This inspection took place on 20 November 2018. We last inspected Kare Plus Enfield on 14 January 2016 and the service was rated good.

This service is a domiciliary care agency. It provides personal care to a range of adults living in their own homes with a broad range of physical, mental health and learning disability needs. At the time of this inspection the service was providing personal care to 53 people.

At the time of the inspection the acting manager was applying to CQC to be registered manager for 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 and their relatives told us they were happy with the care provide and staff were kind and caring and treated them with respect.

We found discrepancies between the paper based care records based at the office and people’s homes and the electronic system staff used to prompt tasks. This included the management of medicines. There were risk assessments to guide staff in meeting some people’s needs, but not others.

The majority of staff understood their responsibilities in relation to safeguarding adults and the service had processes in place to respond to safeguarding concerns.

The management team had changed in the last year and the full range of audits were not taking place at the service, although spot checks and competency checks of staff took place regularly. We could see the service learnt from accidents and incidents.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, the service did not always record people’s mental capacity effectively.

Recruitment of staff was safe and staff were supported in their roles through induction, training and supervision. Staff told us they enjoyed working at the service.

People told us there were enough staff to meet their needs, who knew them well, and they were usually punctual.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

The service listened and responded to people’s concerns and complaints, and used these to improve the quality of care.

This inspection took place on 14 January 2016. We gave the provider one days’ notice that we would be visiting their head office. We gave the provider notice as we wanted to make sure the registered manager was available on the day of our inspection. This was our first inspection of this service since it was registered with the Care Quality Commission (CQC) in March 2014.

Kare Plus Enfield provides support and personal care to people living at home. There were approximately 20 people using the service at the time of our inspection. However, the registered manager told us that only nine people were currently receiving personal care. The provision of personal care is regulated by the Care Quality Commission.

There was a 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 and associated Regulations about how the service is run.

People told us they were treated well by staff and felt safe with them. Staff could explain how they would recognise and report abuse and they understood their responsibilities in keeping people safe.

Where any risks to people’s safety had been identified, the management had thought about and discussed with the person ways to mitigate risks.

People told us that staff came at the time they were supposed to or they would phone to say they were running a bit late.

The service was following robust recruitment procedures to make sure that only suitable staff were employed at the agency.

Staff we spoke with had a good knowledge of the medicines that people they visited were taking. People told us they were satisfied with the way their medicines were managed.

People who used the service and their relatives were positive about the staff and told us they had confidence in their abilities and staff told us that they were provided with training in the areas they needed in order to support people effectively.

Staff understood that it was not right to make choices for people when they could make choices for themselves. People’s ability around decision making, preferences and choices were recorded in their care plans and followed by staff.

People told us they were happy with the support they received with eating and drinking and staff were aware of people’s dietary requirements and preferences.

People confirmed that they were involved in the planning of their care and support. Care plans included the views of people using the service and their relatives. Relatives told us they were kept up to date about any changes by staff at the office.

People and their relatives told us that the management and staff were quick to respond to any changes in their needs. Care plans reflected how people were supported to receive care and treatment in accordance with their current needs and preferences.

People told us they had no complaints about the service. However, they felt they were able to raise any concerns should they need to.

The agency had a number of quality monitoring systems including six monthly surveys for people using the service and their relatives. People we spoke with confirmed that they were asked about the quality of the service and had made comments about this. They felt the service took their views into account in order to improve service delivery.