, when the service last provided that support, in the summer of 2018, we found medicine administration records were still not accurately and fully completed. The service’s medicines audits had not identified this. Risks to the care and welfare of that person had not, therefore, been identified and addressed. This means the breach of legal requirements was continuing.

The service had systems to assess and manage risks to people’s safety. However, the risk assessments relating to the care and welfare of the person using the service had not been reviewed since November 2016. Audit systems had not identified this. This meant the provider was not taking all practical steps to ensure the person’s safety was kept under regular review.

The service had systems for regular staff supervision and appraisal, but these had not been kept up-to-date for the staff member working with the person using the service, to help ensure staff were being supported to carry out their duties effectively.

Governance systems had been set up but they had not identified the concerns we found at this inspection. There was little the registered manager otherwise showed us to demonstrate that service delivery risks were identified and mitigated, that the service enabled sustainability and supported continuous learning and improvement, or that there was partnership working with other agencies to support the development of the service. We therefore concluded the service was not well-led.

The service was caring and responsive. It ensured that people were treated with kindness, respect and compassion, and that they were given emotional support when needed. There was consistency of trained care staff, which helped trusting relationships to develop and people’s individual needs and preferences to be understood and addressed.

Where appropriate, the service supported people to maintain good health and nutrition and access appropriate community services.

Systems, processes and practices were in place to safeguard people from abuse, prevent or control infection, and ensure that ongoing learning took place when accidents occurred.

The service was working within the principles of the Mental Capacity Act 2005 in terms of acquiring appropriate consent for care.

This is the third consecutive time the service has been rated ‘Requires Improvement’. We found one breach of the Health and Social Care Act 2008 (Regulated A

Eagle Care Ltd is a homecare agency based in Barnet that provides services to people of any age. At the time of this inspection the agency was providing a regulated care service to two people in their own homes. It was providing additional services to other people such as domestic and community support; however, those are not services that we regulate.

The service had a registered manager, which 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 our previous inspection of this service in January 2016, breaches of legal requirements were found. These were in respect of safe care and treatment, record-keeping, and the need for consent to care. At this inspection, we found some of these matters had been addressed, but further improvements were required.

The management of people’s medicines support, although improved, was not robust enough to ensure people always received their medicines safely. Recording shortfalls relating to this had not been identified for improvement. There was therefore a continuing breach of legal requirements.

We found the oversight of the service was inconsistent. Whilst people’s views on service quality were regularly sought and acted on, systems were not embedded to ensure for example staff training and appraisals were always kept up-to-date in support of making sure good quality care was being delivered. This meant there was insufficient oversight of the service as a whole, despite a positive and open culture being in place.

People and their representatives fed back positively about the care and the approach of staff and the registered manager. People received the same staff member wherever possible, which helped positive and caring relationships to develop and their needs and preferences to be addressed.

People were supported to eat and drink enough and maintain balanced diets, and were provided with support for health matters where needed. Staff had the knowledge and skills needed to carry out their roles so that people received effective care and support.

People were supported to express their views and be involved in decisions about their care. The service was working within the principles of the Mental Capacity Act 2005 in terms of acquiring appropriate consent for care. People received individualised care that was backed by appropriate care plans that were kept under review. The registered manager responded to any service delivery issues identified.

Whilst the service could not guarantee they could always provide suitable staff to people, they informed people of this in good time to help ensure alternative arrangements could be made. There were therefore enough staff to meet people’s needs and keep them safe.

The service had systems to help ensure people were protected from abuse. It paid good attention to the prevention and control of infection, and to the management of many care delivery risks in people’s homes.

We found one breach 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.

This was an announced inspection that took place on 22 January 2016. It was the first inspection of this agency at this location, after the agency had moved addresses locally.

The agency is registered to provide homecare services to anybody in the community. At the time of this inspection the agency was providing a regulated care service to four people in their own homes. It was providing additional services to other people such as domestic and community support; however, those are not services that we regulate.

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. The registered manager was also the nominated individual for the registered provider.

People’s relatives told us they were very happy with the service. Staff provided support in a friendly and considerate manner, and so their family members were well cared for.

However, we found that the service was not consistently safe. Risk was not adequately assessed in people’s homes, including for medicines and supporting people to move. One person was provided with support with both moving around and eating despite no risk assessments on these matters. There was therefore a foreseeable risk of the care and support not being undertaken safely or appropriately.

We found that the service had not developed systems to ensure that it was working within the principles of the Mental Capacity Act 2005. We also found the service’s record-keeping approach was not consistently accurate and current, which undermined the effectiveness of the service.

People received consistent staff, which helped positive and caring relationships to develop. The service had an experienced team that had been appropriately recruited, and there were enough staff to meet people’s needs.

People’s opinions, preferences and choices were sought and acted upon, and their privacy and dignity were respected and promoted by staff.

People were supported to eat and drink enough, and have their health needs addressed, as part of the service’s care delivery.

Care packages were regularly reviewed with the involvement of the person using their service or their representatives. This resulted in care plans that guided staff on meeting people’s individual needs and respecting their preferences.

The staff we spoke with were knowledgeable about the needs and preferences of people they supported. They had appropriate skills and provided care and support in a way that was focussed on the individual. Staff said the organisation was a good one to work for and they were well supported by the registered manager.

We found the registered manager to be approachable and responsive. Feedback from people’s relatives indicated that the registered manager enabled a supportive and flexible service that people were satisfied with.

The provider undertook quality checks that reflected the service’s small size. Action was taken to improve the service where these checks identified shortfalls.

There were overall three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.