This inspection took place on 27 April and 11 May 2017 and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. A comprehensive inspection was carried out on 19 January 2016 during which breaches of regulation in relation to safe care and treatment and fit and proper persons employed were found. We then carried out a focussed inspection on 11 August 2016 at which time the provider had met their action plan in response to the breaches found, however we did not improve the rating at this inspection.

NTA - Tooting Neighbourhood Centre Home Care provides personal care for people in their own homes, the majority within the London Borough of Wandsworth. At the time of our inspection there were 43 people receiving personal care from the service.

There was a registered manager at the service however they were not managing the service at the time of the inspection. An interim manager was in place and the director told us they had recently recruited a permanent manager who would be applying to become the 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 and their relatives told us that care workers had a caring attitude and they had no concerns about their suitability for a role in providing care. They said they felt safe in their presence and they were trustworthy. The provider had organised a ‘carers recognition day’ where awards were given to care workers that had excelled in their duties.

Care plans were written in plain English and easy to understand. They were split into client details, service information, objectives and the agreement between people and the service. Details of the tasks to be completed by care workers and the agreed hours were documented. Care plans contained person centred information in relation to people’s preferences about their life choices, their health needs, meals and other information related to their care. Objectives included how care workers could support people to lead independent lives in a range of areas such as maintaining a balanced diet, mobility, continence and other areas.

Work had been completed to ensure that all staff files contained appropriate reference identity and criminal record checks. This helped to ensure that care workers were recruited safely.

Care workers were given opportunities to develop through regular training opportunities. They received regular supervision.

Risk assessments were completed when people first started to use the service. Some of the areas that were assessed included the environment, moving and handling, equipment, COSHH, electrical appliances and fire safety amongst others. For those that needed more support with moving and handling, a separate, more detailed assessment was in place which included moving and handling guidelines from occupational therapists.

The provider had adequate systems in place to monitor the quality of the care and support people received. The quality assurance policy made reference for the need for one quality assurance check to be completed annually.

Senior care workers were responsible for carrying out spot checks and monitoring. These included checking medicine administration record (MAR) charts in people’s homes.

Feedback was sought through surveys and we saw actions were identified and assigned to people to follow up.

We carried out an announced comprehensive inspection of this service on 19 January 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to staffing.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breaches found. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'NTA - Tooting Neighbourhood Centre Home Care' on our website at www.cqc.org.uk.

Tooting Neighbourhood Centre Home Care provides personal care for people in their own homes, the majority within the London borough of Wandsworth. At the time of our inspection, there were 49 people receiving personal care from the service.

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.

At our previous inspection we found that where people were being supported with their medicines, care records did not contain accurate information about the medicines which had been prompted or administered. We also found that staff files were not always complete, for example some references were not always present and Disclosure and Barring Service (DBS) checks were not carried out in line with the providers own policy. At this inspection, we found that improvements had been made in both areas.

The provider had audited all the staff files, identified those with missing records and had taken action to ensure these were up to date. New medicine administration records had been introduced to help ensure that care workers accurately recorded the medicines that people were supported with during each visit.

This inspection took place on 19 January 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. At our previous inspection on 24 April 2014 we found the provider was meeting regulations in relation to the outcomes we inspected.

Tooting Neighbourhood Centre Home Care provides personal care for people in their own homes, the majority within the Borough of Wandsworth. At the time of our inspection, there were approximately 40 people receiving personal care from the service.

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.

People using the service told us that care workers spoke to them in a respectful way and attended to their needs. Care workers spoke about people’s support needs and were aware of the importance of providing personal care in a way that preserved people’s dignity. Care workers were aware of the importance of asking people for their consent before delivering personal care and offering them choice.

Risk assessments were carried out when people first began to use the service. These helped to ensure that people were supported in a safe environment. Specific risk assessments were completed for people with mobility issues or needed support with medicines.

Support plans were in place for each person but we found that they were task orientated and did not always include people’s preferences about how they liked aspects of their personal care to be managed.

People and their relatives did not raise any concerns about how their nutritional or healthcare needs were being met by the provider. Care workers prepared food that was already available in people’s homes or heated up ready meals for them. Where people had specific dietary requirements, guidelines were available in support plans for staff to refer to. Support plans contained details of people’s health concerns and also contact details of their GP and pharmacist in case they needed to contact them.

People told us that care workers prompted them to take their medicines and care workers completed record books of when they supported people with their medicines. However, some of the records we saw were not accurate in terms of which medicines had been prompted.

We also found that some staff files were not complete, for example some references were not always present and DBS checks were not in line with the providers own policy.

Although feedback surveys had been conducted to gather the views of people using the service and their relatives and the outcome of these were positive, some aspects of quality monitoring was not being carried out regularly such as unannounced spot checks. Some people and relatives told us that communication at weekends could be better.

We have found a breach of regulation in relation to employment of fit and proper persons and 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.

NTA - Tooting Neighbourhood Centre Home Care is a domiciliary care provider that offers a service to a range of individuals. In the main it provides a service to adults and older people, some with a diagnosis of dementia. During the time of this inspection it was providing care for approximately twenty people.

Care plans were individual to people using the service and recorded their support needs. Risks to people and also staff working in people’s homes were identified and recorded. Although care plans were not always reviewed on time, people using the service felt involved in their care and were happy with the support they received.

Many of the care workers had been employed by the provider for a number of years which meant that people received a consistent service which was important to them. People told us the care workers treated them well.

The Deprivation of Liberty Safeguards (DoLS) apply only in hospitals and care homes, for domiciliary care providers, the deprivation of liberty safeguards do not apply.

People felt able to raise their concerns with the provider, either through the care workers or directly with managers.

People using the service told us on the telephone that they were treated with dignity and respect. People told us "I'm very satisfied".

They were involved in choosing the type of care and support they needed and when they needed it. Someone said "They turn up on time".

They thought the quality of care they received was very good and they felt safe receiving the service. They commented "They meet my present needs".

People did not tell us about the safeguarding measures followed, number of staff employed or support staff received from the service. They said that the office staff often contacted them and visited them to see that they were satisfied with their service and the staff providing it.

We saw that people received clear, accessible information to help them decide if they wanted the organisation to provide them with a service.

The service provided was of good quality with people's needs being met.

There was a safeguarding policy and procedure that staff had read, understood and followed.

Staff received thorough induction training and were part of a rolling training programme that was monitored. They also received regular supervision and an annual appraisal.

There was a complaints procedure that we saw was available to people who use the service and that it was adhered to, efficient and thorough. The service had regular contact with people using the service and carried out spot checks.

We spoke with six people using the service and their relatives. People that we spoke with told us "they felt safe". Another person told us "I have no concerns". One relative we spoke with said they felt confident leaving their family member in the company of the care workers.

The provider had updated their safeguarding vulnerable adults policy. The manager told us they had recently acquired a new training provider to deliver safeguarding and first aid training. We saw evidence that 10 care workers had been booked to attend safeguarding training on 27 April 2013. Further training sessions for the remaining care workers had been booked.

Care workers that we spoke with told us they had recently attended a number of training sessions covering aspects such as food hygiene, infection control, first aid and health and safety. One care worker told us "the training has improved". Another care worker told us "the training was relevant to my job". They also told us "we are encouraged to attend training sessions". The manager also told us that they supported people in their professional development. All care workers had attained a National Vocational Qualification (NVQ) Level 2 in Health & Social care or were currently undergoing training to obtain this qualification.

We spoke to 5 people using the service about the care that they received. Comments included “care workers treat my mum really well”, “the workers now are caring” and “some of the carers are good”. People were of the opinion that some positive changes had been made since a recent organisational restructure, “the service is improving, and they are trying their best”.

A few people using the service raised concerns about staff training. They told us that care workers “lack training around the use of hoists”. People using the service told us that “it’s a good service, it just needs tightening up”.

The provider had recently gone through some organisational changes. At the time of this visit, the new management team were reviewing a number of their current policies and procedures to try and improve them.

Approximately 40 people were receiving home care from NTA - Tooting Neighbourhood Centre Home Care at the time of our inspection.

We spoke with three people who use the service and three relatives of people who use the service.

The people we spoke with were happy with the regular care worker and were complimentary about the standard of care they provided. However, concerns were expressed about the attitude and competence of some workers.

People said they could contact the office when they had a query. Some of them were happy with the response, but there were concerns that issues were not dealt with adequately.

People said they had not been asked by the provider for their views about the service.