About the service: Mackley Home Care Limited is a small domiciliary care agency. It provides personal care to people living in their own houses and flats. It mainly provides a service to older adults. At this service two registered managers share the responsibilities as registered manager, one working on a full-time basis and the other part time. At the time of the inspection there were 15 people receiving personal care from the service.

People’s experience of using this service:

¿ Some improvement was needed to ensure a recommendation we had made at the last inspection in relation to medicines management was fully acted on in a timely way.

¿ The registered manager assessed and monitored the quality of service delivered through spot checks, monitoring visits and audits. However, the medicines audit required some improvement to ensure they were fully effective.

¿ The registered managers worked together and communicated regularly. They understood their roles and responsibilities and their registration requirements.

¿ People and their relatives’ views about the service were sought and considered to make improvements.

¿ The registered managers worked in partnership with the local authority and health and social care professionals to meet people’s needs

¿ People felt safe using the service and staff had a clear understanding of safeguarding procedures.

¿ There were enough staff to meet the needs of people using the service. No new staff had been recruited but there was a system for safe recruitment practices to be followed.

¿ Risks to people had been identified and assessed to ensure people’s needs were safely met.

¿ People were receiving their medicines as prescribed by health care professionals and staff understood how to reduce the risk of the spread of infections.

¿ Assessments of people’s care and support needs were carried out when they started to use the service.

¿ Staff received training and support to meet people’s needs.

¿ 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 support this practice.

¿ People were supported, where needed to maintain a balanced diet.

¿ People told us staff were kind, caring and respected their dignity and privacy. They enjoyed having the same staff members to give them care and support.

¿ People were consulted about their care and support needs.

¿ People received personalised care from staff members who knew them well.

¿ Staff received training on end of life care and end of life care and support could be provided to people when required.

¿ People and their relatives knew how to make a complaint if they were unhappy with the service.

Rating at last inspection: Good (Report published on 13 December 2016).

Why we inspected: This was a planned inspection based on the last inspection rating.

Follow up: We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

.This announced inspection took place on 9 November 2016. We told the provider two days before our visit that we would be coming, as we wanted to make sure the registered manager would be available. At the last inspection, on 4 February 2014, the service was meeting all the legal requirements that we inspected.

Mackley Home Care Limited is a domiciliary care service providing personal care and support for people living in their own homes in the Bromley area. At the time of this inspection there were approximately 25 people using the service.

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. At the time of this inspection the operations manager was in the process of applying to job share with the current registered manager.

People received their medicines when they should and staff had received training on the safe administration of medicines. However we found some aspects of the medicines policies and procedures required updating to include current guidance for staff. We have therefore made a recommendation about some aspects of the safe management of medicines. We will check the progress on this at our next inspection.

People told us they felt safe from harm and well cared for by the service. Care workers had received training on safeguarding adults, so they knew the signs of possible abuse. There were suitable arrangements to deal with a range of emergencies if needed. Possible risks to people were identified and guidance was in place to reduce risk.

People said their care workers were caring and kind, and, that some of them went out of their way to support them. People had the same care worker or small group of care workers, who they said knew their needs and preferences well. People said they were involved in decisions about their care and they were treated with respect and dignity at all times.

People commented that their care workers were reliable and were rarely late. There were enough care workers and office staff to meet people’s needs and the provider followed safe recruitment policies. Staff received suitable training and support to carry out their roles. People were asked for their consent before care was provided and staff were aware of their responsibilities under the Mental Capacity Act (2005). People’s dietary needs were met, where they needed support to manage this. The service worked with health professionals, when necessary, to ensure people’s changing health needs were addressed.

People had an assessed and written plan of care available in their homes; these were up to date and people told us they reflected their needs and individuality. People said they were involved in reviewing the plans and that any changes were updated in the care plan. There was a complaints procedure and people knew how to raise a complaint.

People and their relatives told us the service was efficient and provided consistently good care. It was a small service with a stable management team, who, were involved in direct care delivery and therefore had frequent contact with people. They were therefore familiar with people’s needs and able to directly monitor the quality of the service. There were robust communication systems about people’s needs and staff felt well supported in their roles. People told us they were asked for their views about the service and felt listened to and that the service considered any improvements that could be made.

People we spoke with were happy with the care they received from the agency. People told us the carers mostly arrived on time, were reliable and delivered appropriate care. One person told us “the carer has been coming to me for a long time and knows exactly what I like and is always pleasant and respectful.” Another person said "they were very happy, the staff are kind and caring and very good".

We found that the care was planned and delivered in a way that met people's needs. Risk assessments and care plans were individualised and reflected people’s needs. The provider sought people’s consent and agreement before a care package was started. Staff were aware of safeguarding procedures and knew how to raise concerns. Staff received medication training via an eLearning programme in order to support people to take their medication. Records were adequately maintained and following our visit are now stored securely.

We found that the staff received support and training in different aspects of care to ensure people were cared for by appropriately trained staff.

People we spoke with told us that they were very happy with the service provided and that staff were reliable. People said that staff were polite, courteous and caring. A relative told us they were happy with the service.

We found that care plans had been re written and reviewed on a regular basis and information was clearly documented. Staff were not supported to deliver care and treatment safely and to an appropriate standard because mandatory training had not been completed at the frequency stipulated within the providers policies.

I have a good relationship with my carer.

I consider my carer as part of the family.

Occasionally the carer is late and my mother likes her lunch at 1230 but the office does let her know if this happens.

I’m very happy with my care especially my regular carer, staff are respectful and pleasant at all times.