Northolt

Northolt, also known as Lean On Me, is a domiciliary care agency. It provides personal care to mostly older people living in their own homes in the London Borough of Ealing. It also supports some adults who are living with dementia and adults who have physical disabilities. At the time of our inspection the service was providing care and support to 72 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they felt safe. However, the provider had not always appropriately completed risk management plans regarding the risks of the COVID-19 virus to people’s health and well-being so as to identify all t reasonably practicable measures to reduce those risks.

The provider’s systems in place to monitor the quality of the service and make improvements when required had not always been effective. Despite the provider’s checks and audits some people’s care plans had not been updated to set out the care they received, reflect people’s preferences or clearly identify how to meet some people’s communication or sensory impairment needs.

We found the provider’s systems for coordinating care visits only provided limited assurance staff were always deployed effectively to meet people’s care needs. The provider was in the process of launching an online monitoring staff monitoring system to reduce the risk of late or missed care visits.

People and relatives felt staff were caring and treated them with dignity and respect. Staff promoted people’s privacy.

There were arrangements in place to support people to take their medicines safely.

Staff felt supported in their roles and were confident they would be listened if they raised concerns. They were provided with induction, a blend of online and room-based training and supervision. Staff helped people to access healthcare services.

The provider regularly sought people’s and their relatives’ views about the quality of the care people received. The provider conducted regular checks on staff to assess the performance and how they were working with people.

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

We have made a recommendations about and the safe handling of people’s money.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 28 August 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. It was also prompted in part due to concerns received about how the provider deployed staff to meet people’s needs effectively and a decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. The rating for the service remains requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northolt on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, person-centred care, and having effective systems in place to monitor and improve the quality of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Northolt, also known as Lean On Me, is a domiciliary care agency. It provides personal care to mostly older people living in their own homes in the London Borough of Ealing. It also supports some adults who are living with dementia and adults who have physical disabilities. At the time of our inspection the service was providing care and support to 139 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We received mixed feedback from people and their relatives about using the service. People said their regular carers were caring, treated them with respect and promoted their dignity and privacy. Some people felt less confident with staff who visited them occasionally.

People told us they felt safe. However, the provider had not always assessed risks to people’s health and well-being or done all that was reasonably practicable to reduce those risks.

There were processes to support people with their medicines, but the provider did not always ensure the safe and proper management of medicines. The provider had not regularly assessed staff to ensure they were competent to give the medicines support being asked of them.

People’s care and risk management plans were not always kept up to date so staff were not always provided with sufficient up to date information on how to provide personalised care.

Some people had experienced late or missed care visits. The provider was implementing new ways of working to address this.

There were systems in place to monitor the quality of the service and recognise when improvements were required. These had identified issues such as people’s care and risk management plans being out of date, but had not been sufficiently robust to have identified some of the issues we found at this inspection.

There were mixed views from people and their relatives regarding the way the service was managed by the provider. People and their relatives’ views were sought about the quality of the care being provided.

People knew how to make a complaint or raise a concern, but the provider did not always happen in a timely manner.

Staff received induction, training and supervision. A new management structure had recently been introduced at the time of our inspection and staff felt supported in their roles. The registered manager was approachable, listened to staff and staff told us they felt supported.

We have made recommendations about sharing safeguarding adults information and end of life care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This inspection was a planned inspection based on the previous rating.

Rating at last inspection

The last rating for this service was good (published 27 April 2017).

Enforcement

We have identified four breaches of regulations at this inspection. These were in relation to managing medicines and risks to people’s safety, person-centred care, handling complaints or concerns, and having effective systems in place to monitor and improve the quality of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. We may inspect sooner if we receive any concerning information about the quality and safety of the service.

Northolt is an agency providing personal care and support to people in their own homes. At the time of this inspection, the service employed 85 care workers and was supporting approximately 180 people. The service had a 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.

We found that the provider had a clear policy and procedures for the recruitment of new care workers. They carried out checks to make sure all care workers were suitable to work with people using the service. If required, the provider sought advice from the Home Office before employing people to work in the service.

Northolt is an agency providing personal care and support to people in their own homes. At the time of this inspection, the service was supporting approximately 180 people. The service had a 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.

The provider had improved the ways they reviewed and updated assessments of possible risks to people using the service. People and their relatives told us they felt people were cared for safely. Where people needed support with their medicines they received this safely.

Most people told us their care workers usually arrived on time, stayed for the amount of time allocated in their care plan and gave them the care and support they needed.

The provider had systems in place to carry out checks on new staff to make sure they were suitable to work with people using the service.

People told us they felt their care workers had the training and skills they needed to provide them with care and support. Staff records showed that the provider arranged for care workers to receive regular, formal supervision with a senior member of staff.

The provider assessed and recorded people's healthcare needs as part of their care plan. Where people lacked capacity to make decisions about their care, consent was obtained in their best interests by people who knew them well.

Most people and their relatives told us their care workers were caring and treated them with dignity and respect. Care workers told us they usually worked with the same people and this helped them to establish relationships and provide continuity of care. Care workers completed a daily record of the care and support they provided on each visit. We saw examples of these and care workers wrote in a respectful and caring way.

People told us they had met staff from the service before they started to receive care and support to talk about the care and support they needed. People had a care needs assessment completed by the local authority and the registered manager told us they used this information to inform their own assessment and the person’s care plan. Most people told us they received the care and support detailed in their care plans and that they were satisfied with their care workers.

Most people using the service and their relatives told us that staff from the service carried out regular checks to make sure they were happy with the care and support they received. The service had a clear management structure and the provider had appointed additional staff since our last inspection, including two supervisors and a quality monitoring officer. The provider and registered manager carried out checks to monitor standards in the service and make improvements.

Two inspectors carried out the inspection on day one and one inspector on the second day. We viewed four people's care records and five staff employment and recruitment files. We also looked at complaints records.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

This is a summary of what we found-

Is the service safe?

Although people's needs had been assessed and care plans developed these did not always adequately guide staff so that they could meet people's needs safely. We found out of date and/or missing information in the care records. Documents such as, moving and handling risk assessments were not on all the files where it had stated there should have been one completed. Also, we saw that some people's needs had not been reviewed to ensure there had not been any changes.

Staff recruitment practices did not protect people from staff unsuitable to work with vulnerable people. Some information on one staff file was missing such as a second reference and details of their criminal record check. The staff we met confirmed they had gone through recruitment checks, an induction and had shadowed experienced staff before they worked alone with people in the community.

Is the service effective?

The service was not always effectively meeting people's needs. Staff did not always have the current information about a person's individual needs and presenting risks. Relatives told us staff, 'usually come on time', whilst another person told us 'the second carer (staff) does not always come'.

We met with three members of staff and they were positive about working for the agency. They said where possible, staff were matched to people's individual needs, such as if they spoke a particular language that the person using the service also spoke then this was arranged

Is the service caring?

We had insufficient evidence to make a full judgement on whether the service was caring. However, feedback about the staff from people who use the service and relatives was positive. People said staff were caring and patient. Comments included the staff were 'fantastic, with a brilliant rapport with X', 'happy with the care workers (staff)'. Where there had been issues relatives told us the agency changed the member of staff.

Is the service responsive?

At our previous inspection on 20 November 2013 we found shortfalls in the complaints records. There was information missing regarding how some of the complaints had been investigated and what the outcome was. The provider sent us an action plan and told us they would address these issues by 30 November 2013.

During this inspection we found the provider had made some improvements regarding how they had responded to complaints. However, improvements still needed to be made to ensure all the paperwork regarding the complaints was kept together and in order. The majority of people and relatives who we spoke with said they would be happy to raise a complaint with the agency, although some people were hesitant in making a complaint as they would not want to lose the support they received.

The manager told us people and their relatives were telephoned and visited to check they were happy and to review that their needs had not changed. However, there was no evidence to support that this was taking place on a regular and on-going basis. In addition, people's records were not always up to date and therefore staff would not always have current information about people's individual needs.

Is the service well led?

There was an experienced manager in post (who was also the provider). However, the service did not have effective systems in place to ensure it was well led. Although people had been asked for their views about the service, there were no other effective quality monitoring systems being used to ensure that the service was operating safely and effectively.

Records were not being maintained appropriately, they were not all up to date and information was not always being recorded. Therefore people were not protected against risks that could arise if appropriate and accurate records were not kept.

The provider had procedures to ensure continuity of care and the safety and welfare of people using the service. Staff had the necessary training and contacts to manage risks and emergencies.

The provider had appropriate policies and procedures to manage the administration or supervision of medicines when required. Suitable records were kept and were complete and up to date. Staff had received relevant training on administration of medicines and this was up to date.

The provider cooperated with a variety of different services and health care professionals to ensure a continuous and well-rounded package of care. Staff had access to suitable and safe equipment to support people they cared for.

The provider had an appropriate complaints procedure which was communicated to people using the service, although complaints were not well documented.

We spoke to six people using the service who were satisfied with the quality of care received. One person using the service told us, "they're excellent", while another said, "They are good - I have no complaints."

People we spoke to said they were happy with the staff, one said 'I am very happy with the care received' and another said 'the staff are brilliant and I wouldn't want the staff to change'. One person said ' the carer is absolutely fabulous' People we spoke to said they were always helped to take their medication at the correct times.

People had a care plan which reflects their physical, emotional and social needs and ensures care is delivered safely. People were involved in the planning of their care. Key procedures were in place for staff on safeguarding vulnerable adults and dealing with emergencies.

A recruitment procedure was in place and checks were being made on staff before they started working with people. Staff were receiving skills training and supervision by a line manager.