About the service:

Verity Healthcare – Waltham Forest is a domiciliary care agency.

The service provides personal care and support to people from various client groups, including older people, people with physical and mental disabilities, sensory impairment and younger adults, living in their own homes.

Not everyone using Verity Healthcare – Waltham Forest 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 our inspection there were six people using the service.

People’s experience of using this service:

People and their relatives told us they felt safe with staff.

People were safeguarded against harm and abuse by staff who were trained in safeguarding and understood their responsibilities to report any suspicions of abuse.

People’s medicines needs were met because robust systems were in place to manage medicines safely.

People were protected from the risks of infection by staff who followed safe infection control practices.

The provider ensured that enough and suitable staff were deployed to meet people’s needs.

People received care from staff who were trained and felt supported to efficiently carryout their role.

People’s needs were assessed before joining the service to ensure that staff were appropriately trained and skilled to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans were individualised, and staff provided personalised care.

People and their relatives told us that staff treated people with dignity.

People were involved in their care and their independence was encouraged.

People and relatives knew how to raise concerns. The provider had responded appropriately when a concern was raised.

People and relatives told us they felt the service was managed well and they would recommend the service to friends and relatives.

People were asked their views about the service to help improve the quality of care delivery.

There were systems in place to effectively monitor the quality and safety of the service.

We have made a recommendation about ensuring staff follow guidance from healthcare professionals.

Rating at last inspection:

Requires Improvement (report published on 13 April 2018).

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 9 and 13 November 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. The service was last inspected 28 February and 2 March 2017 when it was found to be in breach of Regulations 9, 11, 12, 13, and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Verity Healthcare – Waltham Forest is a domiciliary care agency. It is registered for personal care and treatment of disease, disorder or injury. At the time of this inspection it was providing personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing a service to 12 people.

There was a registered manager at this service. 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.

We found medicine risk assessments were insufficient and did not inform staff of the individual support needs and risks faced by people they supported to take medicines. Risks people faced had been identified, but the measures in place to mitigate them were not clear. Recruitment processes were not robust. Care records were not always accessible and complete. The governance and audit arrangements had failed to identify or address the range of concerns found during the inspection.

We identified breaches of three regulations. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Staff received support with regular training and supervision. Staff received appraisals however appraisal records were not always robust. .

Staff and senior management had a good understanding of the Mental Capacity Act 2005 (MCA). MCA is legislation protecting people who are unable to make decisions for themselves. We saw people were able to choose what they ate and drank. There were sufficient numbers of staff employed by the service. Medicines were administered and recorded safely.

People who used the service and their relatives were positive about the staff and told us they were caring. People and their relatives told us they were involved in the planning of their care. We found that care plans were in place which included information about how to meet a person’s individual needs.

Staff, people and their relatives told us senior management were approachable and accessible. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff meetings.

The inspection took place on 28 February and 2 March 2017 and was announced. This was the first inspection at this location.

Verity Healthcare – Waltham Forest is a domiciliary care service providing personal care to people in their own homes. They are also registered to provide Treatment for Disease, Disorder and Injury but were not delivering this at the time of our inspection. They were providing support to approximately 60 people at the time of our inspection.

The service had two registered managers, one for each regulated activity. 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 told us they felt safe, and received good care when they had regular care workers. However, other people told us they received care from lots of different care workers and this affected how safe they felt and the quality of their relationships with care workers.

Only one third of staff had been trained on safeguarding adults from abuse. Records showed that investigations into allegations of abuse had not been conducted in line with safeguarding best practice and local authorities told us they found the provider was very defensive during safeguarding investigations.

Risk assessments relating to risks people faced while receiving care were not complete and did not address all risks faced by people during care. Risk assessments were not completed before people started to receive a service.

People were supported to take their medicines by staff from the service. Records did not show that medicines were managed in a safe way.

The service checked that staff were suitable to work in a care setting by completing criminal records checks. Recruitment records showed the service was not always following its own recruitment practice. We have made a recommendation about recruitment.

Care plans were task focussed and did not contain details of people’s preferences. They told staff where they were involved in supporting people with eating and drinking, but did not include details of people’s dietary needs and preferences. We have made a recommendation about meeting people’s dietary needs and preferences.

Staff gave us mixed feedback about the support and training available to them. Records of training and supervision were inconsistent and did not show staff had received the support and training they needed to perform their roles. We have made a recommendation about staff training and support.

Records regarding people’s capacity to consent to their care were not clear. People had not clearly indicated their consent to their care plans.

The service recorded people’s religious beliefs and cultural backgrounds. The service provided care workers who reflected people’s cultural needs where they were able. The service did not explore people’s relationships or sexuality in assessments or care plans. We have made a recommendation about supporting people who identify as lesbian, gay, bisexual and transgender.

The service had responded to complaints made. The service’s complaints policy was not appropriate for the service. We have made a recommendation about complaints.

People and staff gave us mixed feedback about the leadership and management of the service. While some people and staff told us management were accessible and responsive, other people and staff found them inaccessible and unresponsive.

Quality assurance and audit mechanisms had been ineffective as they had not identified or addressed issues with the quality of the service.

We have identified breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will update this report with our regulatory response.

The overall rating for this service is ‘Inadequ