Westminster Homecare Limited (Milton Keynes) provides personal care for over 200 people living within the community and within independent living schemes in the Milton Keynes, Buckinghamshire and Central Bedfordshire area.

The service had two registered managers. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the comprehensive inspection on the 18 and 21 April, 10 and 12 May and the 1 June 2016 we found the provider was not meeting the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to regulations covering, need for consent, safeguarding people from abuse and improper treatment and receiving and acting on complaints. We asked the provider to make improvements and undertook a focused inspection on the 17 November 2016. We found the provider had made the necessary improvements and were meeting the legal requirements.

We carried out a focused inspection on 23, 26 and 30 September 2016 in response to concerns regarding medicines errors. We found the provider was not meeting the legal requirement of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to, safe care and treatment. We asked the provider to make improvements and carried out a focused inspection on 23 January 2017, we found the provider had made the necessary improvements and was meeting the legal requirement.

At this inspection the improvements identified at the previous inspections had been consistently maintained. However the rating of requires improvement for the key question ‘safe’ remains.

Several people told us that staff did not always arrive at their allocated call times, most commonly at weekends. Several of the care staff told us they did not have sufficient travel time allocated in their schedules to consistently meet people’s call times. This is an area the provider needs to further improve.

People’s capacity to consent to their care was assessed in accordance with the Mental Capacity Act 2005 to protect people from the risks of their liberty being unlawfully deprived. The systems to handle complaints had been strengthened to make sure all complaints were managed appropriately and the systems for managing people’s medicines had been strengthened; audits were regularly carried out to ensure staff followed the medicines procedures and people consistently received their medicines as prescribed.

People told us they felt safe and staff knew how to protect people from the risks of abuse. Risk assessments identified areas of specific risks to people using the service and guided staff on how the risks were to be effectively managed.

Safe recruitment practices were followed and staff received appropriate training to meet the needs of people using the service. Staff received regular supervision and annual appraisals from their line managers.

People were supported to eat and drink sufficient amounts to meet their nutritional needs and dietary preferences. The staff worked in partnership with other health care professionals to support people to access health services quickly.

Staff provided care that was kind and compassionate. They enabled people to remain independent and ensured their privacy and dignity was always respected. People were involved in their assessments and in putting together their support plans. The support plans were regularly reviewed and updated to reflect people’s current needs.

Systems were in place to continually monitor the quality of the care and support people received.

This focused follow up inspection was announced and took place on 23 January 2017.

Westminster Homecare Limited (Milton Keynes) is registered to provide 'Personal Care' for people living at home and within independent living accommodation in the Milton Keynes, Buckinghamshire and Central Bedfordshire area. At the time of the inspection the service was providing care for approximately 180 people.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the last inspection of the service that was carried out on the 23, 26 and 30 September 2016, requirements were made in relation to Regulation 12 of the Health and Social Care Act Regulations 2014. This was because monitoring records on the medicine administration systems were not sufficiently robust to drive continuous improvement. This placed people at risk of not always having their medicines consistently managed safely. We asked the provider to take action to make improvements and we received an action plan from the provider telling us how the legal requirement would be met.

We undertook this inspection to check that they had followed their action plan to meet the legal requirement. This report only covers our findings in relation to the requirement that had been made. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westminster Homecare Limited – Milton Keynes on our website at www.cqc.org.uk

Where the provider had taken on the responsibility to administer people’s medicines, suitable systems had been put in place to ensure medicines were managed safely.

All care staff and field support workers had been provided with updated medicine administration training. The medication policy and procedure had been reiterated to all staff that administered medicines to people using the service. The importance of completing the medicines administration records (MAR) charts correctly had been stressed to all staff. This had also been included as a set agenda for discussion during staff one to one supervision meetings and general team meetings.

Field care supervisors had received re-fresher training on the safe handling of medicines, care planning and on completing medicines risk assessments.

The medicine administration support plans had been reviewed and updated as required, to make sure the information was current and reflected how people wished to take their medicines.

The medicine audit process had been reviewed and strengthened and MAR charts were being reviewed on a regular basis.

The call times for all people that required staff to administer their medicines had been reviewed to .ensure ‘time critical’ medicines were administered to people at the specified time.

Medicine audit systems had been strengthened to ensure they took place as scheduled and areas identified for improvement were addressed and relevant action taken to continually improve the service.

While improvements had been made, we have not revised the ratings for the key questions; to improve the ratings to 'Good' would require a longer term track record of consistent good practice. We will review our ratings for safe’ at the next comprehensive inspection.

This focused follow up inspection was announced and took place on 17 November 2016.

Westminster Homecare Limited (Milton Keynes) is registered to provide ‘Personal Care’ for people living at home and within independent living accommodation in the Milton Keynes, Buckinghamshire and Central Bedfordshire area. At the time of the inspection the service was providing care for approximately 220 people.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were told by the provider that the registered manager’s responsibility was to manage the regulated activity ‘Personal Care’ for people using the service that lived in independent living accommodation. Another manager had been appointed to manage the regulated activity ‘Personal Care’ for people living within the community and they were in the process of applying to register with CQC.

At the last inspection on the 18 and 21 April, 10 and 12 May and the 1 June 2016 we asked the provider to take action to make improvements.

Requirements were made in relation to Regulations 11, 13 and 16 of the Health and Social Care Act Regulations 2014. This was because the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards had not been followed in practice and the system for receiving, recording, handling and responding to complaints was not effectively operated. We received an action plan from the provider telling us how the relevant legal requirements would be met.

We undertook this inspection to check that they had followed their action plan to meet the legal requirements. This report only covers our findings in relation to the requirements that had been made. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westminster Homecare Limited – Milton Keynes on our website at www.cqc.org.uk

Systems had been put in place to ensure people’s capacity was assessed in accordance with the Mental Capacity Act 2005 and to protect people from the risks of their liberty being unlawfully deprived. Although the assessment process had not yet been fully embedded and was work in progress.

Feld care supervisors had been provided with additional training on the Mental Capacity Act 2005 to equip them with the knowledge, to carrying out capacity assessments for people using the service.

The systems to receiving, record, handle and respond to complaints had been strengthened to make sure complaints were managed appropriately.

While improvements had been made, we have not revised the ratings for the key questions; to improve the ratings to 'Good' would require a longer term track record of consistent good practice. We will review our ratings for 'effective’ and ‘responsive' at the next comprehensive inspection.

This responsive inspection was unannounced and took place on 23, 26 and 30 September 2016.

Westminster Homecare Limited (Milton Keynes) is registered to provide ‘Personal Care’ for people who live at home and in extra care sheltered housing accommodation in and around Milton Keynes and Buckinghamshire. The service provides care for approximately 220 people.

A registered manager was 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 were told by the provider that the registered manager’s responsibility was to manage the regulated activity ‘Personal Care’ for people using the service that lived in extra care sheltered living accommodation. The provider told us that interviews were taking place to recruit another registered manager to manage the regulated activity ‘Personal Care’ for people living in the community. In the interim an acting manager was overseeing this activity.

At the last inspection on the 18 and 21 April, 10 and 12 May and the 1 June 2016 we asked the provider to take action to make improvements. This was with regards to working with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards legislation and the handling of complaints.

This was a breach of Regulation 11(3) (4) (5) and Regulation 13 (7) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We received an action plan from the provider on how the relevant legal requirements would be met.

We had also identified at the last inspection that the systems to oversee and manage people’s medicines, for which the provider had taken on the responsibility, was not always effectively managed.

After the last inspection we received information of concern that the service may not have consistently managed people’s medicines safely. We therefore inspected the service against one of the five questions we ask about services: is the service safe?

At this inspection we found the audit systems for monitoring medicines administration was not sufficiently robust to drive continuous improvement. This placed people at risk of not always having their medicines consistently safely managed.

You can see what action we told the provider to take at the back of the full version of the report.

Westminster Homecare Limited (Milton Keynes) is registered to provide personal care for people who live at home in and around Milton Keynes and the surrounding villages. The service provides personal care for approximately 220 people.

This inspection was an announced and took place on 18 and 21 April, 10 and 12 May and 1 June 2016.

We had been informed the registered manager had recently resigned and a new manager had been appointed. A registered manager is a person who has registered with CQC 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.

Staffing arrangements had not always ensured sufficient staff were available to consistently respond to people’s assessed needs.

The systems to oversee and manage people’s medicines were not always effectively managed. The provider had not always identified areas requiring urgent action to be taken timely.

The provider had not worked in line with the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff respected people’s privacy and dignity; they provided care that was caring and supportive of people’s choices and preferences.

The systems for handling complaints were not sufficiently robust and the systems to monitor complaints lacked management oversight.

People were supported to have meals, snacks and drinks available to ensure they had adequate nutrition and hydration.

Risk assessments identified specific risks to people and hazards in their home environment.

Staff were knowledgeable of the safeguarding reporting procedures and knew how to respond to any abuse. The staff recruitment systems were robust. Comprehensive induction training and on-going training was provided for staff.

People and their representatives were involved in planning their care. The support plans contained sufficient information for staff to follow in meeting people’s needs. People were supported to see health care professionals as required.

We identified that the provider was not meeting regulatory requirements and were in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with four people and four relatives of people who used the service. We also spoke with four members of staff and the registered manager of the service.

One person who used the service and three relatives told us that they had recently complained to the registered manager about the level of care received at Westminster Homecare. They also told us that during an eight week period the level of care provided had dropped below an acceptable standard. The poor service included staff being late and not fully understanding people’s care needs. However, one person and two relatives told us that most of these issues had now been resolved and that they were now receiving better care.

Most of the people and relatives of people who used services told us that a regular member of staff provided care to a good standard. However, one person and two relatives told us that they still had concerns because their care was not always being provided in line with their care needs.

We found that people gave their consent for the care they received. They were also able to make a complaint if they were not happy with their care and that the registered manager dealt with complaints appropriately. However, we had some concerns that people did not always experience care that met their needs. We also had concerns that staff were not being adequately supported to do their jobs.

We spoke with nine people who used the service and most of them told us that they were happy with the care they received from Westminster Home Care Limited.

People told us that they preferred to receive care from their regular carers because they understood their care needs well, and that this made it easier for them to receive good quality care. Most of the people also told us that they were able to tell the staff and the manager if they had any concerns about their care. They said their concerns would be looked into by an appropriate person and resolved accordingly.

One person told us,” My carer is very good at observing me and knowing what I need support with”. Another person told us that their carer was, “wonderful” and “very trustworthy” and that they were always respectful when caring for them.

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We carried out this inspection to follow up on our previous findings of non-compliance from our inspection on 29 May 2013. During that inspection some people and their relatives told us that Westminster Homecare had not delivered a high standard of care during a period of at least eight weeks during 2013. The poor service provided included staff being late and new care staff not fully understanding people's care needs. Two relatives told us that they had concerns that staff had not received training to the appropriate standard.

During this inspection we found the provider had made the necessary changes.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People’s needs had been assessed and care plans were written to reflect this. There were enough staff on duty to meet the needs of people. Risk assessment’s had been carried out and were documented in people’s care plans.

Is the service effective?

People were happy with the care and support provided, and staff understood their needs. A person who used the service said, “The girl who comes to me is more like a friend than a helper.”

Staff had received appropriate training to enable them to deliver care and support to meet people’s needs.

Is the service caring?

People we spoke with told us that the staff were always polite and caring. One person said, “The care we get is second to none.” Another told us, “I am more than happy with the support we get, and when we needed more, it was there.”

Is the service responsive?

We saw that people’s care plans had been reviewed and updated when people’s needs had changed.

Customer satisfaction surveys had been sent out to people who used the service. Results had been collated and a letter sent out to everyone stating the results and what would, or had, happened to resolve any issues raised.

Is the service well led?

There was a registered manager in post.

The service had a quality assurance system in place; records seen showed shortfalls were addressed promptly.