This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults. At the time of our inspection there were around 200 adults using the service.

We gave the service two working days’ notice of the inspection to ensure a senior member of staff would be available to meet with us. This inspection took place on 10 January 2019.

At our last focused inspection of the service in January 2018 we found breaches in the regulations relating to safe care and treatment and good governance. This was because staff lateness and missed visits meant people were at risk of neglect. In addition, people’s medicines were not always managed safely by staff. The provider lacked governance systems to identify and improve in relation to the concerns we found. At this inspection we found the new management team had improved the service in all areas and people received a good standard of care.

There was no registered manager in post at the time of our 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. In October 2018 a new manager began overseeing the service with close support from a registered manager from another branch, the quality assurance team and director of care. Processes were in place to register a manager with us.

People were cared for by the right number of staff needed to keep them safe. The provider monitored visits closely to ensure people received care at the right time and there were no missed visits. Staff stayed for the allocated time. Staff were recruited through processes which checked they were suitable.

Risks relating to people’s care, including moving and handling, infection control and health conditions were well managed as staff understood the risks and had clear guidance to follow in reducing them. The provider improved their oversight of medicines management ensuring staff were suitably trained and supported and medicines records were frequently audited. Staff understood their responsibilities to safeguard people from abuse and staff were encouraged to whistle blow regarding any poor practice.

Care plans were reliable in guiding staff as they contained accurate information and were regularly reviewed. People were involved in developing and reviewing their care plans. People received their choice of food and drink and any support they required relating to their day to day health. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff received a suitable programme of induction and training to help them understand their roles and responsibilities. A supervision schedule was in place to improve the frequency staff received supervision.

People found staff to be kind and caring and staff understood people’s needs. People were supported to maintain their independence. People felt the provider listened to them and acted on any concerns or complaints they raised. The provider communicated openly with people and staff and had systems to gather feedback and make improvements.

Leadership at the service was visible with a clear hierarchy. The managers and staff understood their roles and responsibilities. The provider had good oversight of the service.

This service provides a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults. At the time of our inspection there were around 200 adults using the service.

We gave the service eight working days’ notice of the inspection visit because we needed to be sure the provider was available over the festive season.

This inspection took place on 2, 19 and 22 January 2018.

At our last comprehensive inspection of the service in February 2017 we found it was meeting the fundamental standards and we rated the service Good overall. At this inspection we found the service had deteriorated and the rating was Requires Improvement overall.

There was no registered manager in post at the time of our 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. There had been instability in management since our last inspection and the most recent manager resigned shortly after we announced our inspection. A new manager had permanently transferred to the role from another branch within the organisation a few days before our inspection. The manager in post had promptly made an application to register with us before we inspected the service. We found they understood their role and they told us they were committed to improving the service in light of our findings.

We arranged this focused inspection because of the high number of safeguarding alerts we received relating to missed visits. Since our previous inspection there had been over ten allegations of neglect due to missed calls or people not receiving their care at the agreed time. We found people still experienced problems with missed calls and also lateness. In addition the provider did not always inform people in advance who would be caring for them which made people feel unsafe. When people felt uncomfortable with a staff member the provider did not always respond to their request to no longer send that member of staff. The provider had not taken sufficient action to assess, monitor and improve in relation to these concerns.

People’s medicines were not always managed safely by the provider. Three people told us staff lateness and missed visits meant they did not always receive the right support to take their medicines, some of which were time critical. The provider had not audited people’s medicines in recent months and this had not been identified until the day of our inspection. The provider was unable to show us recent medicines records for people and instead showed us medicines records for one person for July and August 2017 which had several omissions the provider had not identified and was unable to explain. The provider told us they would improve medicines management immediately in response to our findings.

The provider took action to improve systems to safeguard people following safeguarding incidents, including cooperating with the safeguarding investigations by the local authority, carrying out their own internal investigations and reporting back to the safeguarding team. However, the provider had not always thoroughly investigated why missed visits occurred as part of improving the service.

The provider identified, assessed and managed risks relating to people’s care. The provider held a monthly quality forum where all safeguarding investigations, complaints, compliments and accidents and incidents were discussed in depth as part of reducing the risk of recurrence.

The provider carried out recruitment checks on staff to ensure they were suitable to support people. We received mixed feedback from people and relatives regarding whether there were enough staff d

This inspection took place on 10, 12, 14, 23 February 2017 and was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. MiHomecare – Thornton Heath provides personal care for over 340 people in the London boroughs of Lambeth and Croydon. It provides a service to older adults, and younger adults with disabilities.

At the last inspection of the agency in February 2015 the service met all the regulations we inspected.

At this inspection, there was no 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. A new experienced manager was in charge and present during the inspection. A registered manager’s application had been completed and sent to the Care Quality Commission (CQC).

The agency had policies and procedures in place to help protect people from abuse, and staff had a clear understanding of what to do if safeguarding concerns were identified. Contacts and a whistle blowing hotline were available for all staff to enable them share information confidentially and make the working environment transparent. Staff retention was good and helped promote continuity of service. Staff had been recruited, using a robust recruitment process, to check they were suitable and safe to visit or work in people’s homes.

People were safe when using the service because staff had been trained and knew how to protect people in their care. Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them, and protect people from harm. Appropriate support plans and guidance were provided for staff to follow and make sure that people were kept as safe as possible.

Procedures were in place for supporting staff to respond appropriately to emergencies. Care staff had guidance to follow and were aware of the on call service available so that they had access to information and management guidance at all times when they were working.

People told us they felt safe with the care provided. One person told us, "Most carers that come here are punctual; staff are very caring and fit the service around our needs." Medicines were managed safely and people received the support they required from staff. Independence was promoted for as long as possible with clarity about support such as prompting people to take their medicines as prescribed. Where people had help with their medicines they told us this had worked well.

Staff understood and protected people’s human and civil rights. People were asked for their consent prior to care being undertaken. They were encouraged to make as many choices and decisions for themselves as they could. People and their relatives told us they were supported by kind and caring staff. One person told us they were happy with the care and support provided by the members of staff who visited, they said, “The carers are great, they go way above and beyond the call of duty, truly great."

Staff were suitably trained, well supported and helped develop the knowledge and skills required to ensure people’s health and well-being needs were met. If staff competency and performance were an issue, performance improvement plans were put in place to ensure that staff were competent to carry out their duties. Where it was identified that staff needed training in a particular area, this was provided.

The provider had systems in place for seeking feedback from people using the service which included spot checks, customer reviews and quality monitoring visits. The quality of care provided was continually reviewed by management. Developments or improvements in the service were on-going and made, as appro

As part of our review we contacted 20 people who use the service and 11 relatives by telephone. We also visited 1 person who uses the agency in their own home and spoke at length to them and 2 of their relatives.

Most of the people using the service and relatives we spoke with told us they were generally satisfied with the overall standard of care and support they or their loved one received from this domiciliary care agency. Typical comments made by stakeholders we met, included: “I am more than happy with the care provided by Enara” and “Always happy with my regular carers”.

Most stakeholders we met also felt the agency had got much better at seeking their views about how they did things and usually listened to what they had to say. Several people using the service and relatives we spoke with confirmed the agency had recently invited them to participate in a customer satisfaction survey about the Thornton Heath branch of Enara.

The majority of people using the service and relatives told us they felt the package of care and support they had agreed should be provided by the agency was usually delivered so long as their regular carers visited them. However, the provider may find it useful to note that we received some negative comments from a number of stakeholders concerned about a lack of consistency and a deterioration in the quality of care they were provided when their regular carers were replaced by other agency workers.

Some people using the service and relatives with spoke with also told us they felt the quality of the support they or their loved ones were provided by the agency was sometimes compromised because carers were not always turning up when they were meant to and/or staying the agreed length of time to deliver their package of care properly. Nonetheless, these negative comments notwithstanding most stakeholders told us they had begun to see an improvement in the time keeping of their regular carers during the first quarter of 2012.

The majority of stakeholders we spoke with told us they felt most of their regular carers had the right mix of knowledge, skills and experience to meet their needs and deliver their agreed package of care. Furthermore, most people using the service and relatives we contacted were also complimentary about the attitude of their regular careers and the way the conducted themselves in service users own homes.

On balance the feedback we received from the people who use the service and their relatives who we telephoned as part of the review process was very positive about the standard of support provided by this domiciliary care agency. Everyone told us overall they were either ‘very satisfied’ or ‘fairly satisfied’ with the Thornton Heath branch of Enara care.

All the people who use the service we spoke with told us when they started using the agency they were fully involved in decisions made about how their care needs would be met and thought they received the care they had agreed too. One person said, “Staff always complete the tasks they should and will do extra stuff if you ask them.”

People also told us they felt the agency’s care staff always treated them well and respected their privacy and dignity. Typical comments we received, included: “The care workers treat me like an angel”, “I would always give the care workers a hundred out of a hundred”, and “Staff are fantastic. Mine even turned up when the riots were going on in Croydon.”

However, only half the people we spoke with told us their care workers were always punctual and stayed for the full length of time agreed with the care agency.

Nonetheless, these negative comments notwithstanding, most people also told us they felt staff reliability was one area this relatively new care agency had significantly improved since the recent merger. Peoples comments can be summarised as follows: “Care workers not turning up on time use to be real problem, but not any more”, “Now I have got a regular carer they are rarely late and do everything I need”, and “Since I complained to the agency about care workers not turning up on time things have got a lot better. I am quite satisfied now.”

Finally, most people we spoke with told us they felt able to express their views to the care agency and have their concerns taken seriously. The majority of people informed us they had contacted the agency in recent months to raise concerns felt they had been listened to and appropriate action taken to resolve their complaint. Typical comments, included: “Overall I am happy with the way the agency dealt with my complaint”, “I rang the agency to tell them I was not happy that they kept changing my care workers; so I was pleased when my old carers came back”, “I had to complain to the agency about staff always being late, but they seem to have sorted it out now.”

This inspection took place on 26 and 27 February 2015 The provider was given 48 hours’ notice of the first date of our office visit. This was because the location provides a domiciliary care service and we needed to be sure that we could speak to someone who co-ordinates the staff providing personal care.

MiHomecare - Thornton Heath provides personal support for people living in their own homes in the London boroughs of Lambeth, Croydon, Merton and Sutton, at the time of this inspection they were providing service to 350 people.

We last inspected the service in September 2014. At that inspection it was identified the service needed to make improvements to protect people against the risks of receiving care and treatment that were inappropriate or unsafe.

People were not always protected against the risks of receiving care and treatment that was inappropriate or unsafe, because the, planning and delivery of care was not always coordinated in a way that met individual needs and promoted people's welfare and safety.

The provider had not ensured staff were properly supported to provide care and support to people who used the service. The service did not take appropriate steps to ensure each complaint was investigated fully and responded to appropriately within acceptable timescales. Care needs and risk assessments were routinely reviewed but the information was not always used effectively to make the necessary changes.

The service had experienced numerous changes together with the merging of other branches with this branch, and this had been poorly managed. The registered manager left and a constant change in the office based coordinating staff had impacted on the consistency and continuity of care people experienced.

The locality manager submitted an action plan on 10 October 2014 setting out the actions they planned to address these issues. The time for completion was set for 16 January 2015. We found at this inspection they had addressed all the areas where action was required.

The provider confirmed the appointment of a suitable person to the vacant post of manager. She had successfully completed a probationary period. The newly appointed manager confirmed she had completed an application to register with CQC and was awaiting the assessment interview to become 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.

People experienced improvements in the planning and coordination of care, and these arrangements met individual’s needs and helped protect people against the risks of receiving care and treatment that was inappropriate or unsafe.

Staff were suitably trained and knowledgeable and understood safeguarding policies and procedures and knew what they should do if they suspected abuse or neglect was occurring.

The service had established robust recruitment processes, which made sure staff were suitable to work with people who could be at risk. People and staff told us there were enough staff available to deliver care but at weekends staff worked longer hours if short notice absenteeism were experienced. The agency had an on-going recruitment process to respond to needs of people in specific locations where difficulties were experienced in recruiting car staff.

Care coordinators templated individual care requirements and developed care schedules. Regular care staff were matched and assigned to care for people on a permanent basis. Replacement care staff familiar with the person covered planned absences such as annual leave. This helped ensure continuity of care and consistency and eliminate/reduce missed calls and prevent them from reoccurring.

The service developed individual care plans which were based on need identified by a thorough assessment. The care plans guided staff on how people wished to be supported and recorded the tasks they were required to perform to support the person. The management team and field supervisors undertook frequent spot checks to people’s homes to ensure care arrangements were followed by staff. These plans were reviewed and updated regularly and included people‘s views where possible.

Staff respected people’s privacy and dignity and had a caring attitude towards people they cared for. Dignity and respect were introduced into staff training programmes for all care staff.

Care workers were skilled and dedicated and demonstrated a good understanding of how to support people in their own homes and promote their independence. The provider had their own five day induction training programme that was designed to ensure any new staff members had the skills they needed to do their jobs effectively and competently. All staff employees were trained to the appropriate level for the services they delivered.

Staff received regular supervision which included monitoring of their performance. The field supervisors completed spot checks on staff whilst they were completing tasks, and checked that the care delivery mirrored the care plan. The care delivered was clearly documented in the comment sheets by the care staff.