This announced inspection took place on 14, 15, and 16 May 2018.

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. At the time of inspection, the provider was supporting 48 people with personal care.

Not everyone using Harmony Homecare Limited receives 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.

There was a registered manager in post, they were also the provider. 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 our last inspection on the 7 and 12 April 2016, we rated the service "Good." At this inspection we found that the service 'Required Improvement'.

The quality assurance processes in place to monitor the quality and safety of the service and drive improvement required strengthening. Audits had not identified gaps in the information provided on medicines administration record charts (MARs) or gaps in the recording of medicines administered to people.

Staff recruitment procedures needed to be strengthened to ensure that all necessary risk assessments had been completed as part of the staff selection process.

Staff induction training and some on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles. However, staff would benefit from regular updates of a broader range of training. We have made a recommendation about the scheduling of staff refresher training.

Staff were well supported by the registered manager, and had regular supervision meetings.

People continued to receive safe care. Staff understood their responsibilities to keep people safe from harm. Safeguarding procedures were in place and staff understood their duty to report potential risks to people’s safety.

Risk assessments were in place to manage risks within people’s lives. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staffing levels ensured that people's care and support needs were safely met. People received support from a regular team of staff, who knew them well. Staff treated people with kindness, dignity and respect and provide their care based on their needs and wishes.

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 involved in their own care planning and were able to contribute to the way in which they were supported.

Staff supported people to access support from healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

The provider had a process in place which ensured people could raise any complaints or concerns.

Further information is in the detailed findings below.

This inspection took place on 7 and 12 April 2016 and was announced.

Harmony Homecare Limited provides personal care to people who live in their own homes in order for them to maintain their independence. At the time of our inspection the provider confirmed they were providing personal care to 77 people.

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.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse and people had risk assessments in place to enable them to be as independent as possible.

Staffing levels were adequate to meet people’s current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

People told us that their medicines were administered safely and on time.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People were able to choose the food and drink they wanted and staff supported people with this, and people were supported to access health appointments when necessary.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People were involved in their own care planning and were able to contribute to the way in which they were supported.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The people we spoke with knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed

During our inspection of Harmony Home Care we set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Below is a summary of what we found.

Is the service safe?

We found that people's needs had been appropriately assessed before they were provided with domiciliary care support. We saw documentary evidence of this in the eight care files we looked at. This meant that staff had the information they needed about people’s care and support needs and were able to provide safe care. We also found that the registered manager had initiated improvements to keep people safe such as the safe storage of medication in their own homes.

Is the service effective?

We saw that individualised care plans and risk assessments were in place that ensured people were supported in an effective way. It was clear from our observations and from speaking with staff that they had a good understanding of the individual care and support needs that people required. We found that prompt action had been taken if there were concerns about people’s wellbeing, either directly with family members or to external professionals such as their GP or district nursing team.

Is the service caring?

When we visited people at home we observed staff responding to people with kindness. We saw that people were supported by knowledgeable and approachable staff. We heard staff speak with people in an encouraging and sensitive way which evidenced their knowledge of people’s individual needs. We found that whenever possible people had been involved in the planning of their care and support requirements so that their wishes were respected. People told us “the staff are very kind; I would recommend Harmony to anyone”.

Is the service responsive?

We found that the assessments had included identifying any risks to people and detailing how staff should care for people to support their safety and wellbeing. This meant that care and support had been provided in accordance with people’s wishes. We read that when people had become unwell the GP, district nurse or family members had been contacted promptly so that a re-assessment of their needs was undertaken.

Is the service well led?

The staff we spoke with had a good understanding of the ethos of Harmony Home Care and their individual part they played to ensure that people were well supported in all of their day to day activities. We found that there was a system in place to monitor the quality and safety of the care and support that was provided by regular spot checks and audits. We saw that satisfaction surveys to gain feedback about the service had been regularly undertaken and that the feedback with regard to the quality of the service was very good. One person told us “I am very happy with the way they help me, I like all the staff". One relative told us “My relative receives consistent staff that know her and what she likes; she feels safe with them”.

We spoke with approximately 20% of the people who received domiciliary care from this agency. This included speaking with twenty people on the telephone and, by prior agreement with each person, we visited five people in their own home.

All the people we spoke with told us they received a good standard of care and support. They told us the staff knew their job and were reliable. One person we spoke with said, “I cannot fault them. They have never let me down.” Other people variously described the agency staff as “ever so friendly and helpful”, “conscientious”, and “very respectful”.

We found this agency was providing a safe, effective, and appropriately managed service.

We carried out a themed inspection that looked at the services provided by domiciliary care agencies. We spoke with ten people on the telephone to ask them about their experience of receiving a service from staff from this agency. With their prior agreement we also visited four people to hear what they had to say and to look at the records maintained by agency staff and kept at each person's home.

All the people we spoke with confirmed that the agency provided a very reliable service. One person told us, "You can count on them. They do a really good job. I am more than satisfied." People told us the care workers who supported them at home were all friendly and always treated them with respect. One relative commented, "I like the way they do their job. They are all so pleasant and know what they are doing."

The people we telephoned at home told us they were very satisfied with the standard of care and support they get from care workers from Harmony Home Care.

Comments from people included, for example:

• "I can rely on them…”

• “The staff are always so friendly and know what they are doing…”

• “They do a good job. I could not do without them."

People said the manager tried to make sure they had the same care workers so they got to know them. They told us this was important to them.