R4R Home Care Services Ltd/Watford

R4R home care services provided the regulated activity of personal care from an office based on the outskirts of Watford. At the time of this inspection there were two people using the service.

This inspection took place over several dates. On the 29 November 2017 we visited the site office. On the 5 December 2017 we visited people in their own homes and on13 December 2017 we telephoned relatives and staff members in order to obtain their feedback about the service. We gave the provider 48 hours' notice of our intended inspection to make sure that appropriate staff were available to assist us with the 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.

When we previously inspected the service on 8 February 2016 we found that procedures in relation to the recruitment of staff was not always robust and the care and support people received was not always safe. We also found that staff did not always receive the necessary training to carry out their role effectively and the provider's governance systems were not always effective in identifying and improving shortfalls. Following the inspection the provider submitted an action plan which detailed how they were going to implement and sustain the necessary improvement.

At this inspection we found that the provider had made the necessary improvements to ensure people received care and support in a safe, effective and personalised way and there were now systems in place to monitor and review the service provided.

Staff knew what keeping people safe meant as well as how to achieve this by managing any identified risk. Staff were trained in safeguarding people and were informed about who they could report any incident of harm to.

People were given information in a format that they could understand about staying safe.

People's needs were met by staff who were trained appropriately for their role and they were deployed to

ensure people's needs were met.

People were supported to take their prescribed medicines safely. Staff were trained and deemed competent to support people's medicines by staff who had the skills to do this.

Staff were supported in their role and they knew what standard of care was expected. Incidents were used as an opportunity for learning and to help drive improvements.

People were enabled to access healthcare services. People's nutritional needs were met by staff who knew each person's needs well. Staff knew when people needed support and also when to respect people's independence.

The equipment that staff supported people with was regularly checked to make sure that it was safe.

A positive and good working relationship existed between the provider, registered manager, staff and relevant stakeholders. People were supported in partnership with other organisations including healthcare professionals to help provide joined up care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were involved in their care and relatives or friends helped provide information, which contributed to people's independent living skills.

People's care plans contained sufficient information about the person to assist staff with providing person centred care. Staff understood how to provide care that was compassionate as well as promoting people's independence.

People were provided with information about, and or enabled to access, advocacy services when required.

Complaints were investigated in line with the provider's policies and procedures. Concerns were acted upon before they became a complaint.

Support arrangements and procedures were in place to help staff to understand and meet the needs of people requiring end of life care when this was required.

The provider motivated the staff team with regular meetings, formal supervision, mentoring and being shadowed by experienced staff.

The registered manager and provider notified the CQC about events that, by law, they were required to do so. Regular audits were completed and effective in identifying areas that required further development or improvement.

An open and honest staff team culture had been established by the provider and this meant incidents were reported where they needed to be.

The five questions we ask about services and what we found