This announced inspection took place on 18 September 2018. We also re-visited on the 1 October 2018 to complete the inspection.

The last comprehensive inspection was in July 2017. The service was rated requires improvement in the key questions 'Is the service Safe?' and ‘Is the service Well-led?’ this was because we found breaches of regulations regarding safe care and treatment and good governance. The provider had not ensured there was guidance for staff to follow to mitigate the risk of harm to people. In addition, shortfalls in the service had not been identified by the provider’s checks and audits. Overall the service was rated as requires improvement.

Following the inspection in July 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the rating of the key questions 'Is the service Safe?’ and ‘Is the service well-led?’ to at least good. They sent us an action plan stating the measures they would implement to address the breaches of regulations by January 2018.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The service is registered with the CQC to provide a service to older adults some of whom might be living with dementia and younger adults who have learning disabilities, autistic spectrum disorder, physical disabilities, sensory impairment or mental health needs.

Not everyone using Equicare Services Ltd receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection nine people were receiving the regulated activity.

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.

At this inspection we found the provider had made improvements and they had met the regulation regarding undertaking an assessment of the risks to people and had provided guidance to staff. There were audits and checks to ensure the quality of the service provided. However, we found medicines administration records were not always completed fully therefore not all the information staff required was available to enable them to support people with their medicines.

One person told us their care worker was always on time. However, one relative said that their care workers were sometimes late and there were at times missed calls. They felt this was not an area that was addressed in a professional manner by the provider. However, they said the care workers were usually good at their job and that their manner was kind and friendly. They said they felt safe with the care workers who they described undertook their work in a safe manner.

The provider told us they monitored staff attendance by use of an electronic system and assessed staffing levels so they employed enough staff to meet people’s support needs. They recruited staff using safe recruitment processes.

The registered manager undertook assessments to ensure they could meet people’s care needs and the care provided was reviewed on a regular basis to make sure it was suitable. People’s care plans were person centred and contained a good amount of detail to support staff to understand the person and to deliver their care as they wanted it to be done.

The registered manager and care staff worked in line with the Mental Capacity Act 2005 and ensured they obtained people’s consent before providing care and support. Care staff offered people choice in their everyday life.

The provider ensured staff received a thorough induction an

This inspection took place on 10 July 2017 and was announced. We gave the provider 48 hours’ notice because the location provides a home care service and we wanted to make sure someone would be available to speak with us.

The agency was first registered with CQC on 23 September 2013. On 16 December 2015 the agency was taken over by the current provider and on 22 June 2016 the agency had changed their location from Harrow Business Centre, 429-433, Pinner Road, North Harrow, Middlesex, HA1 4HN to the current one. This was the first rating inspection of the agency.

Equicare is a domiciliary care agency that provides personal care and support to people living with dementia, learning disabilities and mental health conditions, as well as older people with physical disabilities or sensory impairments. On the day of our inspection, the agency provided support to 51 people out of which 22 were receiving personal care.

The agency had assessed risks to the health and wellbeing of people who used the service, however, not all identified risks had risk management plans in place to guide staff on how to support people in minimising these risks.

Staff received regular training, however, we found that staff did not always have a good knowledge and understanding around safeguarding of adults and children and the Mental Capacity Act 2005.

Some of the agency’s auditing systems were not fully effective in monitoring all the areas of the service provision to identify areas for improvement so these could be addressed.

People using the service told us the agency had helped to protect them from harm and abuse. The majority of people said they felt safe with staff that supported them.

Staff received regular supervision, spot checks and other informal support to help them carry out their roles effectively.

Records showed that people’s care had been planned in their best interests and staff asked for people’s consent before providing the care and support.

The provider had an appropriate recruitment procedure in place and there were sufficient staffing deployed to support people in meeting their care and support needs.

People received their medicines as prescribed and staff were sufficiently trained to administer medicines safely.

Staff supported people to have sufficient food and a nutritious diet and they ensured people had access to external health professionals if people’s health deteriorated.

People using the service told us staff provided care that was kind and compassionate and they were willing to go beyond what was agreed in people’s care plans to meet people’s changing needs.

Staff had supported people to be independent and encouraged them to make decisions about their care and treatment.

Staff respected people’s dignity and privacy and they sought people’s consent before providing personal care.

The agency had assessed people’s care needs and preferences and gathered information which was used to develop people’s plans of care. Staff had access to these plans and were able to use information recorded there when providing support to people.

Staff supported people to follow their interests and take part in social activities and various community events.

The agency had a complaints procedure in place and people and their relatives knew what they could do in case of any concern and complaints they might have had about the service they received.

The provider supported people using the service and where appropriate their relatives in sharing their experience of the care and support provided by the agency.

The majority of the staff we spoke with thought the agency was well-led and they felt supported by their managers. Staff worked well as a team and there was an ongoing and effective communication between the staff and the managers.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and we made two recommendations related to additi