This comprehensive inspection took place on 27 June 2018 and was announced. We gave the provider 48 hours' notice that we would be visiting their main office so that someone would be available to support us with the inspection process.

We last inspected the service on 13 February 2017 and found the service to be in breach of Regulations 12, 13, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was not always undertaking robust risk assessments in areas such as moving and handling. Medicines management and administration was not always safe. Not all staff were able to explain the service's procedure in reporting abuse. Staff files did not hold recent criminal record checks and still had checks carried out by their previous employer that had passed the required three months period. Overall the service was not maintaining accurate records of people's care plans, risk assessments, medicines management, daily care logs and staff recruitment documents. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-led to at least good.

At this inspection, we found that the service had made significant improvements and had met the breaches of regulations which had been identified at the last inspection. However, we did note some minor discrepancies around risks associated with people’s health and medical needs, which had been identified by the service but had not been assessed and guidance had not been provided to staff on how to manage and mitigate the identified risks to keep people safe. This was immediately addressed by the registered manager following the inspection and we were sent fully completed risk assessments reflecting the improvements that they had made.

Swifthand Care Services trading as Heritage Healthcare - Barnet 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 predominately older adults with physical disabilities or those living with dementia. Not everyone using the service receives regulated activity; CQC only inspects the service being 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 this inspection the service was providing personal care services to 24 people.

There was a registered manager in post who was also the company director. 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.

Risk assessments were in place which covered specific areas such as moving and handling, environmental, falls and support equipment. However, where people had been identified with risks associated with their individual health and social care needs had been identified, an assessment had not been completed which gave staff guidance on how to reduce or mitigate the known risk in order to keep people safe.

Care staff received appropriate mandatory training and support to enable them to deliver their role effectively. However, we did note that the service did not always provide training to care staff in order to support people with specific health care needs such as stoma care. Following the inspection, the provider provided evidence that relevant training was being sourced.

The service had processes and systems in place to ensure the safe administration of medicines. However, as the electronic systems were relatively new, the service was facing some initial teething problems with the recording of administration of medicines which the service was working to reso

The inspection took place on 8 February 2017. This was an announced inspection. We gave the provider 48 hours’ notice of the inspection as this is a domiciliary care agency and we wanted to ensure the manager was available in the office to meet us. This service has not been inspected since its registration on 16 September 2015.

Swifthand Care Support Services Limited T/A Heritage Healthcare Barnet is a domiciliary care service run by Swifthand Care Support Services Limited. The service provides personal care to over 20 people with dementia and older people in their own homes. At the time of inspection 22 people were receiving services.

The service had a registered manager 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 using the service and their relatives were generally happy with the service and provided positive feedback. They told us staff were caring and professional. People’s health and nutrition and hydration needs were met. People were generally happy with staff’s punctuality and told us they mostly received the same staff. People were treated with dignity and respect and told us staff listened to their requests.

The service risk assessed the care and support provided to people however, the assessments were not personalised and in some cases relevant information was missing. The risk assessments did not always include sufficient information and instructions to staff on the safe management of identified risks including medicines. We found gaps in medicine administration records.

The service did not always follow appropriate safeguarding procedures, some staff did not have updated criminal record checks and their references were not sought as per the provider’s policy. Staff demonstrated a good understanding of protecting people against abuse, but not all were able to describe their role in promptly reporting poor care and abuse.

Staff received regular support and supervision to do their job effectively. Staff were experienced and well-trained and able to demonstrate their understanding of the needs and preferences of the people they cared for by giving examples of how they supported people.

The service implemented good procedures around the Mental Capacity Act 2005 and supported people that lacked capacity to make decisions about their care.

Care plans were detailed but were task oriented. Not all care plans were complete and did not always record information on people’s individual preferences, likes and dislikes. The daily care logs did not always record what food and drinks people consumed and how they were supported. People felt comfortable in raising concerns and complaints to the management and they were addressed where possible.

The service sought people’s feedback and observed staff supporting people with their care needs, and addressed any concerns raised immediately. The service was in the process of conducting an analysis of annual feedback survey forms. However, the service lacked robust systems and processes to assess, monitor and improve the quality and safety of the care delivery.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.