Wandle Healthcare Services is a domiciliary care agency. This service provides personal care to people living in their own houses and flats. It provides a service to older adults, some of whom are on end of life care, living with dementia and have physical disabilities. At the time of inspection 33 adults were receiving support from this service.

At the last inspection, carried out on 6 February 2018, the service was rated Requires Improvement overall, with Requires Improvement in both the key questions, ‘Is the service effective?’ and ‘Is the service responsive?’. We found two breaches of the Regulations in relation to staffing and safe care and treatment.

This inspection took place on 4 and 5 February 2019 and was announced. We contacted the service 48 hours before the inspection to let them know that we will be coming to inspect them. We wanted to make sure that the management team would be available on the day of inspection.

This was a comprehensive inspection of the service and we rated the service Requires Improvement again. Their previous rating for the key question, Is the service effective? Has improved to Good. However, the rating for the key question, Is the service responsive remained Requires Improvement. The key questions, Is the service safe? and Is the service well-led? Has deteriorated from Good to requires improvement at this inspection.

The service had a registered manager 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.

Risks to people's health and safety were not sufficiently assessed to ensure that appropriate guidance was provided for staff to mitigate the potential risks to people.

Care plans had not addressed the support people required to manage their health needs and to meet their individual care needs.

The provider did not have robust systems in place to monitor the quality of the services provided for people, including accuracy of care records and reviewing of incidents and accidents and complaints.

People felt well supported by staff and safe in their care. Staff had to undertake appropriate checks before they were employed by the service. Staff followed the service’s processes to provide immediate support to people if they noticed people being at risk to harm or when incidents and accidents took place. People had support to manage their medicines safely. However, some improvement was required to ensure that the medicine administration records were maintained appropriately.

Staff accessed appropriate training that gave them the knowledge and skills to support people effectively. Staff were confident that any concerns raised

would be acted upon by the registered manager appropriately. People told us that staff arrived for their shifts mostly on time and that they were contacted if staff were running late. Staff understood and followed the principles of the Mental Capacity Act (MCA) 2005. Healthcare professionals provided guidance to staff where people required support to meet their health needs and dietary requirements.

People’s views were listened to and staff had time to have conversations with people. Staff provided support that was respectful towards people’s privacy, culture and religion. People were treated with dignity and kindness. Staff enhanced people’s independence and encouraged people to take part in the activities of their choice.

People made choices about the support they wanted to receive and how they wanted to be cared for. Staff used people’s preferred communication strategies to involve them in conversations. People’s views were gathered and dealt with in a professional manner. Staff were guided on the support people required at the end stages of their life.

People felt t

Morden is a domiciliary care agency. This service provides personal care to people living in their own houses and flats. It provides a service to older adults, some of whom have dementia, physical disabilities and mental health needs. At the time of inspection 111 people were receiving support from this service.

This inspection was carried out on 6 February 2018 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we needed to be sure that someone would be in when we come to inspect the service.

At the last inspection on 19 November 2015 the service was rated GOOD. At this inspection we rated the service Requires Improvement, with Requires Improvement in effective and responsive.

The service had a registered manager 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.

We found that people’s care plans were not always accurately maintained. Information was missing on some of the needs identified and there were no records available on the support people required to meet these needs.

The training provided for staff was not always effective. Staff received a number of training courses in one day which made it difficult to retain information.

The management team had monitored safeguarding alerts raised and took actions to protect people as necessary. There were risk management plans in place to mitigate known risks to people. Recruitment checks were carried out to assess staff’s suitability for the role. The management team ensured that people had support to take their medicines in line with the service’s procedures. Measures were put in place to control infection and prevent accidents occurring.

Electronic systems were used to monitor the time staff spent with the people they were supporting. Staff also used their phones to share information as quickly as possible. Staff received one-to-one time with the managers to discuss their developmental needs and any concerns they had. People had the same staff members to support them which meant that staff knew people’s care and support needs well. Staff assisted people with their food shopping and cooking meals as necessary. There were processes in place for staff to follow to support people to make their own decisions if there were any concerns in relation to their capacity.

People and their relatives consistently told us that staff were caring, kind and respectful towards their privacy. Staff ensured that people had their dignity maintained and provided personal care in a way that felt comfortable. People had support to go out in the community and to maintain relationships that were important to them. People’s independence was enhanced and staff encouraged people to carry out tasks for themselves if they were able to. Staff knew what was important for people and ensured they provided people with the assistance they required.

People’s care and support needs were monitored and reviewed regularly so staff could provide the required level of care for people. People and their relatives approached the management team for information or if they were not happy about something so improvements could be made as necessary. Systems were in place to gather people’s feedback about the support they received and if they wanted to make any changed to the service delivery.

There was good leadership at the service and the staff team shared responsibilities to ensure effective care for people. Staff were provided with the service’s policies and procedures to follow and to provide consistent care for people. Quality assurance systems were in place and regular audits took place to review the quality of the care being delivered to people. The service worked in partnersh

This was an announced inspection and took place on 19 November 2015. This was the first inspection of this service, registered with the CQC in April 2015.

Wandle Healthcare Services provides domiciliary care and support to 70 people living in their own homes in the Merton area with a range of needs including older people and dementia care needs.

The service had a registered manager in post at the time of this inspection. 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 with the care and support they received in their homes. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place to inform people who used the service, their relatives and staff how to report potential or suspected abuse.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe.

The registered manager ensured there were safe recruitment procedures to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Staff received training in areas of their work identified as essential by the provider. We saw documented evidence of this. This meant that staff had the knowledge and skills to carry out their work with people effectively.

Appropriate arrangements were in place in relation to administering and the recording of medicines which helped to ensure they were given to people safely.

Staff supported people to make choices and decisions about their care.

People had a varied nutritious diet. They were supported to have a balanced diet, food they enjoyed and were enabled to eat and drink well and stay healthy.

People were involved in planning their care and their views were sought when decisions needed to be made about how they were cared for. The service involved them in discussions about any changes that needed to be made to keep them safe and promote their wellbeing.

Staff respected people’s privacy and treated them with respect and dignity.

People said they felt the service responded to their needs and individual preferences. Staff supported people according to their care plans and this included supporting them to access their local community facilities.

The provider encouraged people to raise any concerns they had and responded to them in a timely manner. People were aware of the complaints policy.

People gave positive feedback about the management of the service. The registered manager and the staff were approachable and fully engaged with providing good quality care for people who used the service. The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions via surveys. Action plans were developed where required to address areas for improvements.