Right at home Harrow

There was 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.

Our previous inspection of the service in June 2016 rated the service as Good with no breaches of Regulation. During this inspection on 4 January 2019, we found that the service remained Good.

Some people who used the service were unable to verbally communicate with us due to their mental capacity. We therefore also spoke with relatives of people who used the service. People who received care from the service told us that they had been treated with respect and dignity and felt safe in the presence of care support staff. Relatives told us they were satisfied with the care and services provided. They spoke positively about care support staff and management at the service.

Procedures were in place to protect people and keep them safe. Staff knew how to identify abuse and understood their responsibilities in relation to safeguarding people and reporting concerns. Risks to people's and staff safety were identified and guidance was in place to manage and minimise risks of people being harmed and protected them.

Arrangements were in place in respect of medicines management. Staff had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that these were not always completed fully. There were occasions where the key was used to complete the MAR, but there was no further information recorded on the MAR to indicate whether the medicine had been administered or the circumstances surrounding the administration. Further, where medicines formed part of a blister pack, the medicines were not always detailed on the MARs and therefore it was not clear what medicines had been administered. We discussed this with management and they advised that they would ensure that medicines contained in a blister pack would be clearly recorded on the MAR in future. They confirmed that they would take immediate action in respect of this. Following the inspection, the director sent us an action plan which detailed the improvements they would make and timescales. This included refresher training and workshop sessions.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. People received care from the same care support staff on a regular basis and experienced consistency in the level of care they received. The registered manager explained that each person that received care had an allocated group of care support staff so that they were always familiar with them. The service operated a "No stranger policy" which ensured that people always knew who was providing their care.

Comprehensive recruitment processes were in place and the service carried out appropriate checks so only staff who were suitable to work with people using the service were employed by the service.

People were cared for by staff that were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities. Records showed that care support staff had undertaken a comprehensive three-day induction when they started working for the service. They completed training in areas that helped them to provide the support people needed and covered areas such as client care, carer role, duty of care, communication, food hygiene and medication. Training was provided by an external training provider. Topics included moving and handling, medicines, safeguarding adults, infection control, first aid and health and safety. Staff also received regular refresher training to ensure they were informed of developments and updates.

People's dietary needs were understood and supported by the service. People received the assistance and support that they needed to ensure their nutritional needs were met.

People had been visited by the service who carried out an assessment of their needs prior to them receiving care. People received personalised care and the service was responsive to their needs. People were consulted about how they would like to receive their care and their preferences were supported. People's care plans were up to date and included information staff needed about how best to support them. People's daily routines were reflected in their care plans and the service encouraged and prompted people's independence. Care support plans included information about people's life history.

Staff had a good understanding and were aware of the importance of treating people with respect and dignity. They also understood what privacy and dignity meant in relation to supporting people with personal care. Feedback from people indicated that positive relationships had developed between people using the service and care support staff and people were treated with dignity and respect.

The director explained that the service focused on trying to get people out into the community. One example was that the service had arranged a workshop with an external organisation for one person to get together with a younger person to do fun activities. The idea behind this was to encourage the younger and older generation to get together. The service had also arranged a "musical memories" event at a local hall which was held for people with dementia to bring them together to listen to music. The service had participated in the Macmillan cancer coffee morning and arranged for people to come to the office.

The service had a complaints procedure. The service had clear procedures for receiving, handling and responding to comments and complaints. People and relatives told us they did not have any complaints about the service but knew what to do if they needed to raise a complaint or concern.

People and relatives spoke positively about the management of the service. There was a clear management structure in place with the director, registered manager, team of care support staff and office staff which included a recruitment manager, senior scheduler, care coordinator and field care manager.

Systems were in place to monitor and improve the quality of the service. We found the service had a

comprehensive system in place to obtain feedback from people about the quality of the service they received through review meetings, telephone monitoring and home visits. The service implemented their own quality assurance system. This provided a structured system for obtaining feedback from people and relatives and ensured that this was consistently carried out for all people.

The five questions we ask about services and what we found