The inspection took place on 23 May 2017 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 available.

Quality Caring Ltd is a domiciliary care agency providing personal care and support to older people living in their own homes. The agency is a privately owned company. At the time of our inspection they provided approximately 1,400 hours of care each week to older people who lived in the London Borough of Hounslow. The majority of people had their care funded by the London Borough of Hounslow, although some people funded or partly funded their own care. There was 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 and associated Regulations about how the service is run.

The last inspection took place on 16 June 2015 and the service was rated Good. At the inspection of 23 May 2017 we found the service remained Good.

People who used the service were happy. They felt their needs were being met and they liked the staff who cared for them. Relatives were also happy and told us that they felt people were being cared for safely.

The staff felt well supported and had opportunities to meet with the registered manager and senior staff to discuss their work. They were recruited in a safe way, with the provider undertaking checks on their suitability.

People told us that care visits took place at the right time and that the staff stayed for the agreed amount of time. The provider had systems to monitor when care visits were happening and they were able to respond quickly if the staff did not arrive when they were supposed to.

The staff were aware of local authority safeguarding procedures and knew what action to take if they felt a person was at risk of abuse. They were trained to administer medicines safely and people received their medicines in a safe way and as prescribed.

People had consented to their care and treatment, and where they lacked capacity the provider had acted within the principles of the Mental Capacity Act 2005 to make decisions in the person's best interest. The staff had a thorough induction when they started work at the agency and their performance was monitored. Some of the formal training courses which longer serving staff had undertaken had not been updated or renewed and therefore they may not have the most up to date information about current best practice or changes in legislation.

The staff were kind, caring and thoughtful. People using the service liked their care workers and had good relationships with them. The provider was able to discuss examples of care with us that showed the staff had sometimes ''gone the extra mile'' to provide care and support to those most in need, such as people who had been neglected in the past and those with limited resources. In addition, there were instances where the provider had demonstrated their care and compassion for the staff who worked with them, providing assistance when they found themselves in difficult circumstances.

People's care needs were assessed and recorded and the provider reviewed these in partnership with each person. There were clear care plans which were updated when people's needs changed. The staff recorded the care they had delivered and we saw that this reflected the care plans. People knew how to make a complaint and felt confident that they would be listened to and their concerns would be investigated.

The company had been founded and managed by a married couple and had been operating for over 20 years. One of the owners was also the registered manager. People using the service, their families and staff found the owners supportive and approachable. They felt the organisation

The inspection took place on 16 June 2015 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. The last inspection of the service took place on 2 April 2014 where we found no breaches of Regulation.

Quality Caring Ltd is a domiciliary care agency providing personal care and support to older people living in their own homes. The agency is a privately owned company. At the time of our inspection they provided 1,400 hours of care each week to 105 older people who lived in the London Borough of Hounslow. The majority of people had their care funded by the London Borough of Hounslow, although 35 people funded or partly funded their own care. There was 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 and associated Regulations about how the service is run.

There were procedures for safeguarding adults and the staff were aware of these. The risks to people’s wellbeing and safety had been assessed and there were plans to reduce the likelihood of harm.

The agency employed enough staff to meet people’s needs safely.

People were given the support they needed with medicines.

The staff had the training and support they needed to care for people.

People had consented to their care and support.

People’s health and nutrition needs had been assessed, recorded and were monitored.

People had positive relationships with the staff who cared for them. They told us the staff were kind and caring. People said their privacy and dignity was respected.

People’s individual needs had been assessed and recorded in care plans. The care plans reflected their preferences and views. People’s needs were regularly reviewed and they contributed to these reviews.

People knew how to make a complaint and complaints were responded to appropriately.

People felt there was a positive and welcoming culture at the service where they could voice their opinions.

There were systems to assess and monitor the quality of the service and risks. The agency worked closely with the local authority to assess the service. People were asked for their feedback.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in a way which met their needs. There were enough care workers available and they were suitably recruited, trained and supported. People's individual needs and the risks to their well-being had been assessed and recorded. The care workers were aware of what to do if they found someone was unwell or something was wrong. There were clear procedures for supporting people to take medicines. The care workers were trained in these and knew how to give each person the right individual support with their medicines. The people who we spoke with said that they felt they were in ''safe hands'' with the care workers from the agency. They knew who to speak to if they were unhappy about anything and they told us that the agency had dealt with their concerns appropriately.

Is the service effective?

People told us that they were happy with the care they received. They said they care workers knew how to care for them and did this in a respectful way. They told us care workers usually arrived on time and stayed for the agreed length of time. One person said, ''the care workers are very considerate of my needs''. Another person told us, ''I cannot fault the service - they are marvellous''. We spoke with two local authorities who commission and pay for the care people receive. They said they were happy the service was doing a good job and meeting the needs of people. The care workers knew what to do if someone’s needs changed or they became unwell.

Is the service caring?

People were cared for by kind and attentive care workers. They told us that these care workers were caring, considerate and polite. One person said, ‘’they could not improve on anything all the care workers are wonderful’’. Another person told us, ‘’they are very good, very pleasant and the office staff are helpful too’’. The staff we spoke with told us that they had built up good relationships with the people they cared for and that they were happy in their work.

Is the service responsive?

People’s needs were assessed before they started using the service and reassessed when needed. They met with the agency managers to review their care and were asked for their opinions on the service in person, over the telephone and through surveys. People told us they could ring the agency and request changes to their care. They said that they usually had the same regular care workers and they were happy with these.

Is the service well-led

There were good systems for monitoring the quality of the service. Where problems had been identified these had been put right. People felt able to make complaints and felt their concerns were listened to. There were a team of managers who supported the care workers and were available for people who use the service and their relatives. The agency staff we spoke with said that they were well supported and had clear direction, training and information.

During the inspection we received feedback from a person using the service, four relatives and five care workers. People’s needs were assessed when they started to use the service and their relatives or themselves were involved in developing their care plans. Relatives said the care records were accessible and could read these to find out about the care planned for their family members.

People’s care plans were reviewed on an average quarterly but some risk assessments had not been reviewed annually. The manager agreed and had plans to address this issue. People’s preferences, likes and dislikes were appropriately recorded so staff had the necessary information to care for and support people. Relatives said their family members’ privacy and dignity were respected and their needs were met when they received care from their regular care workers at the agreed times. However, our findings showed that people did not always receive care at the times that were agreed so they could carry on with their daily lives, with minimal disruption.

There were arrangements for staff to receive training and supervision to make sure they were supported to do their job. Training in some areas had taken place and more sessions were planned for staff who had not received the training. Records were also available to show that staff received supervision and spot checks.

There were some processes in place for the provider to monitor the quality of the service that people received.

We spoke with four people who received a service or with their relatives over the telephone to find out about their experiences of the support they received from the agency. We also spoke with the registered manager, the general manager and six care workers to find out about the way the agency operated.

People or their relatives said that when they first started to use the agency, they were given information about the service provided and were asked about their needs so the agency’s staff could prepare plans to meet their identified needs. They said they could make decisions about how they wanted to be cared for and their wishes were respected. All people who spoke with us told us staff respected their privacy and dignity. Relatives said they could contact the office if they had any concerns about the safety of their family members and were confident that their concerns would be taken seriously by the provider.

People said that staff knew how to meet their needs appropriately. They reported that care workers were punctual and reliable. Feedback from care workers and the agency’s own records showed that staff were not always appropriately supported in that they did not receive regular appraisals, spot checks and one to one meetings with their line managers. Staff who spoke with us said they had not attended a staff meeting during the last year, so they had the opportunity to meet other staff, make suggestions and share their views about the service.

People said that they were happy with the way they were looked after by the care staff. They said that carers were usually on time and ensured that if they were delayed someone contacted them to ensure that the person using the service knew about the delay. People said that apart from when they first began to use the service, the same carers provided their care on a regular basis. They also said that enough time was allowed for each call to ensure that their individual needs were met.

Almost everyone we spoke with told us that the provider was supportive of them, communicated well with them and made sure that they were involved in their care from the point at which they began to use the service and on an ongoing basis. They told us that the provider responded quickly to comments and requests that they had made.