West Malling service is a domiciliary care agency registered to provide personal care to adults with physical disabilities, learning disabilities, eating disorders and those with mental health conditions. It provides care to people living in their own houses and flats. Not everyone using West Malling receives a 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 the inspection West Malling provided a service to four adults with learning disabilities.

The inspection took place on 10 and 11 January 2018 and was announced. It was the first inspection There was a registered manager at the 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.

Risks to people, the environment and equipment were not always assessed or managed properly. People’s nutrition and hydration needs were not always managed in a way that kept them safe. Some people’s medicines were not always managed safely. People were not always recruited in a safe way because full checks were not always carried out on new staff. We made a recommendation about this. Accidents and incidents were not always being reviewed and analysed by the registered manager in a robust manner. We made a recommendation about this. People were protected from abuse by staff who were knowledgeable about safeguarding processes. There were enough staff working to meet the needs of people. People were protected by the prevention and control of infection.

People’s needs and choices were not assessed when they started using the service. We made a recommendation about this. The registered provider had not always ensured that the principles of the Mental Capacity Act were adhered to when assessing people’s capacity to make decisions and give consent to care and treatment. When people had difficulty making decisions or giving consent the proper processes had not been followed to assess their mental capacity. Staff were trained and their skills and competence checked by the management team. People had enough to eat and drink to meet their needs. Each person had a meal plan in place. People’s care records showed many health and social care professionals were involved in their care. This included care managers from the local authority, GPs, local advocacy services such as IMCAs, speech and language therapists and dentists.

Staff were encouraged to develop positive, caring relationships with the people they support. Staff were seen to be kind and compassionate towards people and were able to communicate to people in ways that were understood. We observed people being involved in the planning and review of their care. People’s privacy and dignity was respected at all times. All staff we spoke to told us how important it was to treat people with respect and to maintain their privacy. Staff were supportive of people’s rights to personal relationships.

People’s care plans did not always reflect their physical, mental, emotional and social needs. Through observations we saw that people were being supported to live active and meaningful lives, but this support was not always recorded accurately. The care plans we saw did not always include details about people’s wishes and preferences. People were supported to take part in meaningful activities and to engage with the local community. Staff told us that they supported people to activities like going to the cinema, attending a local day centre and attending a local college. However care plans did not always provide any information on specific activities. We made a recommendation