This inspection took place on 5 June and was announced. We gave the registered manager two working days’ notice of the inspection to ensure they would be available to meet with us. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. Not everyone using P & E Care Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection the service was providing personal care and support to 27 older adults in the London Borough of Bromley.

The service had 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 our last inspection we found improvement was required to ensure staff had sufficient time for travel between calls, and to the management of people’s medicines because one person’s MAR did not accurately reflect the medicines staff were supporting them with and this had not been identified by the provider’s medicines audits. We also found that improvement was required in regard to record keeping at the service.

At this inspection we found the provider had acted to address the issues we identified at our last inspection. However, we also identified a breach of regulations because risks to people had not always been comprehensively assessed and there was not always detailed guidance in place for staff on how they should manage identified risk safely. We also found that whilst people received safe support with their medicines, further improvement was required because there was not always guidance in place for staff on the support people needed to take medicines that had been prescribed to be taken ‘as required’. Additionally, improvement was required to the provider’s systems for monitoring the quality and safety of the service because audits of people’s care records had not identified any concerns with people’s risk assessments.

There were sufficient staff deployed by the service to meet people’s needs and people told us they were satisfied with the timings of the visits they received. The provider followed safe recruitment practices when employing new staff. People were protected from the risk of abuse because staff received safeguarding training and were aware of the action to take if they suspected abuse had occurred. Staff were also aware of the provider’s whistle blowing policy and told us they would use it if they had concerns. The provider monitored incidents and accidents and acted to reduce the risk of repeat occurrence. Staff were aware of the action to take to reduce the risk of the spread of infection and people told us staff followed safe infection control practices.

People’s needs were assessed in order to ensure the service’s suitability. Staff sought people’s consent when offering them support. 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 supported this practice. People were supported to maintain a balanced diet where this was part of their assessed needs. Staff received an induction when they started working for the service and were supported in their roles through regular training, supervision and an annual appraisal of their performance.

People were able to access a range of healthcare services with the support of staff if needed. The provider worked with other agencies to ensure people received effective care. Staff treated people kindly and with dignity. They respected people’s privacy and involv

This announced inspection took place on 07 and 08 June 2017. This was the service’s first inspection since their registration in June 2016. P & E Care Limited is a domiciliary care service providing personal care to people living in their homes. At the time of the inspection, 14 people were using the service.

The service did not have a registered manager in post since the last registered manager deregistered in August 2016. 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 appointed a new manager in September 2016. The new manager had made an application to become the registered manager for the service. The manager demonstrated good knowledge of their responsibilities, people’s needs and the needs of the staffing. The manager was supported by the director.

People and their relatives told us they felt safe with staff. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. The manager completed risk assessments for people who used the service which provided sufficient guidance for staff to minimise identified risks. The service had a system to manage accidents and incidents to reduce reoccurrence.

The service had enough staff to support people. The service provided an induction and training to staff, and staff were supported through regular supervision to help them undertake their role.

However, we found the rostering of people’s home visits was not managed well in all cases and this required improvement. The service carried out satisfactory background checks of staff before they started working. Staff supported people so they took their medicines safely. However, one person’s medicines administration record (MAR) and medicines care plans did not include information about their prescribed medicine, the dose required and the frequency of administration.

People’s consent was sought before care was provided. The manager was aware of the requirements of the Mental Capacity Act 2005 (MCA). At the time of inspection they told us they were not supporting any people who did not have the capacity to make decisions for themselves.

Staff supported people with food preparation. People’s relatives coordinated health care appointments to meet people’s needs, and staff were available to support people to access health care appointments if needed.

People told us they were consulted about their care and support needs. Staff supported people in a way which was caring, respectful, and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date.

The service had a clear policy and procedure for managing complaints. People knew how to complain and would do so if necessary. Staff felt supported. The manager held regular staff meetings, where staff shared learning and good practice so they understood what was expected of them at all levels.

People and their relatives commented positively about staff and the service. Nevertheless, improvement was required around record keeping and identifying issues at audits. The service carried out unannounced spot checks at people’s homes and telephone monitoring to get the feedback on quality of care.