About the service:

• This service is a domiciliary care agency.

• It provides personal care to a range of adults living in their own homes, of Jewish faith, with a broad range of physical and mental health needs.

People’s experience of using this service:

• People and their relatives told us they felt safe and were happy with the care provided.

• People told us staff were able to look after them well and had the skills to care for them.

• There were enough staff to meet people’s needs; some people told us staff did not always tell them when they were running late.

• Care records promoted person centred care, but the service was not recording medicines administration and support safely at the time of the inspection. The service have made improvements since the inspection.

• Risks identified with caring for people were recorded for the majority of concerns, but the service did not always provide enough detail for staff to support people with significant mental health needs. The service has made improvements in this area since the inspection.

• People and their relatives told us they provided feedback on the service, and they thought it was well run. However, we were concerned at the lack of accurate contemporaneous recording of medicines administration records and lack of effective provider oversight of medicines management. We were of the view the service was not always well led.

• The service met the characteristics for a rating of "Requires Improvement" in two out of five key questions we inspected. We found there was a breach of the regulations in relation to governance of the service. Therefore, our overall rating for the service after this inspection was "Requires Improvement". We have also made a recommendation in relation to the staff understanding of the Mental Capacity Act 2005.

More information is in our full report.

Rating at last inspection: At our last inspection, the service was rated "Requires Improvement". Our last report was published on 27 March 2018. At the last inspection we found two breaches of the regulations related to the safe management of medicines and the governance of the service.

Why we inspected: This inspection was part of our scheduled plan of visiting services in line with the “Require Improvement” rating, to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This inspection took place on11 December 2017. Jewish Care North London and Hertfordshire Home Care Service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. At the time of the inspection the service was supporting 34 people.

At our last inspection on 10 and 11 August 2016 there was a breach of the regulations related to safe care and treatment as risk assessments were not always in place to provide guidance to staff. The service had been rated as ‘Good’ overall in August 2016.

A registered manager was in post at the time of the inspection. 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.

Medicines were not always managed safely although the provider was addressing this at the time of the inspection.

Whilst there were quality assurance processes in place they did not always find the issues of concern we found at the inspection. The registered manager was well regarded by people using the service, and staff told us they felt supported and that they received sufficient training and supervision. Records confirmed staff received appropriate training for their role.

At the last inspection we found issues with risk assessments but this was addressed by the time of this inspection.

People told us they were happy with the service provided and they usually had the same carers which they valued. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, and understood issues of consent. The provider had policies and systems in place to support this practice.

Safe recruitment processes were in place so staff were considered safe to work with vulnerable people. Staff understood the importance of safeguarding and the provider referred concerns to the appropriate authority and notified CQC as required.

The provider had a complaints process in place which dealt with formal complaints, but were not always capturing day to day concerns, however the provider told us they would consider how to do this.

We found the provider was in breach of two fundamental standards. These related to safe care and treatment and the governance of the service.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 10 and 11 August 2016. The inspection was announced and the provider was given 48 hours’ notice that the inspection was going to take place to ensure that the registered manager would be available throughout the inspection process.

The service was last inspected in January 2014 and was found to be meeting all the outcomes that were looked at during that time.

Jewish Care North London and Hertfordshire Homecare Service provide domiciliary care services to approximately 44 older people living in their own home. The service only provides personal care and support to members of the Jewish community. People are supported with a variety of health needs including supporting those living with dementia, physical disabilities and other high care needs.

A registered manager was in post at the time of the inspection. 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.

Feedback received from people and relatives was positive and people were happy with the care and support that they received from the agency.

Each person had a detailed care plan which included information about the person and the care and support that they required. A pre-service assessment had been completed along with an environmental and generic risk assessment which identified some common risks associated with people’s care and support needs. However, although the service identified individualised risks associated with people’s care, these risks were not assessed and relevant information was not available in order to mitigate those identified risks in order to keep people safe from harm.

Care plans were detailed and person centred. People’s likes and dislikes as well as choices and preferences had been recorded. A background history of the person had also been recorded which gave insight about the person and their life history.

The registered manager, assistant managers and care staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA). Training records confirmed that each staff had received training on the MCA. In addition, each care plan that we looked at had been signed by either the person receiving care or where the person was unable to sign, a relative had signed on their behalf consenting to the care and support that they were receiving.

People and relatives that we spoke with were happy with the care that they received and felt safe with the care staff that supported them. Care staff had a good awareness of what safeguarding was and the actions they would take if abuse was suspected.

The service followed safe recruitment processes to ensure that only suitable staff were employed to work with people requiring care and support. As part of the recruitment process staff underwent an in-depth induction period which covered a variety of topics including mandatory training in subjects such as manual handling, first aid and safeguarding.

Care staff told us that they felt supported in their role and received regular supervision. Records that we looked at confirmed that since the current registered manager had been in place systems were in place ensuring that care staff received regular supervision. However, previous to the current registered manager it was noted that regular supervisions were not taking place.

People were supported with their medicines by care staff. Systems and processes were in place to ensure safe management of medicines. However, where care staff were required to administer medicines we found that care staff did not complete a Medicine Administration Record (MAR) confirming which medicines and at what times these medicines had been administered. An in-house daily recording sheet was completed but this d

We received feedback from 29 people who use the service and or their representatives. The feedback was positive from most people about the support they had received. Comments included, "they are all nice people - never had anyone who was rude or upset me in many many years” and “It’s the relationship that matters. I can tell that my carer is a very caring person in the way she talks about other clients in such a loving way.”

We found that people's rights to receive information about the care and treatment they received, in order to give informed consent, were respected. People's views on service quality were routinely asked for or acted on, and risks to people from missed and late visits were identified and addressed. We also found that when some people started using the service, their needs and risk factors were assessed promptly by the agency. Individual care review visits took place in a timely manner.

We found that there were effective recruitment processes in place to help ensure that people were cared for by suitable staff who were adequately supported by the agency. Systems to assess and monitor the quality of service were effective.

People using the service were treated with respect and their views taken into account. Staff described how they showed an interest in people and listened to them. A person we spoke with told us “I said what I wanted. They wrote it and I signed.”

Care plans were up to date and continuity of care was delivered. The provider had taken reasonable steps to protect people from the risk of abuse. People using the service told us “I feel safe here.”

Staff were supervised and trained regularly. We found there had been delays in receiving some training. The induction programme was comprehensive. However, the manager confirmed that staff sometimes worked alone with people in the two or three months it could take for the formal five day part of the programme to start.

Surveys showed high levels of satisfaction with the service and issues had been identified and managed. Systems were also in place to identify, assess and manage risks to people using the service, protecting them from inappropriate or unsafe care.

We spoke to people who use the service and their relatives regarding their experiences of using care provided by the agency. We also asked an expert by experience to talk to people regarding their care. An expert by experience has personal experience of using or caring for someone who uses a health, mental health and/or social care service. Most of the people told us they had been provided with information regarding the service. People told us the agency explained to them how their needs could be met. They said that they were treated with respect and dignity. The following were a few of people's comments:

"[Staff] are wonderful, amazing."

"The carers are like family."

Some of the people we talked to said they could not remember receiving information about their care. When we asked if people were able to make decisions or choices, a person told us they did not have much choice as "[the agency] kept changing the goal posts". Most of the people we talked to told us staff were punctual and did all required tasks. However, a few people told us that staff kept changing the agreed time without consultation. This meant that some people could be put at risk as they were not receiving appropriate care and support on time.

People we spoke to said they were satisfied with the care they received. A person confirmed that they had a care plan which was regularly reviewed. A person told us that their opinions were sought and they had signed to confirm their agreement to the care plan. Most people we talked to were satisfied with their care. The following were some of people's comments:

"I am extremely happy with [the agency".

"The lady who now comes is very nice and obliging".

"A very kind and nice lady visits me".

We also noted that the care provided to some people were sometimes less than people's expectations. We were told that staff did not always respond to people's religious needs. We were told that despite people's satisfaction with their care plans the outcomes were not satisfactory because people did not always turn up on time or stay to complete tasks. The following comment summarise people's views:

"[The staff] are a bit abrupt sometimes and always seem in a hurry".

People told us they trusted staff and felt safe. A person commented: "The carers are delightful". Many people told us the agency gave them information about abuse and they knew who to contact if they had concerns. People told us that they had rung the agency and were able to discuss their issues with the staff. Some people said they did not have an immediate response to their telephone calls to the agency's office.

People who use the service told us that they "had a variety of care workers" that provided them with care and support. They said in most cases the care workers were known to them and knew what was required of them. People stated that they were satisfied with the care provided by the agency. A person said: "[The agency] is very understanding. There is no question of a lack of training". Another person felt staff had appropriate training and were "quite good".

However, a person felt that the attitude of some staff was not satisfactory. A person told us some staff needed more training to ensure they are always respectful to people and understood each person’s care and support needs.

People's views about the agency's arrangements for asking them for feedback about the service that they received were mixed. Many people told us the agency sent them "all kinds of surveys". Some people told us they had never received a survey form from the agency. However, people said staff asked them if they were satisfied with their care. A relative told us they could contact the staff to talk to them about the wellbeing of a person. They said the management and staff were accessible.