HF Trust Kingston Domiciliary Care Agency (DCA) provides care and support for 14 people with learning disabilities, who live in their own homes in the borough of Kingston. This service includes assistance with bathing, dressing, eating and medicines, home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. We only looked at the service for the 11 people receiving personal care during this inspection as this is the service that is regulated by CQC.

At the last Care Quality Commission (CQC) inspection in October 2015, the overall rating for this service was Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards.

People remained safe in their homes. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with people’s homes, to help keep people and staff safe. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. We observed staff gave people time to make their own decisions and gave them the encouragement and support to do so. Staff were providing support in line with the Mental Capacity Act 2005. People were supported to eat and drink sufficient amounts to meet their needs. When required staff supported people to access a range of healthcare professionals.

Respondents to our survey said staff were caring, kind and efficient and respected their privacy and treated them with dignity.

People’s needs were assessed before they started to use the service and care was planned and delivered in response to their needs. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

Staff we spoke with described the management as approachable and easy to get on with. Systems were in place to monitor and improve the quality of the service. The provider had effective quality assurance systems to monitor the scheme’s processes. These systems continue to help ensure people received the care they needed as detailed in their support plans.

We spoke with three people who use the service and their relatives, two care managers, four support workers and the manager during this inspection.

"Staff listen", "I make decisions" and "I'm not worried about anything" were just a few of the comments from people who use the service. People told us that staff respected their privacy; they said that they made choices about important things in their lives and they felt able to raise any issues.

Relatives' comments included "the service is well run", "staff treat people properly", "they empower them to do things", "the care provided is good" and "we are involved in care planning and reviews".

Care managers reported that the service had "declined over the last year" which they felt was due to a lack of consistency of staff. They said that they were aware of the providers action plan to make the required improvements and said "the right things are being done". One care manager said that they were "kept informed of issues" and said that this was one of the things the service did well.

Support workers told us that they had the training and support they needed to carry out their job. They said some of the things the service did well was provided good care, worked flexibly with people, encouraged them to do their best and gave them opportunities to make decisions in their lives.

We saw that the provider was working through an action plan to improve services provided. The system for notifications needed improving.

We spoke with two people who use the service while they were at their day centre about the domiciliary care service they received and four members of staff during this unannounced inspection.

People who use the service were happy with the services provided, saying "staff listen", "staff help", "staff maintain my privacy" and that they liked the staff. People said that they felt safe using the service, saying "I would speak to my relative or a member of staff if I was worried about anything".

Support plans seen were person centred and reviewed regularly, giving staff detailed information to help them meet the individuals needs.

Staff told us that it was a good place to work, saying "we respect people", "the service is person centred", "we go into people's homes and support them in the way they want" and "we look to match staff to individuals". Appropriate systems were in place to recruit staff. Staff said they had good access to training, although they had not had regular supervision.

This inspection took place on 14 and 15 October 2015 and was announced. We told the provider two days before our visit that we would be coming. At the last inspection on 23 October 2013 the service was meeting the regulations we checked.

HF Trust Kingston Domiciliary Care Agency (DCA) provides care and support for 14 people with learning disabilities, who live in their own homes in the borough of Kingston.

The service had a registered manager in post. 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.’

People told us they felt safe with the support they received from staff. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place to inform people who used the service and staff how to report potential or suspected abuse.Staff we spoke with understood what constituted abuse and the steps to take to protect people.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe.

The registered manager ensured there were safe recruitment procedures in place to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Staff received training in areas of their work identified as essential by the provider. We saw documented evidence of this. This training enabled staff to support people effectively.

Appropriate arrangements were in place in relation to administering and the recording of medicines which helped to ensure they were given to people safely.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. Staff supported people to make choices and decisions about their care wherever they had the capacity to do so. Where people did not have the capacity to make their own decisions, other professionals and families were involved in making decisions for people that were in the person's best interest.

People chose their meals and were supported to have a varied nutritious diet, to eat and drink well and stay healthy. Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

People were involved in planning the support they received and their views were sought when decisions needed to be made about how they were supported. The service involved them in discussions about any changes that needed to be made to keep them safe and promote their wellbeing.

Staff respected people’s privacy and treated them with respect and dignity. Staff supported people according to their personalised care plans, including supporting them to access activities of their choice.

The provider encouraged people to raise any concerns they had and responded to them in a timely manner. The complaints policy that was provided in an easy read format.

Staff gave positive feedback about the management of the service. The registered manager and senior staff were approachable and fully engaged with providing good quality care for people who used the service. The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions and action plans were developed where required to address areas for improvements.