This inspection took place on 30 April and 1 May 2018, and was announced.

London Care (Holloway) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to people living with dementia, learning disabilities or autistic spectrum disorder as well as physical disability and sensory impairment. There were approximately 390 people using the service at the time of the inspection. All of them were receiving personal care.

The service had a registered manager in the 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 and associated Regulations about how the service is run. We found that the registered manager had sufficient experience and training to be able to manage the regulated activity effectively.

At our previous inspection on 17, 18 and 19 January 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the agency did not manage people’s medicines safely and did not respond to complaints effectively. Issues around lateness, missed visits and poor communication had not been addressed appropriately and immediate improvements had not been implemented. At this inspection we found that some improvements had been made. More improvements were required to ensure the service fully met the requirements of Regulations and effectively addressed issues around the service delivery.

At this inspection we found improvements in how the agency dealt with people’s complaints. However, further progress was needed as not all people using the service had confidence that the agency would deal with complaints raised by them effectively and to people’s satisfaction.

At this inspection improvements were observed in how the agency managed people’s medicines. Further improvements were needed to ensure that staff competencies in medicines management had been assessed and that staff had access to up to date information about medicines prescribed to people.

At this inspection we found the agency had not assessed risks to health and wellbeing that were associated with the diagnosis of diabetes. Therefore, we were not confident that staff were provided with sufficient guidelines on how to support people with this diagnosis safely.

We saw that risks associated with other conditions had been assessed as staff were provided with guidelines on how to support people. Staff understood their role in reporting of any accidents and incidents. These were recorded and monitored by the management team. We found that the agency had not informed the Commission about two incidents. They should have done it as required by the Regulations and we are currently looking into this matter.

There were sufficient staff deployed to support people and care visits had taken place. However, people told us care staff allocation had not always been consistent and people did not always know which staff member would visit them. This had impacted people as they felt uncomfortable receiving support from different care staff.

People felt safe with staff who supported them. Staff had received safeguarding training and they knew what to do if they thought people were at risk of harm. The agency worked alongside the local authority to ensure any safeguarding concerns had been investigated and actions were taken to protect people. Appropriate recruitment procedures ensured that people were protected from unsuitable staff.

People had their needs and preferences assessed before they started receiving support from the agency. This information was then used to inform plans of care for each individual person using the service. Staff thought care plans were

This inspection took place on 17, 18 and 19 January 2017 and was announced. We gave the provider 48 hours’ notice that we would be visiting their main office to ensure that the registered manager would be available on the day of the inspection.

The service was last inspected on 8 January 2016 and was meeting all the standards that we looked at. However, since the last inspection the service had moved offices and re-registered at a new address. The new location therefore required an inspection for it to be rated under the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

London Care (Holloway) provides personal care and support to people living in their own homes or within supported living schemes. There were 397 people using the service at the time of the inspection.

The service had a registered manager 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.

People and relatives that we spoke with were generally happy with the care that they received. They also told us that staff were caring and ensured that their privacy and dignity was maintained at all times. However, concerns and complaints raised by people and their relatives were consistently around staff arriving late to their call, missed visits and the poor communication from the office informing them of any changes. Although the service had a number of monitoring systems in place, rotas that we looked at did not evidence that care staff were allocated sufficient travel time between each call. The registered manager highlighted to us that they had recognised these issues and that an action plan was in place to address them.

In addition people and relatives also told us that generally from Monday to Friday they received regular and consistent staff to support them. However, at weekends this was not always the case and communication was poor on the part of the service when informing people and relatives of any changes or lateness that may occur.

Complaints received by the service were dealt with according to the provider’s complaints policy. Full details of the complaint, an investigation report with details of actions taken and responses to the most complainants were recorded. An overview of all complaints was available which allowed the registered manager to monitor for any trends or patterns. However, where some records confirmed that the person or their relative had been spoken or written to and feedback had been provided this was not seen for all complaints that had been received. In addition people and relatives feedback was that although they felt able to complain to the service they never received any feedback on the outcome of the complaint.

The registered manager had systems in place to monitor and check the quality of care being provided. This included spot checks, random weekly checks of care plans and staff files, electronic monitoring systems, overviews of staff training and when it was due, missed and late visits, complaints and safeguarding investigations. However, where significant concerns and issues had been raised around lateness and missed visits, or ensuring people and relatives received appropriate feedback upon raising a complaint, this had not been addressed.

Medicines were not always managed safely. Medicine Administration Records (MAR) that we looked at were incomplete as care staff were not always signing the MAR to confirm that medicines had been administered where required. Therefore, we were unable to confirm that people were taking and receiving their medicine as prescribed. The registered manager explained that safe medicines management was a concern that they had already i