This inspection took place on 30 November 2017 and was announced. We gave the provider 48 hours’ notice of the inspection to ensure that somebody would be available at the office to assist us with the inspection.

Pristine Recruitment 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 who are older or younger adults who have a disability.

The agency is also registered to treat disease, disorder or injury through employment of nurses to provide treatment to people in their homes. At the time of the inspection, the service was not providing nursing care and there were no nurses employed with the service.

The office is based in Totteridge and people receiving care were living in Barnet, Enfield and Hertfordshire. At the time of this inspection there were seven people receiving a service from Pristine Recruitment.

There is 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection of this agency in November 2016 there were two breaches of legal requirements.These were about safe staff recruitment and overall governance of the service. At this inspection we found that improvements had been made in both these areas.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve and they told us what they would do to meet the legal requirements. We found that governance of the service had improved as the provider had introduced a new electronic record keeping system which was more effective than the previous system in place.They were also carrying out regular spot checks in people’s homes. Staff said they felt well supported working for Pristine Recruitment.

Staff recruitment had improved since the last inspection as the provider had improved the recording of checks carried out on staff but there were still areas for improvement as the provider had not ensured explanations were clearly recorded for how a reference was verified, gaps in application forms and the reason why a last employer reference had not been requested.The registered manager told us that they also would ensure that future interviews of potential staff would be recorded in a written record as these had not been recorded to date. A new template was ready for the next care worker interviews. We have made a recommendation that staff recruitment improves further in line with best practice.

People told us they were happy with the care provided by this agency. Each person had their own allocated care worker or team of care workers and had opportunity to form a good relationship.

Staff understood how to safeguard people and what to do if they had any concerns that a person might be subjected to abuse.

People had risk assessments to advise staff on how to help the person to keep safe in their home. The registered manager carried out health and safety and fire risk assessments with people in their homes.

Staff received training and supervision and told us they felt well supported by the registered manager.

People received effective support with personal care, their meals and medicines and in accessing health care. The registered manager liaised with GPs, pharmacists and healthcare professionals to ensure people received the support they needed.

Care was provided with people’s consent and where a person did not have capacity to consent there was a record of who could make decisions in their best interests. Care plans detailed people’s needs and they told us their care was personalised to suit their preferences.

There was a clear complaints procedure and people said they felt

We inspected this service on 9 November 2016. The inspection was announced. Pristine Recruitment is registered to provide personal care and support for people in their own homes. Pristine is also registered to treat disease, disorder or injury through employment of qualified nurses, in their own homes. At the time of our inspection eight people received care and support from this service. The provider had plans in place to start a care service for a further three people. There were no people receiving support for disease, disorder or injury from qualified nursing staff.

We previously inspected the service on 18 July 2013 and the service was found to be meeting the regulations inspected.

At the time of the inspection there was a registered manager in place. 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 who used the service told us they were happy with the care provided by the care staff.

The provider was unable to evidence safe recruitment practices. We found one reference for a staff member signed by someone who was no longer working at the referring agency. The registered manager had not sought another reference. Another staff member had been sent to work with vulnerable people for the provider prior to all recruitment checks being completed.

Staff told us they felt supported and management support was available. Some new staff told us they had undertaken training at their previous employers. We could see that staff had a three day induction and training took place in key areas. We noted eight to ten refresher courses were covered in one day for two staff members. Supervision took place regularly for staff.

Assessments were undertaken to assess any risks to the people using the service and the staff supporting them. The risk assessments included information about action to be taken to minimise these risks.

Safe medicines support was provided where appropriate. People were prompted to take medicines and we saw that medicine administration sheets were completed by care staff.

There were some aspects in which the service was well led. For example, random checks were undertaken by the registered manager to ensure people were happy with the care provided and medicine administration sheets were audited by the registered manager. However, there were other areas of concern. For example, there was a lack of coherent systems for storing information, including staff recruitment records and records related to the provision of the service.

Some relatives, who had commissioned the service privately, told us they were not invoiced as regularly as they would like. This meant it was difficult for them to manage the finances for their family member’s care package.

We identified two breaches of the regulations, in relation to the recruitment of staff and the governance of the service.

We asked people who use the service and their relatives what they thought about the support they received from the agency. Everyone responded positively and said they felt supported by the staff and that they were included in decisions about their care as far as possible. One person told us, “the staff are brilliant.”

People told us they were very appreciative that the agency provided a consistent care package and made sure the same staff visited and provided support as much as possible. People described the staff as, “reliable, friendly, kind and caring.” One person told us, “they have been absolutely fantastic.”

People who use the service confirmed that the manager and staff asked them how things were going and if they were satisfied with the care and support they received. One person told us, “the manager is very proactive.”

Effective recruitment and selection processes were in place and appropriate checks were undertaken before staff began work. Staff told us they felt supported by the registered manager and confirmed they received regular supervision and that there were good training opportunities for them to improve their knowledge and skills.

We spoke with four people who use the service or their advocates. One person said “there is nothing I could suggest the agency could do better." People's privacy and dignity was respected, and the provider had arrangements in place to demonstrate that people were involved in their care. People received care and treatment that met their needs. The provider had systems in place to protect people's safety.

We identified concerns with the recruitment process. Evidence from staff files showed that appropriate recruitment checks were not always in place before staff commenced working with people who used the service. Staff did not receive regular supervision. We found that the agency did not have effective systems in place to monitor the quality of the service or to identify and assess potential risks, in order to ensure the safety and welfare of service users. We also found that care staff did not have timely access to information to provide them with a sufficient understanding of people's needs.