Care Outlook (Forest Hill)

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Care Outlook (Forest Hill) is a domiciliary care service which provides personal care to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of the inspection there were 270 people receiving care and support for personal care.

Right Support: The provider was not following the principles of the Mental Capacity Act as they had not carried out mental capacity assessments when they had reason to believe people lacked capacity to consent to their care and support. The provider was unable to provide any evidence where decisions were made in people's best interest.

Right Care: There were ongoing issues with the provider’s electronic call monitoring system which meant there was a continued risk people would not get their care visits as planned. The information in care plans and risk assessments was inconsistent which meant there was a risk staff would not be given the most up to date information about how to mitigate risks. Medicines support was not always in line with current guidelines. People’s nutritional needs were recorded however there was a lack of information regarding people’s preferences around food.

Right Culture: The quality assurance and governance processes were not always effective as they had not identified the issues we found with care plans and risk assessments. The provider was following up on some of the issues with staff attendance, but they had not identified all the issues we found. Despite these issues people were mainly positive about the care and support they received. People told us, “I have found them to be brilliant and I have no problems and “I would recommend this company to others if they were going to have the carers I have.” There were processes in place to gather feedback. The provider worked with a range of health and social care professionals when planning care and support.

Rating at last inspection and update

The last rating for this service was good (published 21 January 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the scheduling and monitoring of people’s care visits and the way the provider responded to concerns raised. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care Outlook (Forest Hill) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of risks, staffing, consent to care and good governance. We have made recommendations in relation to training for staff and making care plans more person-centred. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Care Outlook (Forest Hill) is a domiciliary care service which provides personal care to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of the inspection there were 337 people receiving care and support for personal care.

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

The provider had improved the system of scheduling care visits since the last inspection and people told us they now received care visits on time. The provider had improved the way risks to people’s health and wellbeing were recorded and managed. People’s medicines were managed safely by staff who had received relevant training. The provider followed safe recruitment processes.

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 supported this practice. People’s health and social care needs were fully assessed, and care plans contained clear information for staff to ensure they understood how to meet people’s needs. Staff received support and training to enable them to carry out their roles.

The provider had improved the way they managed and responded to complaints. People and their representatives were involved in decisions about their care and support needs. Staff knew people’s preferences and needs and delivered person-centred care. People’s communication needs were assessed and documented. Staff consulted with people about their future wishes when assessing their needs and writing their care plan.

There were ongoing issues with the provider’s electronic call monitoring system which meant there was a continued risk people would not get their care visits as planned. We have made a recommendation about improving the management of this system.

The provider had made improvements to the quality assurance processes since the last inspection. People told us they received the care and support they needed, and managers regularly checked on them to make sure they were happy with the service. The provider worked in partnership with other professionals to plan and deliver care.

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 October 2019) and there were multiple breaches of regulation.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Safe, Effective, Responsive and Well-led which contain those requirements.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care Outlook (London office) is a domiciliary care service which provides personal care to people living in their own homes. 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. At the time of the inspection there were 700 people receiving care and support for personal care.

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

Risks to people were not consistently managed. Risk assessments and care plans had conflicting information and guidelines for staff were not always clear.

People’s medicines were not always managed safely. Important information about how to take certain medicines was not available to staff. Risks associated with some medicines were not identified.

The service had received a high number of complaints related to late and missed visits. Complaints were not always managed in line with the provider’s policy. There were quality monitoring systems in place, but these were not always effective as they had not resolved the issues we found.

The provider had safe recruitment processes and staff received appropriate induction and ongoing training to ensure they would be competent to fulfil their role.

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 supported this practice.

People told us the staff were kind and caring. People were supported to be active and involved in every day choices. People's privacy, dignity and independence was maintained.

People and their representatives were involved in decisions about their care and support needs. Staff knew people’s preferences and needs well and delivered person-centred care. Communication needs were assessed and documented, and staff knew the best way to communicate with people.

We have made a recommendation about how the service should improve the process for documenting people’s capacity to consent to their care and support.

Rating at last inspection

The rating for this service was good (published 14 March 2017).

Why we inspected

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

Enforcement

We have identified breaches in relation to the management of risks including those related to medicines, safe staffing and the quality monitoring process and acting on complaints. Please see the action we have asked the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Care Outlook (London Office) is a domiciliary care agency providing personal care and support to people in their own homes. At the time of the inspection the service was providing support to 501 people. The provider met a range of needs including those of older people, people with physical disabilities and people with a learning disability.

The service had a registered manager at the time of the inspection. 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 helped to keep people safe by assessing and managing their risks. Staff received training in safeguarding and understood how to identify abuse and the actions they should take if they suspected it. Staff were recruited through a robust process and there were enough staff to deliver care and support to people. Staff supported people to receive their medicines in line with the prescriber’s instructions. People were protected by the infection prevention and control practices of staff.

People received care and support delivered by trained and supervised staff. Managers and staff understood their responsibilities in relation to the Mental Capacity Act 2005. People received the support they required to eat and drink enough and staff ensured that people had ready access to healthcare professionals when required.

Staff were caring and kind towards people. People were treated with dignity and respect. Staff promoted people’s independence and people were encouraged to make decisions. People approaching the end of their lives were supported with end of life care plans.

People received personalised care that met their individual needs. People’s needs were assessed and they were involved in the care plans designed to meet their needs. The level of support people required was reviewed regularly. The service responded to complaints in a timely and appropriate manner.

The service had a registered manager. Staff felt supported by their line managers. Quality audits and checks were undertaken to review and improve the quality of the service. The provider worked in partnership with other agencies.