This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. Not everyone using Tigheaven Limited receives a regulated activity; The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’ such as 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 the inspection eight people were using the service.

This inspection took place on 17 December 2017 and was announced. At the last inspection on 30 October 2015, the service was rated Good. However, we found that at this inspection the service did not meet all the regulations we inspected and it has therefore been rated Requires Improvement.

The service has a 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 2008 and associated Regulations about how the service is run.

There were systems in place for the safe management of medicines. There was a medicines policy that provided staff with guidance for the administration, ordering and storage of people’s medicines. However, one person told us they had not always received their medicines as prescribed.

The registered provider had a safeguarding process in place on how to report an allegation of abuse. However, we found people were at risk from financial abuse due to poor management and monitoring of people's money when staff supported them with their shopping.

People had their needs and choices assessed before receiving care. However we found that people’s choices were not always respected because staff often arrived late and changed the time of their visits without discussing it with people first.

Staff did not always care for people in a way that demonstrated dignity and respect. People’s dignity was not always respected by staff. This was because some staff spoke in a language people did not understand while delivering care. Staff were kind, compassionate and helpful to people.

Staff received training, supervision and an appraisal to support them effectively in their roles. Staff were supported by the registered manager to assist them with their professional and development needs.

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Staff identified risks to people’s health and well-being. Risks were recorded in a risk management plan that and contained guidance for staff to follow.

The registered manager had systems in place to record accidents and incidents that occurred and the provider learnt lessons from these. People had support from staff who understood their wishes at the end of their lives.

The registered manager had a rota that showed enough staff were available to care for people. Staff were safely recruited and pre-employment checks were carried out before they were employed at the service.

People were supported by staff to eat and drink enough and their preferences were met. Staff supported people with shopping and provided meals that helped people maintain their nutritional and health needs.

Staff followed safe infection control procedures to reduce the risk of infection. Personal protective equipment was available for staff to use.

The registered provider had developed relationships with health and social care professionals to deliver effective care for people. Staff supported people to attend health appointments when needed.

People gave their consent to care and support. Staff cared for people and had an understanding of the Mental Capacity act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the polici

The inspection took place on 30 October 2015 and was announced. Tigheaven Limited provides personal care for people living in their own home in the London borough of Lewisham. At the time of the inspection there were 10 people using the service.

At the last inspection on 24 April 2014, the service was meeting the regulations we inspected.

The service has a 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 2008 and associated Regulations about how the service is run.

People were protected from harm. The service had processes to keep people safe. Needs and risks assessment were completed and care plans were developed to appropriately meet people’s needs and manage any risks identified.

People were cared for by staff that had appropriate skills, qualifications, support, training and knowledge. Sufficient numbers of staff were employed to care and support people. Medicines were managed safely and people received their medicines as prescribed.

Staff sought consent from people and encouraged them to make choices and decisions about the way in which they wanted to be cared for. The registered manager had an awareness of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They were aware of their responsibilities of MCA while providing care and support people living in their own homes.

People were treated with kindness and compassion and their dignity and privacy respected.

People were cared for by staff that knew them well and met their care and support needs. They had access to health care advice and support when required. People had access food and drink to meet their needs and preferences.

There were systems in place to monitor and improve the quality of service delivery. People and their relatives were asked for their views and their feedback. The manager was aware of their responsibilities as registered manager with the Care Quality Commission.

People were provided with the provider’s complaints process. Staff acted on complaints to resolve them promptly.

During the inspection, the inspector gathered information to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Is the service safe?

People told us they were treated with kindness and in a respectful manner by staff and the managers at the office. We looked at five care records and saw the provider ensured that people understood the care which was to be provided. Staff supported people to consent to care and support, by providing people with information and choices for their care.

Staff demonstrated that they were aware of how to report, manage and respond to concerns raised by people and staff. There were systems in place so staff were able to learn from events such as incidents, compliments, complaints and safeguarding alerts. This helped to reduce the risk to people and improved the quality of the care they received. Procedures for dealing with emergencies were in place and staff were able to describe these to us.

The provider and staff understood their responsibilities under the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People had an assessment of their needs before receiving care and support; from this information individual care plans were developed. Assessments included needs for any equipment, mobility aids and specialist dietary requirements. Risks associated with people's conditions were assessed and a management plan to minimise them.

We saw care plans were made available to people and their relatives. Care plans identified people's wishes, concerns, risk assessment and a management plan to minimise risks identified. Peoples' needs were assessed and appropriate support provided for people to meet those needs and reduce risks.

Is the service caring?

People told us that staff were kind and supportive. Staff were aware of the individual needs and preferences of the people they provided care for. We saw that people were supported to be independent within their local community and were encouraged to attend social activities outside the home, with support if required. For example, people were escorted by care staff, to a range of health care appointments when required.

Is the service responsive?

People told us that they were able to choose when they wanted to make changes regarding their care. For example when a person required the carer to visit them early than at their normal visit time, because they had to attend a social activity. We saw where staff had accommodated this person’s request.

Staff supported people with their decisions and made arrangements with the person so that they were able to have their needs and wishes listened to. We saw that the service made arrangements with people for additional health and social care support when required. We saw that referrals had been made to a social worker for people, meeting their changing care needs. People told us they were involved in reviewing their plans of care when their needs changed and we saw that following the review appropriate support recommended was implemented. For example a change in carer.

Is the service well led?

People told us that they felt able to raise and discuss concerns with staff or the manager as appropriate. There were quality assurance systems in place to improve the lives for people. We saw that staff had regular team meetings, care plan reviews with people living.

People knew how to make a complaint if they were unhappy with any aspect of the service. There was a complaint form for people which was available in a format that people would be able to understand and use, with support if required. People, relatives and staff were asked for their views of their care provided.