About the service:

¿ Virtue Care is a domiciliary care agency that was providing personal care to nine people at the time of the inspection. Although the provider’s office is based in Aldershot, they provide care to people living in Chiswick and Hounslow.

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

People’s experience of using this service:

¿ The provider had strengthened their recruitment procedures since the last inspection, but they were still not fully robust.

¿ People provided mixed feedback about the timing of their care calls.

¿ People received their medicines and topical creams from trained staff. The provider had not ensured people’s medicine needs had been fully assessed nor were people’s medicine records complete.

¿ People’s daily records were not always either complete or accurate. Electronic care plans were not fully person centred.

¿ Processes to monitor the quality of the service and drive improvements were not fully effective.

¿ People’s feedback indicated some aspects of staff’s practice in relation to infection control required improvement.

¿ The provider’s management of verbal complaints needed to be documented.

¿ People overall reported they experienced positive, kind and caring relationships with staff. One person said, "The majority are smiley, chatty and create a positive vibe."

¿ People overall told us they had been consulted about the provision of their care.

¿ People told us their privacy and dignity was upheld during the provision of their care.

¿ Risks to people had been assessed and mitigated.

¿ People received their care from staff who had received appropriate training.

Rating at last inspection:

¿ At the last inspection the service was rated requires improvement (07 July 2018).

Why we inspected:

¿ All services rated "requires improvement" are re-inspected within one year of our prior inspection.

¿ This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement

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

This inspection took place on 14 May 2018 and was announced. We gave the provider prior notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office.

Virtue Care is a domiciliary care agency that provides personal care to people in their own homes. It provides a service to older adults, people living with dementia, with a physical or learning disability and mental health. The Care Quality Commission (CQC) only inspects the service being received by people provided with the regulated activity ‘personal care’; help with tasks related to personal hygiene and eating. Not everyone using the service receives the regulated activity. Where they do, we also take into account any wider social care provided. At the time of our inspection the service was providing personal care to 14 people.

The service had 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.

During this inspection we found a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not follow their recruitment procedure to carry out checks before new staff were employed to work with people. They did not gather necessary information to ensure staff were suitable for their role.

You can see what action we have asked the provider to take at the end of the full version of this report.

The registered manager had quality assurance systems in place to monitor the running of the service and the quality of the service being delivered. However, they were not able to evidence these systems were effective at all times to identify issues and improvements necessary and what actions they would take. We made a recommendation about how to use and record the quality assurance system to assess and monitor quality of the service.

Staff supported people with taking their medicine by prompting them. Only the registered manager and one staff had medicine training. We could not be sure all staff knew the safe systems of medicine management without appropriate training. We asked the registered manager to address this. They confirmed they had booked staff for training after the inspection.

The registered manager had planned and booked all other training when necessary to ensure all staff had the appropriate knowledge to support people. Staff training records such as training matrix and policy indicated which training was considered mandatory.

Staff had received ongoing support however regular supervision and appraisals were not recorded. Staff felt supported by the registered manager and maintained great team work. People were complimentary of the staff support and care they provided.

People felt safe while supported by the staff. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these when necessary. Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns.

People were supported by sufficient numbers of staff to meet their individual needs. People were informed about the changes to their visits as necessary. People received support that was individualised to their specific needs. Their plans of care were kept under review and amended as changes occurred. People's rights to make their own decisions, where possible, were protected and respected. Staff were aware of their responsibilities to ensure people's rights were promoted.

People were treated with respect, and their privacy and dignity were promoted. People and relatives felt the staff supported them in the way they wanted. Staff were responsive to the needs of the people and enabled them to