This announced inspection took place on 10 May 2018. At our previous inspection on 28 and 29 May 2016 the service was meeting all the legal requirements we inspected.

Home Care & Support Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to approximately 240 older adults in the London Borough of Bromley. Not everyone using Home Care & Support Limited receives the 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. At the time of our inspection there were 148 using the service.

At this inspection we found improvement was required because where risks to people were identified, risk management plans did not always have detailed guidance in place for staff on how to manage these risks safely. Medicine Administration Records (MAR) had not been properly completed to detail why people had sometimes not had their medicines. People did not have protocols in place for their 'as required' medicines (PRN). The provider did not have effective processes in place to monitor the quality of the service as they had not identified the issues we found at this inspection.

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.

There were appropriate safeguarding and whistleblowing procedures in place and staff knew how to safeguard people and how to raise any concerns. Accidents and incidents were logged and investigated in a timely manner. People were protected from the risk of infection as staff had been trained in infection control. Appropriate recruitment checks took place before staff started work. There were enough staff deployed to meet people's care and support needs.

Staff completed an induction when they started work and they had received training that was relevant to peoples’ needs. They were supported through regular supervisions and appraisals. Staff also obtained people’s consent before assisting them with their care needs. People's needs were assessed to ensure the service could meet these. 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 also supported to have a balanced diet and had access to a range of healthcare professionals when required to maintain good health.

People told us staff were kind and caring. Staff respected people’s privacy and dignity, and they encouraged people to be as independent as possible. People were involved in making decisions about their daily care and support requirements and were provided with information about the service in the form of a service user guide.

People were involved in planning their care and support. They were aware of the provider’s complaints procedure and knew how to make a complaint. Complaints were managed and dealt with in a timely manner. Staff had received training on equality and diversity. The registered manager said that the service would support people according to their diverse needs where required. Where appropriate, people had their end of life care wishes recorded in care plans.

The provider carried out regular spot and competency checks to make sure people were being supported in line with their care plans. Regular staff meetings were held and feedback was sought from people about the service through telephone checks and annual surveys. Staff were complimentary about the service and said that they enjoyed working for th

This inspection took place on 28 and 29 April 2016. We gave the provider 48 hours’ notice we would be visiting to ensure the registered manager would be at the service. At our previous inspection on 06 and 11 June 2014 the service was meeting all the legal requirements we inspected.

Home Care & Support Limited provides personal care and support for approximately 240 people in their own homes in the London Borough of Bromley. On the day of our inspection there were 240 people using the service.

Home Care & Support Limited had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

There were systems in place that ensured people received their care on time and people were kept safe and their needs were met. Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. The service had systems in place to manage accidents and incidents whilst trying to reduce reoccurrence.

Medicine records showed that people were receiving their medicines as prescribed by health care professionals.

There were enough staff on duty to meet people's needs and there was an out of hours on call system.

The provider conducted appropriate recruitment checks before staff started work to ensure staff were suitable and fit to support people using the service.

Staff training was up to date. Staff received supervision, appraisals and training appropriate to meet people’s needs and enable them to carry out their roles effectively. There were processes in place to ensure staff new to the service were inducted into the service appropriately.

The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and acted according to this legislation.

People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with kindness and compassion and people's privacy and dignity was respected. People were provided with information about the service when they joined in the form of a 'service user guide' which included the service's complaints policy.

People were involved in their care planning and the care and support they received was personalised and staff respected their wishes and met their needs. Support plans and risk assessments provided clear information for staff on how to support people using the service with their needs. Support plans were reflective of people's individual care needs and preferences and were reviewed on a regular basis. Peoples' care files were kept both in people's home and in the office. People were supported to be independent where possible such as attending to some aspects of their own personal care.

People and their relatives knew about the home's complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

People told us they thought the service was generally well run and that the registered manager was supportive. There were systems in place to carry out staff spot checks to ensure consistency and quality was maintained whilst supporting people in the community. The registered manager was aware of their responsibilities as a registered manager in relation to notifying CQC about reportable incidents.

There were effective processes in place to monitor the quality of the service and the registered manager recognised the importance of regularly monitoring the quality of the service provided. People and their relatives were provided with opportunities to provide feedback about the service.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were aware of the importance of consent and people were asked for their consent before care was provided. People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support.

The manager and other supervisors were available on a daily basis and out of office hours to oversee the staff, and monitor that people were being safely supported, for example in helping people to be safe during personal care. The staffing levels were agreed appropriate to people’s assessed care needs. We were told by staff and people who used the service that the agreed numbers of staff were available when providing support. And that staff were on time and responded to requests for additional support such as calling the GP if requested.

There were arrangements in place to deal with emergencies and to make sure people were safe. People's health needs, such as epilepsy were included in their care planning to ensure that important health needs were met. The staff and manager were trained in protecting people from neglect or abuse and people told us they felt safe in their home.

Staff wore uniforms and carried photographic identification issued by the agency, to ensure that people who used the service were able to identify them and feel safe. All of the people we spoke with said that the staff always used these items and many said it helped them to be confident about who arrived at their door.

All of the 40 people we spoke with who used the service said they felt safe in the way staff supported them. The majority said that staff were well trained and knew how to support them.

Is the service caring?

We spoke with 40 people who used the service or their families and people told us that the staff and supervisors were very caring and supportive. Many said staff always took the time to speak with them and spoke with them in a manner they understood. One person said: “the staff are very conscientious never make me feel uncomfortable.” Another person said:” I think the standard is very high, staff are down to earth and will have a laugh with you, and are willing to do any little thing I ask.”

Is the service effective?

We saw from 12 people’s records we looked at that people's needs were assessed and a plan drawn up to meet those needs. People we spoke with told us they were happy with the plan provided. Regular reviews were made of the plan provided and people or their families told us they were involved in the reviews.

There were suitable policies in place for consent to care, assessing and planning care, safeguarding people, medication and quality assurance. All of the people we spoke with told us the staff knew how to support them well. People who used the service were consulted for their views on the service they received a regular basis, which involved the person, their family or advocate and social services. We saw that any changes they requested were included in a revised care plan.

People’s medication support needs were assessed and an appropriate level of support was provided.

Staff were provided with adequate support, guidance and training to do their job. They were experienced in supporting people with care needs such as dementia and continence management and they told us that the training they received equipped them to support people with confidence.

Is the service responsive?

People we spoke with who used the service told us that the staff and manager always listen to their concerns and do something to help sort out any problems they are experiencing. People were asked for their views about their service and action was taken to address any problems, for example comments received about some staff speaking about confidential information had been discussed with individual staff where necessary and at team meetings.

People's support plans were reviewed and changed when necessary in response to changing needs, for example in negotiating higher levels of support when necessary, or in changing the time of visits to accommodate support in religious activities. Ten people told us that staff responded to requests for additional help such as making phone calls to family of GPs if needed, which they said was very helpful.

Is the service well led?

The registered manager was qualified and experienced and was involved in the day to day management of the service. There was an out of office hours on call system in operation to ensure that management support and advice was always available. There was a system for doing spot checks on staff working with people to monitor the quality and safety of care provided. Comments received from people who used the service and families included: “the supervisors are very good and regularly call in to see how the staff are doing, I once had a problem with one staff and it was dealt with immediately,”

Staff we spoke with told us that they felt the agency was very well managed and they received direction and training to help them to support people. Regular staff meetings and supervision sessions were held and staff said they felt able to raise any issues with the management openly and honestly, and felt the manager followed up on any issues quickly.

People who used the service told us that they felt the agency was well managed and that they had regular contact from the office to check that their support was happening as planned.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed.