About the service: Renaissance Personnel Ltd (Kentish Town) provides personal care and support to people living either in their own home or in a supported living scheme. There were approximately 46 people using the service and receiving the regulated activity of personal care and treatment of disease, disorder or injury.

People’s experience of using this service:

We found shortfalls related to the monitoring of the service quality and we could not be assured that care provided by the service was always safe. The shortfalls were related to medicines management and governance. We also found that improvements were needed to improve how people with no capacity were supported to make decisions and how records related to people’s care were audited and stored.

There were not always clear records related to what medicines people were prescribed. Medicines administration records (MARs) did not always have sufficient information about medicines staff were giving to people. Not all MARs were completed at the time of administration as required by the law. Staff competencies in medicines administration had not been checked to ensure they knew how to administer medicines safely.

There were enough staff deployed to support people. However, staff rotas showed care visits were often scheduled back to back with no time for staff to travel. Staff confirmed this was the case.

There was evidence of mental capacity assessments in place and most people we spoke with said staff asked for their permission before providing personal care. However, some people and relatives said that at times staff provided personal care routinely without discussing it with people. People’s care plans did not have sufficient information of what decision people could make when they were assessed as lacking capacity.

We discussed our concerns with the registered manager and members of the management team. They were responsive to our feedback and assured us action would be taken to address issues highlighted during the inspection.

People told us they felt safe with staff who supported them. There were systems and procedures in place to help protect people and ensure their safety. The recruitment procedure ensured that people were protected from unsuitable staff. There were risk assessments in place to guide staff on how to manage and minimise risks to people’s health and wellbeing. Staff understood how to protect people from potential abuse from others. The agency took appropriate action when they thought people were at risk of harm. Staff received infection control training and they followed appropriate infection control measures when supporting people.

The agency had received positive feedback from people using the service and staff who worked there. People thought the agency was well managed and staff were appropriately trained to support them. Staff felt supported and listened to by the members of the management team.

When possible, people were supported by the same staff therefore positive friendly relationships could be created between people and staff.

Staff had received induction to the agency as well as training to ensure they had skills to support people. Staff received supervision and appraisals of their skills from the management team to help them to support people effectively.

People said staff knew their needs well. People had individualised care plans which had sufficient information about people and how to support them. The agency was in the process of introducing a new online care planning system. The aim was to enable an immediate update of people’s changing needs so staff could have an instant access to the most current information about people’s needs.

Staff were given guidelines on how to help people to live a healthy life. Staff supported people to have sufficient food and drink and a nutritional diet that matched people’s requirements and preferences. When needed, staff ensured people had access to health professionals so their changi

This inspection took place on 17 June 2016. We gave the provider 14 days’ notice that we would be visiting their head office. We gave the provider notice as we wanted to make sure that the registered manage was available on the day of the inspection to support us with the process. At the last inspection in September 2014, the service was meeting all the regulations that were looked at during that time.

Renaissance Personnel Ltd (Kentish Town) provide personal care and support to people living either in their own home or in a supported living scheme. There was approximately 22 people using the service at the time of the inspection.

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 2008 and associated Regulations about how the service is run.

People we spoke with told us that they were happy with the care and support that they received and felt safe in the hands of the care staff that supported them.

Care staff that we spoke with were able to describe the different types of abuse, how to recognise abuse and the actions they would take if abuse was suspected.

The agency ensured that detailed assessments were completed which identified people’s individual risks. As part of the assessment information and direction was recorded to guide care staff on how to reduce and/or mitigate the risk to ensure that people were kept safe.

Where the service supported people with the administration of medicines, we saw appropriate records in place to ensure that people were supported safely. Six monthly medicine audits were completed as a method of checking that care staff were adhering to the company policy and to check that people’s medicines were being administered correctly.

The service had robust recruitment process in place to ensure that only suitable staff were employed. This included an enhanced check for fraudulent documents and the persons legality to work in the UK.

People who used the service and relatives that we spoke with were positive about the care staff that supported them and had confidence in their skills and abilities. Care staff also confirmed that they received regular training in the areas that they needed in order to support people effectively.

Care staff confirmed that they felt supported by the registered manager and the care co-ordinators and received regular supervision with them.

The registered manager, senior carers, care co-ordinator and most care staff were able to explain to use their understanding of the Mental Capacity Act 2005 (MCA) and how this was relevant to the care and support that they provided to people. However two care staff members that we spoke with were not able to explain the basic principles of the MCA and confirmed that they had not received any training in this area.

Care staff were able to explain the importance of ensuring that people were able to choose and make decisions about the way in which they were supported. People’s preferences, likes and dislikes were recorded in their support plan. People and relatives confirmed that the care staff were aware of this and followed the directives outlined within the care plan.

An assessment of activities and daily living skills was completed as a pre-service assessment to determine whether the service was able to meet the needs of the person requiring care and support. Care plans had been signed by the person receiving care and support and where the person was unable to sign, relatives had signed on their behalf. People and relatives confirmed that they were involved in the planning of their care and were changes were required, appropriate discussions and communication took place between the person and the service.

People and relatives told us tha

One inspector visited the location and gathered evidence against the outcomes inspected to help answer the five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

During our inspection we spoke with the registered manager, a field supervisor, two compliance administrators, three care workers, two relatives, one advocate and four people who used the service. The service currently provides care and support to twenty five people.

Is the service safe?

People who used the service were protected from the risk of abuse. People we spoke with told us they felt safe. The provider followed safeguarding procedures when incidents took place and they contacted the correct authorities in a timely manner in the event of safeguarding incidents. One person we spoke with told us, "the quality of care is really good." Another told us, "I feel safe with my care worker." Relatives we spoke with did not raise any areas of concern regarding safety.

The manager and training director ensured staff received safeguarding training as part of their mandatory training. Staff we spoke with confirmed they were trained in safeguarding people and were able to discuss with us the different forms of abuse. People told us they were treated with dignity and respect and their rights were respected.

Is the service effective?

People's needs were assessed and care and support was planned and delivered in line with their individual care plan. We looked at four people's care and support folders and found people's care needs had been assessed effectively. We found people had risk assessments in place which were reviewed regularly by the service. We spoke with a relative who told us, "care is reviewed monthly." A person who used the service told us, "the quality of the care is really good."

Is the service caring?

Relatives and people who used the service we spoke with were positive about the care provided by their care workers. A relative we spoke with told us, "The care worker is respectful and kind." One person who used the service told us, "everybody is kind and I feel safe." Another person said their care worker was, "terrific, very caring."

Staff at all levels told us how they cared for people who used the service and demonstrated they understood and knew people's individual care needs.

Is the service responsive?

People and their relatives we spoke with knew how to raise a concern or make a complaint. We looked at the investigations carried out by the provider for two complaints received since our last inspection which confirmed they had been completed to a satisfactory conclusion. Learning from incidents or investigations had been documented. The provider held regular team meetings and staff we spoke with confirmed they had attended staff meetings. This meant that people were benefiting from a service that was taking on board lessons learnt and reviewing and analysing adverse events.

Is the service well-led?

The service had a quality assurance system. The manager told us and we saw evidence of monthly staff meetings which covered areas which affected both people who used the service and staff. The staff received regular supervision and training which focussed on their development to encourage good practice.

Staff told us they were supported in their job which helped to ensure people who used the service received a good standard of care and support. They felt they could raise issues or concerns with the manager and these would be acted upon. One care worker told us their manager, "was a good boss, very supportive."

People's independence and personal choices were actively promoted and supported by the use of personalised care planning. One person told us ' I am treated with respect by the carers'. Another told us 'I am very happy with the care I am given'.

Staff told us they received both mandatory and specialist training in order to deliver safe and effective care and support to people who used their services. People told us that staff were ‘excellent’ and that they ‘felt safe’ when they received care and support.

Staff were trained in safeguarding and knew where to find the safeguarding policy. Staff we spoke to were able to recognise different types of abuse. This meant their safeguarding training had been effective.

We saw there were sufficient numbers of staff with the right competencies, training and knowledge to provide safe, effective care. The manager told us they had systems in place to be able to respond to changing circumstances within the service.

We saw evidence that the provider regularly monitored the quality of the service provided. Staff told us that home visits were undertaken by care management staff to observe care and ensure it was given appropriately. We noted that risk and needs assessments were updated and reviewed on a regular basis. This meant that people received safe and effective care in a safe environment.

During our inspection we found that people were satisfied with the care and treatment they received from Renaissance Personnel.

People indicated that care workers were "friendly" and one person told us that they “do what I ask them to do”. Another person said that “staff listen to me and take directions". People also told us that staff treated them with respect and dignity.

Relatives of the people supported by the agency told us that they were involved and consulted whenever there was a need.

People felt that safe practice was followed and we saw that, where incidents took place, the provider followed safeguarding procedures.

People told us that staff were competent and able to complete tasks as required.

The provider had effective recruitment procedures in place. There were sufficient numbers of staff with the right knowledge and competencies in order to meet peoples’ care needs and respond to changing circumstances in the service.

People told us that the provider occasionally visits their home to check if staff were there on time and to observe the practice. We saw that the provider monitored the quality of the service received by people.