The inspection took place on 5 and 6 April 2018 and was an announced inspection. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. This was the first inspection of Head Office since its registration.

Head Office is a domiciliary care service run by Marieco Care Limited. It provides personal care to people living in their own homes in the community. They provide a service to people with dementia, mental health needs, a learning disability or autistic spectrum disorder, physical disability, sensory impairment, older adults and younger adults.

Not everyone using Head Office receives a regulated activity. The Care Quality Commission 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 Head Office was providing personal care to 106 people in their own homes in the London borough of Waltham Forest.

The service had a registered manager. 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 and their relatives told us they felt safe with staff and found them trustworthy. The provider had robust systems in place to ensure people were protected from harm and abuse. Staff were trained in safeguarding and knew how to report concerns of abuse and poor care. People’s risk assessments were individualised and gave staff adequate information on risks to people and how to manage those risks. People that required support with medicines told us their needs were met safely.

There were sufficient staff to meet people’s needs. People told us staff generally arrived on time and contacted them if they were running late. Staff told us they had sufficient time between care visits. However, due to roadworks in a specific geographical area they were not able to always arrive on time. The registered manager had identified this as an issue and was liaising with people and their relatives regarding finding a solution. Staff were provided with sufficient personal protective equipment to prevent risk of spread of infection.

Staff knew people’s individual needs and abilities. People told us their needs were met by well trained staff. Staff told us they received regular and adequate training and supervision to deliver effective care. People’s nutrition and hydration needs were met. Staff supported people to access healthcare services. People told us staff gave them choices and asked their permission before supporting them. Staff knew people’s right to choice.

People told us staff were caring and respectful. Staff were trained in equality and diversity, and respected people’s wishes and privacy. People’s religious and cultural preferences and needs were recorded and met. Staff encouraged people to be independent.

People’s care plans were personalised and gave information on their background history, likes and dislikes. Staff were trained in person-centred care and knew how people liked to be supported. People and their relatives knew how to make a complaint. Relatives told us their complaints were addressed in a timely manner. The provider did not discuss people’s end of life care wishes. We have made a recommendation about the management of people's end of life care wishes.

The provider had systems and processes in place to assess, monitor and evaluate people’s safety and quality of care. However, we found the audits did not always identify gaps in people’s care related documents including care plans, consent to care forms, medicines administration record charts an