This comprehensive inspection took place on 13 September 2018 and was announced.

We last inspected Millennium Employment Agency Limited on 29 January 2016 and found two breaches of legal requirements. These were in relation to safe medicines management, and staffing levels. We also made a recommendation in relation to the management of safeguarding concerns. At this inspection we found the provider had made improvements to the management of medicines and monitoring of staffing levels in relation to meeting people’s needs.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults and younger disabled adults. At the time of the inspection there were two people receiving personal care 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.

The provider did not have comprehensive auditing systems in place to manage the oversight of the service and drive improvements. Audits undertaken did not always identify issues in a timely manner. We made a recommendation in relation to the management oversight and auditing processes of the service.

People’s medicines were not always managed in line with good practice. Medicine administration recording sheets did not always contain adequate information to ensure the safe administration of medicines. We shared our concerns with the registered manager who submitted updated medicines administration records. We were satisfied with the provider’s response and will review this at their next inspection.

People received care and support from adequate numbers of staff deployed to meet their needs. People’s dependency needs were assessed regularly and staffing levels adjusted accordingly. Staff underwent robust pre-employment checks prior to commencing their role.

Risk management plans did not always give staff clear guidance on how to safely manage behaviours that challenged the service. We raised our concerns with the registered manager who sent us updated risk assessments. We were satisfied with their response.

People were protected against the risk of abuse as staff knew how to identify, respond and escalate suspected abuse. Staff received on-going safeguarding training and felt confident in whistleblowing.

Infection control measures in place ensured people were protected against the risk of cross contamination. Staff continued to be provided with adequate amounts of personal protective equipment to carry out their role safely.

Staff and the manager were aware of their roles and responsibilities in line with the Mental Capacity Act 2005. People’s consent to care and treatment was sought prior to care being delivered. People confirmed their consent to care and treatment was sought prior to being delivered.

Staff received guidance and support from the registered manager and reflected on their working practices through regular supervisions. People continued to receive support and guidance from staff who received regular training to enhance their skills and knowledge.

People were treated with dignity and respect and had their human rights protected and encouraged. Staff were aware of the importance of maintaining people’s dignity and confidentiality.

People received personalised care and support from staff as care plans were person centred, reviewed regularly and devised with input from people.

People were aware of the provider’s policy in reporting concerns and complaints. Complaints were investigated and a positive outcome sought in a timely manner. Where possible people were encouraged to participate in activities that met their social needs and interests.

People spoke positiv

This inspection took place on 29 January 2016 and was announced. Millenium Employment Agency Limited provides personal care for people living in their own homes in the London borough of Lambeth. The service is registered to provide personal care. At the time of the inspection there were two people using the service.

At the last inspection on 24 December 2013, the service was meeting the regulations we inspected.

The service has 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 inspection, we found three breaches of regulations. The registered manager did not know whether sufficient numbers of staff were employed to care and support people. Medicines were not managed safely, because checks were not carried out on the safe management of people’s medicines. There were quality assurance systems in place; however, they were not effective.

People were protected from harm. The service had processes and guidance for staff to keep people safe. Staff completed assessments of people’s needs and associated risks They developed care plans to meet people’s needs and manage any risks identified.

Staff that had suitable skills, qualifications, support, training, and knowledge cared for people.

Staff sought consent from people and encouraged them to make choices and decisions about the way they wanted to receive care and support. The registered manager had an awareness of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They were aware of their responsibilities in relation to the MCA while providing care and support to people living in their own homes.

Staff treated people with kindness and compassion and respected their dignity and privacy.

Staff knew people they cared for well and met their care and support needs. People had access to health care advice and support when required. People had access to food and drink to meet their needs and preferences.

People and their relatives had the opportunity to give feedback and their views of the service. The registered manager kept the Care Quality Commission informed of notifiable events that happened at the service.

People were provided with the provider’s complaint process. Staff acted on complaints to resolve them promptly.

We spoke with the two people using the service, both received 24 hour care packages which enabled them remain independent in their own homes.

A person using the service told us how the service had successfully supported them. They told us, “All is going well, I have the same carers from the agency, they understand what support and care I need, I have complex needs which carers understand, they are suitably trained and are able and competent at supporting me appropriately."

The relatives of another person using the service told us, they felt reassured by the reliable care staff and had confidence in the agency. They said "I know my relative receives the calls at the time agreed, carers are pleasant and good humoured. They are interested in their roles".

The provider frequently visited people using the service, during the visits they discussed their care needs and referred to appropriate professionals for advice on using equipment safely.

We found there was a minor concern with the quality assurance system, it was not sufficiently robust and did not demonstrate the provider was checking and reviewing the records maintained by the agency.

We spoke to two people that used the services of this agency. One person said that he had a regular team of care staff to attend to his needs. He had a team of carers assigned to him that covered shifts on a rota, over a twenty four hour period for 7 days of the week. He found that the carers worked with him to deliver the care in the way he preferred and considered his cultural needs.

Another person receiving the service found that he was placed at the centre of the care arrangements. The service enabled him take control and offered him independence. He found that the team of carers understood how to respond to his needs and delivered the care he needed, carers he found were pleasant and competent in their role

Stakeholders (2) spoken with told us that the agency had delivered a good service to people. People in the community had been successfully supported to remain in their own homes. They found that if there were issues with the service the agency addressed these and managed them appropriately, the service provided teams of consistent and reliable carers.

Although the people receiving the service said they were satisfied with the service, we identified concerns with some of areas of practice that placed people at risk of receiving unsafe care.

People experience a service that is well run, reliable and consistent.

People find that the service is delivered for the length of time required and as agreed in care plans.

People said that they have confidence in the service; as trained and skilled staff are employed to them remain independently in their own homes.

People said that they are included in the planning and delivery of the service.

They find that they have regular meetings with supervisory and management staff who are interested in monitoring how the service is performing.