This inspection took place on 9 and 10 October 2018 and was announced. The provider was given 24 hours notice of the inspection as they provide personal care to people in their own homes and we needed to be sure someone would be available in the office during the inspection.

The service was last inspected in June 2018 when we identified the service had not yet met breaches of regulations identified in January 2018. We required the provider to submit regular updates on their action plan to address our concerns.

At this inspection we found the provider had made progress since our June 2018 inspection. However, the service was not operating at full capacity and issues with the quality of care plans, risk assessments and deployment of staff remained.

London borough of Waltham Forest – Independent Living Team is registered to provide personal care to people in their own homes. They provide up to six weeks support to people to help them regain their independence and confidence. At the time of the inspection in October 2018 they were providing personal care support to approximately 20 people. The provider told us their target operating capacity was 45 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.

Risks to people were identified as part of the assessment process. However, the measures in place to mitigate risks were not always clear and not all risks had been subject to a risk assessment. The service was not supporting people to take medicines at the time of this inspection so we were not able to evaluate if they had made progress in this area.

The provider told us they had made significant improvements in terms of staff deployment. Although there were now fewer missed visits, staff punctuality was poor and people experienced a lack of continuity in their reablement officers. Despite operating well below their usual capacity, the service was unable to offer people fixed times for their care and did not demonstrate a person centred approach to scheduling.

The provider had made improvements to their referral and assessment process. People and referring agencies now had much better information about the nature and scope of the service. Assessments were completed in a timely manner and people told us they were involved in the process. However, although there were improvements in terms of capturing information about people’s personal history, care plans continued to lack detail about how staff needed to support people to achieve their goals. Information about people’s health conditions and the impact these had on people’s care was not consistent and was not always clear. The service was not consistently exploring the impact of people’s sexual or gender identity, religious beliefs or cultural background on their care preferences. We have made a recommendation about including these aspects as part of the assessment and care planning process.

The provider had strengthened their governance and quality assurance systems. However, they were not yet operating effectively and had not always identified issues with the quality and safety of the service.

The provider collected feedback from people at regular intervals but did not always capture negative feedback as complaints. Complaints were investigated and responded to in line with the provider’s policy, but as the systems did not include negative feedback some issues had not been identified by thematic analysis. We have made a recommendation about complaints.

People told us staff treated them with kindness and compassion. Staff told us the provision of additional time when they visited someone for the first time helped them establish positive, caring r

This focussed inspection took place on 5 June 2018 and was announced. The service was last inspected in January 2018 when we issued warning notices for breaches of regulations regarding safe care and treatment, person centred care, staffing and good governance. These required the provider to be meeting the regulations regarding safe care and treatment and person-centred care by 10 April 2018. The date for compliance with regulations about staffing and good governance are in September 2018 as significant structural changes were required which take time to implement.

Following the inspection in January 2018 we met with the provider and asked them to complete an action plan to show how they would make the improvements required to the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements for safe care and treatment and person centred care. This report only covers our findings in relation to those requirements. We inspected the key questions: Is the service safe, and is the service responsive? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

London Borough of Waltham Forest, Independent Living Team is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to adults. The service is designed to provide short term support to people to enable them to achieve independence and regain skills they may have lost following a change in their circumstances, such as an admission to hospital.

The service is required to have 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. We have received an application from the interim service manager to become registered with us.

The provider had failed to take effective action to improve the safety of the service. Risks had not been appropriately identified and measures in place to mitigate risks were unclear and insufficient. Staff did not have access to all the information held by the service about how risks were mitigated.

People told us they were not fully involved in their assessments and writing their care plans. Relatives told us they were involved. The quality of care plans had not improved. They remained task focussed and did not include information about people’s preferences or guidance for staff about how to support people to achieve their goals. Care plans were not completed in a timely way which meant staff relied on commissioning referrals for information about how to meet people’s needs.

The service was not providing support to people who needed help to take their medicines.

Staff knew how to raise concerns that people were being abused. The safeguarding lead in the borough now felt confident staff understood their role and responsibility in relation to safeguarding adults. People told us they felt safe with staff.

The service had not directly recruited any new staff. Although we did not inspect staff deployment as the dates of the warning notice have not passed, people and staff told us issues with scheduling and timekeeping remained.

People told us staff followed good hand hygiene practice and we saw personal protective equipment was available for staff.

Record keeping around incidents had improved and the service was able to show where actions had been taken in response to incidents.

People knew how to make complaints. Records showed complaints were responded to in line with the provider’s policy.

The service had clarified the referral criteria so it was clear to referring agencies the service was not suitable fo

This inspection took place on 23 and 24 January 2018 and was announced. The provider was given 48 hours notice of the inspection as they provide personal care to people in their own homes and we needed to be sure someone would be available in the office during the inspection.

The service was last inspected in July 2016 when we identified breaches of three regulations regarding person centred care, staff training and support and good governance. We asked the provider to complete an action plan to show what they would do by when to address these breaches and improve the key questions of Effective, Responsive and Well-Led to at least good.

Although the provider had taken action to address the concerns around staff training and support, breaches of regulations regarding person centred care and good governance continued. We found additional concerns regarding risk management and medicines and the service had not followed the action plan submitted to us.

The reablement and support at home team is registered to provide personal care to people in their own homes. They provide up to six weeks support to people to help them to regain their confidence and independence. At the time of our inspection in January 2018 they were providing support to approximately 100 people.

The registered manager had left the service in December 2017. 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. The service had just appointed a new team leader who told us they were going to apply to register as manager.

Risks to people during receipt of the service, and in particular in relation to their medicines, had not been appropriately identified or mitigated against. Risk assessments had been completed, but these delegated actions to mitigate risk to people’s relatives and did not inform staff what they needed to do to keep people safe. There was insufficient information about people’s medicines to ensure they were managed in a safe way.

People told us they felt staff had to rush, and did not attend at specific times. Staff told us they were unable to complete aspects of their work because they did not have capacity. Schedules for reablement officers were compiled in a way that meant it was impossible for them to deliver care on time. There were not enough staff deployed to ensure people’s needs were met.

Care plans were not personalised and did not reflect people’s needs and preferences. We saw generic templates were in use and people did not feel involved in the process of needs assessment and care planning. There was limited information about people’s dietary needs and preferences, and care plans did not contain information about how people’s healthcare conditions affected their support needs. There was some information about people’s culture and background, but there was no information about the impact people’s personal circumstances had on their experience of care.

The management and governance structures had not operated effectively to identify and address issues with the quality and safety of the service. Audits were not completed as scheduled and feedback about the quality of the service was not reviewed. There was no analysis completed of call monitoring data, complaints or incidents to ensure lessons were learnt.

People and staff told us their relationships were affected by inconsistent rotas, changing times and staff. People told us individual reablement officers were kind and treated them with respect.

Staff were recruited in a way that ensured they were suitable to work in a care setting. Improvements had been made to staff training and support. Staff received the training and supervision they needed to perform their roles.

The service worked well with othe

The inspection took place on 27, 28 and 29 July 2016. The inspection was announced.

At our last inspection the service was non- compliant in supporting staff but they became compliant before this inspection.

London Borough of Waltham Forest Reablement & Support at Home Team is a service that supports people in their own homes to achieve their independence within six weeks of support. At the time of our inspection, 110 people were using the service

The service should have a registered manager. The current interim manager was in the process of applying to the Care Quality Commission.

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 were kept safe while using the service. Staff understood how to report abuse and were proactive in doing this at the service. The service was based at the council and the local safeguarding team was based there as well and provided support to staff. Some staff were not aware they could contact the CQC with safeguarding matters.

Medicines were not administered by staff at the service. A new medicines policy had been introduced to ensure staff were aware of the level of support they could provide to people with their medicines. This was now being followed by staff.

Risk assessments were carried out to ensure people’s home environment was safe and to check any equipment in their home was safe. Reablement staff told us that if the risk assessment had not been performed before they arrived to start support they would check for risks and inform the office. This helped to keep people safe.

The risk of infection was minimised as staff wore protective clothing. However senior reablement staff were concerned about the risk of cross infection where staff did not change their uniforms after leaving people’s homes with an infectious disease. We have made a recommendation about reducing the risks of cross infection from staff uniforms..

Recruitment was carried out safely and we saw that the service carried out regular criminal records checks every three years to ensure people were cared for by staff of good character.

Staff told us they felt supported as they could approach the interim manager, head of service and colleagues for advice. Staff received an annual appraisal but staff were not receiving regular supervision and training to support them in their role. Staff told us through their years of experience they felt they were good at their job and people told us that staff were good at what they did.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and made sure to obtain people’s consent before providing care. However there were no records of recent training in the MCA.

Staff were very passionate about their job and people and their relatives told us that staff were very caring, kind and patient. People’s dignity and privacy was also respected by staff.

People’s care plans were not person centred. People were set reablement goals which were generalised and sometimes covered many other goals. Furthermore, how staff were to enable people to achieve their goals was not clear. Staff told us they felt more information could be written to explain how to support people to be independent.

Records showed that the level of detail written in people’s care plan was limited and more information was recorded on the service computer system.

We have made a recommendation in following best practice on writing care files.

People were cared for by staff who were prompt in meeting their needs, for example where they had identified if changes in support were required. Staff recorded their observations and people received regular reviews of their care so they were aware of their progress.

People did not

The registered manager was responsible for monitoring the quality of the service, through the auditing of records, review of systems and feedback from people who used the service, their relatives and staff. ‘Client feedback forms’ which had been newly developed and introduced demonstrated that in general people had been satisfied with the service they had received. The ‘service user guide’ had been recently revised to include some additional guidance requested by staff and we saw evidence that a system had been introduced by the provider to analyse data collected from people who use the service on a three monthly basis.