Gentlecare (UK Limited – London) is a domiciliary care agency. It is registered to provide personal care to people in their own homes. The service provides care to people with a range of care needs including those living with dementia, sensory impairments and physical disabilities. It does not provide nursing care. There were 44 people using the service at the time of the inspection.

Not everyone using Gentlecare (UK Limited – London receives a regulated activity; CQC only inspects the service 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.

This comprehensive inspection was announced. We gave the provider two working days’ notice of the inspection because the service provides care to people in their own homes and we wanted to make sure that the provider was available on the day of the inspection.

The previous comprehensive inspection took place on 9 and 15 February 2016. We rated the service 'Requires Improvement' in the area of Safe. A focused inspection on 22 December 2016 found that the provider had addressed our concerns about the way risks to people were managed and we rated the service ‘Good’ in the area of Safe and ‘Good’ overall.

At this inspection we found the service remained Good.

People using the service and their relatives informed us that they were happy with the care and support that they received. People received consistency of care from staff that they knew.

People using the service told us that staff treated them with respect and they felt safe when staff supported them with their care and other tasks. They told us that staff were caring and reliable and respected their dignity and privacy. Staff knew the importance of respecting people’s differences and human rights.

Arrangements were in place to keep people safe. The service had a safeguarding policy and whistleblowing procedure. Staff knew how to identify abuse and understood their responsibilities in relation to safeguarding people and reporting all concerns.

Risks to people’s safety were identified and monitored. Guidance to manage and minimise any risks of people and staff being harmed was in place. Incidents were investigated and action was taken to minimise risk of future recurrence. Learning from incidents led to improvements in the service.

Arrangements were in place to make sure medicines were managed safely and people received their medicines as prescribed.

Appropriate checks were made before staff started to work to make sure they were suitable to work with people using the service.

The provider ensured that there were enough staff in place with the right skills mix to meet people's needs. Staff understood the importance of obtaining people’s consent before supporting them with personal care and other tasks.

People and where applicable their relatives were fully involved in making decisions about people’s care. The service was flexible and responsive. People were listened to and staff respected the choices they made and supported people’s independence.

People’s care plans were person-centred. They included detailed information about the care people needed and their preferences, so staff had the relevant information that they needed to meet people’s needs.

The service liaised closely with healthcare and social care professionals to make sure people’s needs were met.

People and their relatives had opportunities to feedback about the service and issues raised by them were addressed.

Staff received training and learning which was relevant to their role. They received ongoing support through supervision and day to day contact with the registered manager and other senior staff. The performance and development of staff were regularly reviewed. Staff were encouraged to contribute ideas and suggestions about improving and developing working practices and other areas of the service.

There were a range of s

We carried out an announced comprehensive inspection of this service on 9 and 15 February 2016 at which a breach of legal requirements was found. This was because the provider did not always ensure risks to people were identified and appropriately managed.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook an announced focused inspection on the 22 December 2016 to check they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to the safe topic area. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gentlecare (UK) Limited – London on our website at www.cqc.org.uk.

At our last inspection in February 2016 we rated the service good in the four topic areas; effective, caring, responsive and well-led and good as the overall rating. The service was rated requires improvement in the topic area safe.

Gentlecare (UK) Limited - London is registered to provide the regulated activity personal care to people in their own homes

There was a registered manager in place. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our focused inspection on the 22 December 2016, we found that the provider had followed their plan and legal requirements had been met. The provider had taken action to address our concerns about the way risks to people were managed.

We found risk assessments had been updated and risks were identified according to people’s specific care needs. There were risk management plans in place so risks were managed so that people were safe and their freedom supported and protected. Copies of risk assessments were kept at people's homes to ensure care staff were able to access them as required.

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

People’s privacy, dignity and independence were respected. Some people’s care needs had not been monitored and there was no regular consultation with people who used the service and their relatives.

The provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening

There were some qualified, skilled and experienced staff to meet people’s needs. Staff did not feel they were supported to deliver care and treatment safely and to an appropriate standard.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received and to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

There was a complaints system available however comments and complaints people made were not responded to appropriately. Some records were out of date and not fit for purpose.

We carried out an unannounced inspection on the 27 August 2014 to check compliance following enforcement action we took against Gentlecare (UK) Limited after our inspection on 19 September 2013.

During our inspection on 19 September 2013, we found there was a lack of evidence which showed the service were identifying, assessing and managing any risks relating to people's health, welfare and safety. The provider failed to comply with Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010.

The provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider had failed to comply with Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010.

There were some qualified, skilled and experienced staff to meet people’s needs. Staff did not feel they were supported to deliver care and treatment safely and to an appropriate standard. The provider had failed to comply with Regulations 22 and 23 HSCA 2008 (Regulated Activities) Regulations 2010.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received and to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. The provider had failed to comply with Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010.

There was a complaints system available, however comments and complaints people made were not responded to appropriately. Some records were out of date and not fit for purpose. The provider had failed to comply Regulations 19 and 20 HSCA 2008 (Regulated Activities) Regulations 2010.

We received an action plan from the provider which detailed what they would do to comply with the regulations.

We carried out an announced inspection on 21 March 2014 to see if the provider took action to comply with Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010. We found improvements had been made and the provider was found to complaint with this regulation.

We carried out an announced inspection on the 27 August 2014 to check whether improvements had been made to comply with the Regulations 11, 22, 23, 10, 19 and 20 HSCA 2008 (Regulated Activities) Regulations 2010.

During the inspection on 27 August 2014, we spoke with twenty one people and five staff. We looked at four care plans and four staff records and found that the provider had made improvements to the service.

We looked at training records and saw staff had received the relevant training in safeguarding adults, Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005.

We found two field care supervisors had been recruited to help with the planning and scheduling of visits and the registered manager had a system in place to monitor calls. One person who used the service told us “They are now usually on time. In the past we had lots of issues relating to timing but in the last 6 months this has improved vastly”.

Staff felt they were supported to deliver care and treatment safely and to an appropriate standard. We found staff appraisals and spot checks had been conducted. One member of staff told us “Yes things have improved since I started working for the company. We are receiving better training and more of it.”

We found the registered manager had a system to monitor the quality of care provided and there had been some consultations with the people who used the service which had given them the opportunity to discuss any issues or concerns they had and any complaints they wished to make.

There was a complaints system available and comments and complaints people made were responded to appropriately. Records were up to date and fit for purpose.