About the service: Senacare is a domiciliary care agency that provides care to people in their homes. There were 27 people using the service at the time of our inspection, one person did not receive support with personal care. CQC does not regulate this part of the service. Most people using the service were older adults (over 65 years of age), although some younger adults with physical disabilities received a service. Everyone using the service lived within the London Borough of Harrow and the majority had their service commissioned by the local authority.

People’s experience of using this service: People we spoke with told us that they were satisfied with the level of care they received from the service. People told us they felt safe in the presence of care workers and said they had been treated with respect. Relatives spoke positively about the service and told us they were confident people were well looked after by care workers and treated in a caring and dignified manner.

Our previous inspection in August 2018 found that the service had failed to ensure the safe and proper management of medicines and we found a breach of regulation in respect of this. During this recent inspection on 14 March 2019, we found that the service had made improvements and had taken appropriate action to address the breach of regulation. Our previous inspection found that Medication Administration Records (MARs) were not completed correctly and it was therefore not evident whether medicines were being administered as prescribed. During this recent inspection, we found that the service had addressed this issue and found that MARs were completed fully.

Our previous inspection found that where medicines prescribed formed part of a blister pack, the service had no record on MARs of what medicines formed the blister pack. It was therefore not clear from the MARs what medicines had been administered to people. During this recent inspection, we found the service had made improvements and MARs clearly detailed what medicines were in the blister pack.

Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

Systems were in place to help ensure people were protected from the risk of abuse. Staff records indicated that staff had received safeguarding training and staff confirmed this. Staff were aware of the process for identifying concerns and said that they would report their concerns to management without hesitation.

Our previous inspection found that there had been instances where care workers had failed to arrive at people’s home and therefore missed visits. The electronic call monitoring system had failed to identify this and therefore the system was not working effectively. We previously found a breach of regulation in respect of this. During this recent inspection, we found that the service had taken action to make improvements. They had upgraded their electronic call monitoring system so that it clearly highlighted when a member of staff was late or missed a visit. This enabled the service to monitor staff punctuality and ensure staff stayed for the duration of the visit. They deputy branch manager confirmed that since the previous inspection, there had been no missed visits.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

People received care and support from the same team of care workers and this was confirmed by people and relatives we spoke with. This maintained consistency and ensured that staff knew people and could build friendly professional relationships with people. People and relatives spoke positively about this aspect of the service.

People and relatives told us they were confident that care workers had the necessary knowledge and skills they needed to carry out their roles and re

The inspection took place on 13 and 15 August 2018. We told the provider two working days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

The inspection has been rated inadequate for the last two inspections of 24 April 2017 and 13 December 2017. This is because we found that the service was not safe or well-led. We placed the service into special measures following the inspection of April 2017. The service remained in special measures after the inspection of December 2017.

At this inspection of 13 and 15 August 2018, we found that improvements had been made in many of the areas where we had concerns. However, we identified risks which had not been appropriately monitored or managed and this meant that some aspects of the service were still not safe or well-led.

The rating for the question, 'Is the service well-led?' remains inadequate. Where the rating of any key question remains inadequate for more than one inspection, the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Senacare Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. There were 28 people using the service at the time of our inspection, one person did not receive support with personal care. CQC does not regulate this part of the service. Most people using the service were older adults (over 65 years of age), although some younger adults with physical disabilities received a service. Everyone using the service lived within the London Borough of Harrow and most had their service commissioned by the local authority.

There was a registered manager in post. The deputy manager at the service had applied to be a second 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 in the Health and Social Care Act and associated Regulations about how the service is run.

There were a small number of occasions when care workers had not carried out care visits as planned. Whilst the provider had responded to these by speaking with the staff concerned, they had not taken action to make sure such instances did not happen again. For example, the electronic call monitoring system had not identified when the most recent incident took place and neither would it do so if the same mistake happened in the future because it did not guard against human error. In addition, the provider's own records of staff compliance with the electronic call monitoring system showed that some staff regularly did not log into visits. No action had been taken in respect of this, meaning that managers did not have a fail-safe way of monitoring whether visits took place or not.

We di

We undertook an announced inspection of Senacare Ltd on 13 and 14 December 2017. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Senacare Ltd is a domiciliary care agency that provides personal care to around 27 people in their own homes in the London Borough of Harrow. The majority of people’s care was funded by the London Borough of Harrow. We previously inspected Senacare Ltd on 24 and 25 April 2017 and we identified breaches of legal requirements in relation to person centred care (Regulation 9), safe care and treatment (Regulation 12), safeguarding service users (Regulation 13), good governance (Regulation 17) and fit and proper person employed (Regulation 19). We issued warning notices in relation to all five regulations.

Following the last inspection the provider was rated Inadequate in the key questions of Effective and Well-led. Our concerns were sufficiently significant for us to issue an overall rating for the service as Inadequate and place the service in Special Measures.

At this inspection we found that improvements had been made in some areas. However the provider had failed to meet breaches in relation to person centred care (Regulation 9), safe care and treatment (Regulation 12), good governance (regulation 17) and fit and proper person employed (Regulation 19). The service remains rated Inadequate.

At the time of the inspection a registered manager was 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 provider had a procedure in place for the management of medicines and had implemented the use of Medicine Administration Record (MAR) chart since the previous inspection but we saw medicines were still not recorded and administered consistently.

Risk assessments were now in place to assess general risks but risk management plans were not in place to provide care workers with appropriate guidance. Risk assessments were not reviewed following an incident and accident.

The provider had made some improvements to the recruitment process but we found the procedure was still not consistently implemented.

People were supported by care workers with their shopping but the provider did not have a financial transaction recording system in place.

People using the service commented that some care workers did not always arrive on time. Some care workers were not allocated travel time between some of the visits scheduled on their rota.

The provider did not have processes in place to ensure care was provided within the principles of the Mental Capacity Act 2005.

Care workers completed the Care Certificate as part of their induction but the completed workbooks were not checked to monitor their understanding of the training. Care workers had regular supervision meetings with their manager and annual appraisals.

The provider had introduced new care plans which identified people’s wishes in relation to how their care was provided but the care plans were not reviewed and updated when changes to the person’s support needs occurred.

New audits had been introduced but they did not provide appropriate information to enable the provider to identify areas were improvement was required.

People we spoke with felt safe when they received care in their homes. The provider had a system in place to respond to any concerns raised about the care provided.

A detailed support needs assessment was completed before people received care in their home.

Relatives confirmed the provider had a good relationship with healthcare professionals supporting their family member.

People were

We undertook an announced inspection of Senacare Limited on 24th and 25th April 2017. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Senacare Limited is a domiciliary care agency that provides personal care to around 45 people in their own homes in the London Borough of Harrow. The majority of care packages are paid for by the London Borough of Harrow with two people directly funding their own care.

This was the first inspection of the service since it registered with the Care Quality Commission in August 2016.

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.

The provider had a recruitment process in place but this was not always followed therefore not providing appropriate information regarding applicants to ensure they were suitable for the role.

The provider had a policy in place in relation to the administration of medicines but at the time of the inspections Medicine Administration Record (MAR) charts were not used and care workers were not provided with appropriate information.

Risk assessments were not in place to ensure specific issues related to each person were identified and guidance provided as to how to reduce any possible associated risks.

The provider had a policy in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act.

Training and supervision for care workers was in place but some care workers had completed their induction training a number of months before starting work.

Visits did not always happen at the time recorded on the care plan and the rota.

The care plans did not identify a person’s cultural and religious needs and some care plans did not provide any information about the personal history of the person receiving support.

Care plans were not written in a way that identified each person’s wishes as to how they wanted their care provided. Daily records were focused on the tasks completed and not the person receiving the support.

Records relating to care and people using the service did not provide an accurate and complete picture of their support needs.

Regular audits had not been carried out to identify aspects of the service requiring improvement and action had not always been taken to address issues.

People told us they felt safe when they received care in their own home.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care.

People told us they were happy with the care they received in their home.

The provider had a complaints process in place and people knew how to raise any concerns. People could also provide feedback on the quality of the care they received during the spot check visits on the care workers.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to person-centred care (Regulation 9), the safe care and treatment of people using the service (Regulation 12), safeguarding service users from abuse and improper treatment (Regulation 13), the good governance of the service (Regulation 17), staffing (Regulation 18) and fit and proper persons employed (Regulation 19). You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose t