Westminster Homecare (Bexley) provides domiciliary care and support to people living in the community and to people living in specialist 'extra care’ housing. The domiciliary service provides personal care to people living in their own houses and flats in the community in Dartford, Gravesend, Bexley and surrounding areas. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing. This inspection looked at people's personal care and support service. The service provides support to older adults, people with physical disabilities and people with mental health needs. At the time of the inspection the service was providing care for 282 people.

The service is run by a registered manager who was present at the inspection visit to the office. 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.

At our last inspection we rated the service Good. However, we identified a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that staff received appropriate training in Mental Capacity and record keeping, and supervision as is necessary to enable them to carry out the duties they were employed to perform. We asked the provider to send us a plan of action which they returned on 16 November 2017, setting out what they would do to meet legal requirements in relation to the breach.

At this inspection on 4 June 2018 we found that improvements had been made to ensure that staff had received the training they required for their role, knew how to follow the principles of the Mental Capacity Act 2005 (MCA) and received regular supervisions. We found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on- going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Improvements had been made to staff’s understanding of the Mental Capacity Act 2005 and how to put its principles into practice. Staff had received training in this area, understood that people had capacity to make day to day decisions and best interest meetings were held as needed.

Staff felt well supported. They were supported by means of an annual appraisal, regular staff meetings and supervisions. Improvements had been made to make sure that supervisions were completed in line with the service's policies. Staff underwent a comprehensive induction program and regular training to ensure they were up to date with practice.

Care plans continued to be constructed jointly with people and their relatives and included people's social, physical and emotional needs. They were drawn up after a comprehensive assessment and reviewed regularly.

People told us they felt safe and trusted the staff who cared for them. Staff understood how to follow the service’s safeguarding and whistle blowing policy to keep people safe.

People told us they were treated with dignity and respect by staff who were polite and caring. The service had received compliments about the caring nature of the staff team.

Staff were aware of the risk assessments in place for people and their environment and the appropriate management strategies in place to protect people from avoidable harm.

There continued to be enough staff available to s

This announced inspection took place on 13 and 19 September 2016. At our previous inspection in January 2014 the provider met all five regulations we inspected.

Westminster Homecare provides personal care to 347 people, 23 of whom are currently residing in an extra care facility (self-contained flats within a retirement housing development aimed at promoting independence).

The current manager had recently transferred from another branch and was in the process of becoming the 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.

Care plans were constructed jointly with people and their relatives and included people's social and emotional needs. These were drawn up after an assessment and reviewed regularly. However we noted that the section of people’s hopes and aspirations was sometimes left blank. In addition where people lacked capacity to make decisions about their support, there was no record of capacity assessments or evidence that relatives had power of attorney.

Staff were supported by means of annual appraisal, supervisions and regular staff meetings. However, supervisions were not being completed in line with the service's policies thereby breaching the regulation.

Staff underwent a comprehensive induction program and regular training to ensure they were up to date with practice. However, staff had not received the Mental Capacity Act 2005 training and therefore did not have an understanding of how this impacted on people and the way they were cared for.

People told us they felt safe and trusted the staff who cared for them. Staff explained the procedures they would take in an emergency and how and where they would report any allegations of abuse. There was a safeguarding and whistle blowing policy in place and staff told us they would not hesitate to report any concerns to the management.

Staff were aware of the risk assessments in place for people and their environment and the appropriate management strategies in place to protect people from avoidable harm.

People told us there were enough staff to support them and that they always obtained consent before delivering care. We saw that there was an on-going robust recruitment program to ensure there were enough staff to support people. Where missed or late visits were identified, staff involved were met with to discuss and ensure they followed the proper procedures so as to avoid missed visits in future and protect people from avoidable harm.

Medicines were administered safely by staff that had been assessed as competent. There were regular audits and spot checks in place to ensure that medicines were administered as prescribed.

People were supported to eat a balanced diet and maintain their health. Staff reported any deterioration or changes in health and care needs to the office in order to ensure appropriate referrals were made where extra and/ or specialist support was required.

People, their relatives and staff told us that the service was well- run by an approachable management team. They told us they were aware of how to make a complaint and that any issues and concerns raised were investigated and rectified.

There were regular quality assurance systems and audits in place to ensure care was delivered safely. Spot checks (unannounced checks to ensure staff administered care safely) were completed to ensure staff were following appropriate infection control guidelines and delivering individualised care that met people's needs.

People told us they were treated with dignity and respect by staff who were polite and caring.

At the time of this inspection the agency had over one hundred active care workers who provided personal care to over two hundred people including several who received 24 hour support. We telephoned them 48 hours before visiting to inform them of the inspection and to ask them to arrange for us to see two people who used the service in their own homes. We also spoke with three relatives on the telephone and five members of staff, the manager and their deputy.

People or their representatives told us that they had been involved in the assessment and care planning process and their likes, dislikes and preferences had been taken into account. They told us that any change in their needs was addressed quickly. They were all complimentary about the care and support provided by their regular care workers. Comments included “I receive good care from regular, capable and friendly staff” and “They look after my relative wonderfully well, treat them with respect and they feel safe”.

We saw that people were supported to receive their medicines safely and as prescribed by appropriately trained staff.

The provider employed sufficient trained and experienced staff to meet people’s needs and provide the consistency of care which was highly valued by all the people with whom we spoke.

The provider had effective systems to regularly assess and monitor the quality of its service. They used a variety of methods to collect feedback from those involved and acted on any concerns or complaints they received.

Relatives we spoke to told us that they were happy with the service provided by the agency. Comments included “I have nothing but praise for the agency”.

Relatives told us they were happy with the carers they were sent, “the carers are superb, I can’t fault them” and “the carers are extremely good at their work and they are also very nice people”.

Relatives told us that they were involved in the initial care planning and that staff were well trained and knew what they were doing.