London Community Care and Support Services is an Outreach service that delivers personal care and support to people, who have a hearing impairment, in their own homes. At the time of the inspection the service was supporting 50 people, two of whom received support with the regulated activity personal care. Not everyone using London Community Care and Support Services receives 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.

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.

The service was previously inspected on 8 August 2016 and was given an overall rating of ‘Requires Improvement’. At this inspection we have changed the overall rating to ‘Good’ for each of the five key questions, ‘is the service Safe, Effective, Caring, Responsive and Well-led?’. Following the last inspection, we asked the provider to complete an action plan to demonstrate what they would do and by when to improve the key questions, ‘Is the service safe’, and ‘Is the service well-led’ to at least ‘Good’.

At this comprehensive inspection we found the provider had made improvements in relation to the safety of the medicines management and risk assessments.

The service had developed risk management plans to keep people safe. Risk management plans gave staff clear guidance on responding to identified risks and were reviewed regularly.

People were protected against the risk of harm and abuse. Staff received on-going safeguarding training to identify, respond and escalate suspected abuse. Staff were aware of the provider’s policy on safeguarding and told us they would whistleblow if they felt their concerns were not addressed in a timely manner.

People were supported by staff that had undergone robust pre-employment checks. People were encouraged to participate in the recruitment and selection of potential staff. Relatives confirmed there were sufficient numbers of staff deployed to keep people safe. Staff received on-going training in areas the provider deemed as mandatory. Staff reflected on their working practices through regular supervisions and annual appraisals.

The provider ensured systems and processes in place recorded and monitored people’s medicine. Staff received training in supporting people to receive their medicines as intended.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had sufficient knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s wellbeing was regularly monitored to ensure their health was maintained. Staff supported people to access a wide range of healthcare professional services. Where people’s care package included support with meal preparation, this was delivered and people were encouraged to maintain a healthy lifestyle.

People’s care plan were person-centred to meet their needs. Care plans were regularly reviewed and people were supported and encouraged to participate in the development. The provider demonstrated a commitment to providing people with accessible information to ensure they understood the care and support they were receiving.

People were aware of how to raise their concerns and complaints. The provider managed complaints in a timely manner, seeking positive outcomes for those involved.

The service carried out regular audits and sought feedback from stakeholders to drive improvements. Audits and fee

We conducted an inspection of London Community Care and Support Service on 8 August 2016. This was our first inspection of the service since registration with the Care Quality Commission. The service provides care and support to deaf people living in their own homes. There were 34 people using the service when we visited.

There was a registered manager at the service. 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 identified two instances where specific risk assessments were required and had not been produced. Support plans were otherwise thorough and contained clear information for staff. All records were reviewed within three months or where the person’s care needs had changed.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard people they supported. Staff had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. Specific details about people’s life histories were also recorded within their care records.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role.

Care workers were provided with appropriate training to help them carry out their duties. Care workers received regular supervision and appraisals of their performance. There were enough staff employed to meet people’s needs.

People were supported to maintain a balanced and nutritious diet. People were supported effectively with their health needs and were supported to access a range of healthcare professionals when needed.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

The systems in place to monitor the quality of the service were not always effective. We saw a copy of a recently completed audit which included a check of care records. However, this section of the audit was not completed and therefore issues with risk assessments were not identified. We saw evidence that feedback was obtained from people using the service and the results of this was positive.

We have made a recommendation in relation to medicines management and we found a breach of regulations in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.