We undertook an announced inspection of Right at Home (Harrow) on 4 January 2019. Right at Home (Harrow) provides a range of domiciliary care services which include live-in care and support, administration of medication, food preparation and housework.

CQC only inspect the service 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 inspection, the service provided care to 54 people, of which 39 people received ‘personal 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 2008 and associated Regulations about how the service is run.

Our previous inspection of the service in June 2016 rated the service as Good with no breaches of Regulation. During this inspection on 4 January 2019, we found that the service remained Good.

Some people who used the service were unable to verbally communicate with us due to their mental capacity. We therefore also spoke with relatives of people who used the service. People who received care from the service told us that they had been treated with respect and dignity and felt safe in the presence of care support staff. Relatives told us they were satisfied with the care and services provided. They spoke positively about care support staff and management at the service.

Procedures were in place to protect people and keep them safe. Staff knew how to identify abuse and understood their responsibilities in relation to safeguarding people and reporting concerns. Risks to people's and staff safety were identified and guidance was in place to manage and minimise risks of people being harmed and protected them.

Arrangements were in place in respect of medicines management. Staff had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that these were not always completed fully. There were occasions where the key was used to complete the MAR, but there was no further information recorded on the MAR to indicate whether the medicine had been administered or the circumstances surrounding the administration. Further, where medicines formed part of a blister pack, the medicines were not always detailed on the MARs and therefore it was not clear what medicines had been administered. We discussed this with management and they advised that they would ensure that medicines contained in a blister pack would be clearly recorded on the MAR in future. They confirmed that they would take immediate action in respect of this. Following the inspection, the director sent us an action plan which detailed the improvements they would make and timescales. This included refresher training and workshop sessions.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. People received care from the same care support staff on a regular basis and experienced consistency in the level of care they received. The registered manager explained that each person that received care had an allocated group of care support staff so that they were always familiar with them. The service operated a “No stranger policy” which ensured that people always knew who was providing their care.

Comprehensive recruitment processes were in place and the service carried out appropriate checks so only staff who were suitable to work with people using the service were employed by the service.

People were cared for by staff that were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities. Records showed that care support staff had undertaken a comprehensive three-day

We undertook an announced inspection of Right at Home (Harrow) on 13 June 2016. Right at Home (Harrow) is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to people of all ages and different abilities. At the time of inspection the service provided care to approximately 58 people.

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 2008 and associated Regulations about how the service is run.

The service was registered with the CQC in June 2014. This inspection on 13 June 2016 was the first inspection for the service.

Some people who used the service were unable to verbally communicate with us due to their mental capacity. We therefore spoke with relatives of people who used the service. People and relatives told us that they were satisfied with the care and services provided. They said they were confident that people were treated with respect and they were safe when cared for by care workers. They spoke positively about care workers and management at the service.

Systems and processes were in place to help protect people from the risk of harm and care workers demonstrated that they were aware of these. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and care workers were aware of potential risks to people and how to protect people from harm. These included details of the triggers and warning signs which indicated when people were upset and how to support people appropriately.

We checked the arrangements in place in respect of medicines. Care workers had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that all with the exception of one of these were completed fully. We found the service had an effective medicines audit in place.

People told us their care workers turned up on time and they received the same care worker on a regular basis and had consistency in the level of care they received. This was also confirmed by relatives we spoke with. The service had a system in place to monitor care workers punctuality.

People and relatives told us that they were confident that care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers spoke positively about their experiences working for the service and said that they received support from management and morale amongst staff was positive.

Care workers had a good understanding of and were aware of the importance of treating people with respect and dignity. Feedback from relatives indicated that positive relationships had developed between people using the service and their care worker and people were treated with dignity and respect.

People received care that was responsive to their needs. People’s daily routines were reflected in their care plans and the service encouraged and prompted people’s independence. Care plans included information about people’s preferences.

The service had a complaints procedure and there was a record of complaints received. People and relatives spoke positively about the service and told us they thought it was well managed. There was a clear management structure in place with a team of care workers, office staff, the registered manager and the director.

Staff were informed of changes occurring within the service through regular staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

Systems were in place to monitor