This inspection took place on 7 January 2019 and was announced. Harmony Home Aid Services Limited - Unit A2 Broomsleigh Business Park is a domiciliary care agency. The service is registered to provide personal care for people living in their own homes. It provides a service to older adults and younger disabled adults. At the time of the inspection, 103 people were using the service.

The previous inspection of the service was on 3 and 11 October 2017 and we found the service was not meeting all the regulations. Two breaches of regulation were found. One breach related to safe care and treatment because risk assessments did not always identify and manage potential risks for people, systems for the management of medicines were not effective, missed and late visits were not always recorded and there was not always a risk assessment recorded on staff records where this was appropriate. The second breach related to good governance because care records and risk assessments were not regularly checked to ensure they reflected people’s current needs.

We issued requirement notices for each of these breaches. The overall rating for this service was ‘Requires improvement’. We asked and received from the registered manager an action plan that detailed how they would make those improvements to the service.

At this inspection, we followed up on the previous breaches of regulation. We found that the registered manager had taken action to meet all of the regulations we inspected. The overall rating for this service is ‘good’.

The service had 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.

Staff completed assessments with people which identified risks associated with their health and well-being. The management plans guided staff to manage and mitigate potential risks.

People’s medicines were managed in a safe way. Each person had a medicines administration record (MAR). Staff completed these accurately. When a medicine was not administered staff used an appropriate code on the MAR to explain why. Staff completed an audit on MARs and reviewed supplies of medicines to ensure there was enough stock for people’s needs.

Staff understood how to protect people from harm and abuse. Staff followed the safeguarding processes in place to report allegations of abuse. Staff captured and investigated missed and late visits and took action to inform the local authority of these incidents for their investigation.

The provider had safer recruitment processes in place. Newly recruited staff completed pre-employment checks before their employment was confirmed and they were assessed as suitable to work with people using the service. People had enough staff to support them. The staff rota showed people received the assessed care and support required to meet their individual needs. The registered manager supported staff through an induction, training, supervision and an annual appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were provided with enough information for them to give staff their consent to receive care and support.

People said staff were kind and caring. People commented that staff respected them, their home and their privacy.

Staff supported people with their meal preparation and they had enough food and drink to meet their needs and preferences.

Staff completed assessments with people to identify their needs. Each person had a care plan that detailed the care and support people required to meet their needs.

People accessed health care services whe

This inspection took place on 3 and 11 October 2017 and was announced. Harmony Home Aid Services Limited - Unit A2 Broomsleigh Business Park is a domiciliary care service. The service is registered to provide personal care for people living in their own homes. At the time of the inspection, 135 people were using the service.

The last time we inspected this service on 15 and 20 December 2016 the service was not meeting all the regulations. Three breaches of regulations were found. We found that the service was in breach of regulations in relation to safe care and treatment and good governance. We issued warning notices for each breach. The registered provider was also in breach of the regulation related to notifications. We issued a requirement notice for that breach of regulation. The overall rating for this service was ‘Inadequate’ and the service was placed in ‘special measures’. You can read previous inspection reports for the service, by selecting the ‘all reports’ link for Harmony Home Aid Services Limited - Unit A2 Broomsleigh Business Park on our website at www.cqc.org.uk.

At this inspection, we followed up on the breaches of regulations to see if the registered provider had made sufficient improvements. We found that the registered provider had taken some action to meet the regulations. The registered provider now met the regulation relating to notifications. They had also taken action to manage risk management plans, the management of missed and late visits, the management of medicines, the quality assurance process and improvements in the management of the service. However, further improvements were required.

The service had 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.

People had assessments which identified risks associated with their health and well-being. However we found that the control measures in place to manage risks were not always followed to keep people safe.

People’s medicines were not always managed safely. People’s medicine administration record (MARs) charts were not always accurate or up to date. People were at risk of receiving medicines that were not administered as prescribed. The registered manager had implemented a new medicine audit tool. However, this was not effective as it had not identified the concerns we found.

The registered manager had systems in place to monitor, review and improve the quality of people’s care records and risk assessments. However this system was not effective because information contained in people’s care records was not always accurate.

Missed and late visits were recorded and monitored. However, there was evidence that staff were not always reporting missed visits to the local authority.

The registered provider had a recruitment system in place. Staff followed the recruitment process to ensure staff had pre-employment checks carried out to assess their suitability to work with people. However, we found that on two occasions the provider had not followed up information contained in pre-employment checks to ensure that staff were safe to work with people. The provider sent us further information following the inspection to evidence how they had addressed this.

Staff had regular training, supervision and an annual appraisal. Newly employed staff had an induction which helped them familiarise themselves with the service and the expectations of their role before they started working with people.

There were enough staff to meet people’s care needs. The rota showed sufficient staff were deployed to meet people’s care and support needs safely.

The registered provider had safeguarding processes in place that staff followed to help keep people sa

This inspection took place on 15 and 20 December 2016 and was announced. Harmony Home Aid Services Limited - Unit A2 Broomsleigh Business Park is a domiciliary care service. The service provides personal care for people living in their own homes. At the time of the inspection, 167 people were using the service.

The service had 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 last time we inspected this service on 8 January 2014 the service was meeting all the regulations we inspected.

At this inspection, we found the provider had breached three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to safe care and treatment, good governance and notifications. CQC is considering the appropriate regulatory response to resolve the problems we found in respect of these regulations. We will report on action we have taken in respect of these breaches when it is complete.

There were no processes in place for the monitoring, and reviewing incidents of missed call visits to people. People we spoke with told us that they had either late of missed care visits. They said sometimes the office staff would contact them and other times no contact was made. The service could not appropriately manage missed care visits because there were no records of the numbers or details of them or accurate numbers of people using the service.

The registered manager did not always effectively manage the service. They did not have insight of the quality of care because there were no systems in place that gave an overall view of the service. The Care Quality Commission were not informed of safeguarding incidents that should have been reported to us by law.

Risks to people‘s health and well-being were identified. Risk management plans were not always effective because they did not often relate to the identified risk. Staff were not able to manage risks to people because risk assessments did not give clear guidance to manage and mitigate them.

People’s medicines were not always managed safely. The management of people’s medicines were not safe because staff did not always complete Medicine administration records (MARs) accurately. There were no processes in place to collect completed MARs from people’s homes on a regular basis, therefore the quality audit of these could not be reviewed promptly. The registered manager could not detect medicine errors and take action to reduce the likelihood of unsafe medicine management.

The quality assurance systems were not effective. Checks and monitoring of the quality of care at the service took place. This included feedback from people using the service, staff observations and spot checks. However we found that people’s care records and risk assessments were not regularly checked to ensure they were of a good standard and reflected people’s current needs.

A recruitment process was used by the service to ensure staff employed had appropriate checks carried out before working with people. The registered manager did not always formally follow up results from criminal records checks appropriately to ensure the continued safety of people.

Staff had access to an induction, training, supervision and an appraisal. Staff underwent and induction and shadowed experienced staff. There was a training programme in place that ensured staff completed mandatory training. Supervision meetings occurred with staff and their manager. These identified issues with staff employment and these were recorded but staff or the supervisor did not always sign these records. Staff completed self-appraisal that discussed their progress within their role over the past year. There wer

Harmony Home Aid Services Limited provides a domiciliary home care services across the three boroughs of Bromley, Greenwich and Croydon. We spoke with eight people who used the service and five of their relatives all of which told us they were happy with the services they received. They said they were satisfied with the service and would recommend it to others.

The provider had systems in place to gain consent from people before providing care. We found care plans and support plans in people’s records and one person said “I am happy with my carer she is helping me.”

The provider had an infection control policy in place and staff completed infection control training. Staff had access to personal protective equipment such as disposable gloves and aprons and all the people and relatives we spoke with told us staff used these when providing personal care.

The provider had a complaints policy in place. People were supported to provide feedback on the service they received through regular quality monitoring visits and an annual survey. People told us that when they had raised a concern it had been responded to.

We found the agency had enough qualified and experienced staff to meet people's needs. Staff told us they get to know the needs of people they are allocated to. People told us that they had regular care workers who visited them at home.

Nine people who used the service and their relatives we spoke with told us they were happy with the service they received. They said they found staff were kind and caring, and they felt assured and safe because they received a reliable service.

The agency had high retention levels for carers which contributed to consistency in the service. A person receiving the service said,"I was reluctant to allow a carer provide for my personal care needs, but my views have changed, the carer made me feel me at ease and reassured me, I would be lost without her assistance now".

People were treated with respect and were involved by the agency in decisions about their care arrangements. They found that care staff generally arrived on time and stayed for the time required. Any concerns raised by people with the agency such as timekeeping were responded to promptly and addressed as appropriate.

The agency had experienced members of staff dedicated and assigned to the roles of planning and overseeing the care delivery. This helped to ensure that care was planned and delivered to meet individual needs at the agreed times, care staff felt their workload was manageable as good planning made allowances for travel times from people's homes.

Due to the nature of domiciliary care services where people who receive a service live in their own homes across a number of London boroughs it was not possible on this occasion to speak directly with people who use the service. However Harmony Home Aid Services Ltd had just conducted an extensive quality of service survey amongst people who receive services from them and was able to share the findings with the Care Quality Commission. We received copies of the actual responses the agency received from all of the people who responded to the survey. As these comments reflected their current views of the quality of the service the agency provided, they were used as evidence in Care Quality Commissions compliance review. Responses were as follows:

In response to quality of service surveys all people who use the service who responded said the following:

Staff came on time and showed their ID badges. Communication was good and staff treated people with respect and their dignity was protected. The staff provided people with a good standard of care and people who use the service knew who to complain to if needed. Staff knew what care was needed and they do things the way people who use the service want them to.

Direct comments reflecting common views received from people who used the service were:

“Carers provide a very good standard of care”

“I am very satisfied with the service”

“They treat my mum and dad with respect and are very kind and caring”

“Care workers are consistent and put themselves out to make me safe and comfortable”

One person receiving a service said: “When I had a problem with one worker the management were quick to sort it out”

Two people receiving a service said: “The service is good and could be improved by giving some care staff some training in cooking traditional English food”