Archived: CRG Homecare - Hammersmith

This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection the service was providing personal care to 249 people.

People’s experience of using this service

The provider had greatly improved systems to monitor the service and this had resulted in significant improvements.

The service offered support and advice to staff and worked to ensure availability of personal protective equipment in response to the outbreak of COVID 19. There were suitable business continuity plans to continue to deliver a service should staffing be further affected by the crisis.

People were safeguarded from abuse and ill treatment. Staff received training in safeguarding adults and were confident in reporting concerns. The provider had effective systems for assessing risks to people’s safety and wellbeing. This included improved approaches to compiling moving and handling plans. There had been an improvement in punctuality, but people told us they still frequently experienced late visits. Staff did not always have enough time on their rota to travel to calls, which the provider had started to address. People received their medicines safely and there was improved management and audit of this.

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. The provider carried out detailed assessments of people’s needs before they started to receive care. People received the right support to eat and drink. People’s health conditions were assessed and there was improved reporting of concerns when people appeared unwell. Staff received appropriate training and support to carry out their roles and managers checked that staff had the right skills and approach to support people effectively.

People told us they were treated with dignity and respect. Care plans contained improved information on people’s preferences for their care and more detailed information about people’s life stories and what was important to them. Staff understood how to communicate with people well and offer choices.

People’s care was planned to meet their needs. The service checked care was being delivered as planned and regularly reviewed people’s care plans. People knew how to complain and there was an improved response to complaints.

Managers engaged with people to find out their views on the service. There were more rigorous and advanced systems of audit and these were used together with learning from incidents to deliver a credible plan to continue to improve the service. Staff received appropriate support from managers who engaged well with care workers to keep them updated. People told us they had struggled to contact the office, and the registered manager had made changes to office roles and the training of supervisors as a result. The provider worked with the local authority and other agencies to continue to develop and improve the service.

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

Rating at last inspection:

The last rating for this service was requires improvement (published 22 March 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We did not find any breaches of regulations at this inspection. 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.

We will continue to work with the provider to offer support and monitor measures taken to protect people from the outbreak of coronavirus.

Not everyone using this service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We last inspected this service in July 2018 where we found breaches of regulations concerning the management of medicines, good governance and staffing. We served three warning notices against the provider. We carried out this comprehensive inspection to see whether the provider had met these notices.

The service did not have 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. At the time of our inspection the provider was in the process of recruiting a new manager, and the two branches were overseen by area managers.

There were increased visits and phone calls to check that people were happy with how their care had been delivered. When people made complaints these were not always fully addressed, and sometimes the response to complaints was extremely poor.

Risks to people’s safety were assessed, but some issues of risk were not fully addressed. At times management plans were generic and did not meet people’s individual needs.

Safeguarding procedures were not followed and there were insufficient recording and checking of financial records to protect people from potential loss or abuse. There were safer processes in place for recruiting staff but these were not always followed.

People’s experiences of the service had improved since the last inspection. There was improved consultation with people using the service and improved supervision and oversight of staff. People reported improved punctuality and reliability of care workers but the overall performance had not improved. There was a lack of consistent management and supervisory staff sometimes lacked the training to effectively manage care workers.

People told us that their care met their needs. Some care plans had not been reviewed although people’s needs had changed. People described their care workers as kind and patient, and told us they always felt safe when their care workers visited.

At the previous inspection we found that medicines management was not always safe. There had been improvements to how medicines were managed. This included more audits being carried out and increased oversight of care workers when errors had taken place. However, there were still times when audits had not picked up on issues of concern.

At the previous inspection we had found that sometimes people did not receive care from two care workers when this was required. The provider had implemented dedicated rounds where care workers now travelled in pairs. This had lead to an improvement, but a small number of calls remained where care workers did not appear to have worked in pairs.

We have made a recommendation about how the provider presents information in accessible formats.

We found four breaches of regulations relating to safe care and treatment, safeguarding adults, good governance and the management of complaints. You can see what action we told the provider to take at the back of the full version of this report.

CRG Homecare - Hammersmith is a domiciliary care agency. At the time of our inspection they were providing care to 391 people in the London Borough of Hammersmith and Fulham and the Royal Borough of Kensington and Chelsea. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults with disabilities.

Not everyone using 'CRG Homecare - Hammersmith' receives regulated activity; The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We last carried out a comprehensive inspection of this service in May 2017. Breaches of regulations were found regarding the management of medicines, consent to care and good governance. We carried out a focussed inspection in October 2017 where we found improvements had been made around consent to care. However, the provider was still not meeting regulations concerning medicines and good governance.

The service had two branch managers who had applied to be registered managers. 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.

People did not always receive the right support to take their medicines and medicines records were frequently incomplete or inaccurate. Audits were not effective at ensuring that standards were improved and actions identified by audits were not always carried out.

Punctuality of calls remained poor which impacted on the standard of care people received. We identified 12 occasions where this meant that people did not receive care from two care workers when this was required. Where the provider had agreed flexible care arrangements with people these were being followed, but these were not in place for most people.

When people had consistent care workers in place people were positive about the service received. However, when people had inconsistent care they did not always feel that they were treated with kindness by staff.

Managers had systems in place for monitoring people’s care and ensuring care plans still met their needs. People had consented to their care plans and received regular reviews of their care. Plans were detailed about the support people required and care was delivered in line with this, but was sometimes impacted by poor punctuality.

There were appropriate systems in place for assessing people’s health and care needs in order to design effective care plans. People received the right support to eat and drink. People’s communication needs were recorded, but the provider did not have systems in place to make sure that the Accessible Information Standards were followed. We have made a recommendation about this.

There were measures in place to assess and manage risks to people’s health and safety, including skin integrity and moving and handling. Safer recruitment measures were followed. Care workers received the right training to carry out their roles and a detailed induction, but did not always have shadowing opportunities and regular supervisions. Managers carried out spot checks of staff skills and yearly appraisals but sometimes these were not of a high standard. There were systems in place to investigate complaints and to safeguard people from abuse.

We found continuing breaches of regulations regarding the management of medicines and good governance and a breach of regulations concerning staffing levels and supervision. We served warning notices against the provider regarding staffing levels, management of medicines and good governance. These informed the provider that they were required to become compliant with these regulations by 16 November 2018 or we may take further enforcement action.

After the inspection, the provider wrote to us to say what they would do to meet legal requirements. We undertook this announced focused inspection on 31 October and 1 November 2017 to check whether the provider had followed their action plan and made the necessary improvements to meet legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘CRG Homecare – Hammersmith’ on our website at www.cqc.org.uk.

CRG Homecare – Hammersmith is a domiciliary care agency which provides care to older people and people with physical disabilities in the London Borough of Hammersmith and Fulham. At the time of the inspection the provider was providing care to 312 people.

The location had a registered manager, who was the Area 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. A new branch manager was in post who had applied to be become registered manager.

We found there had been some improvements in punctuality, but some people we spoke with still identified lateness as a problem, and a high number of visits were late, including some which could impact on people’s care. A far higher number of care workers used electronic call monitoring to log in and out to calls, but the provider had not yet been able to ensure that planned visit times on this system were accurate, which meant the system was still not being effectively used.

The provider had improved recording in relation to people’s medicines, but sometimes plans contained inaccurate and contradictory information. There were now medicines administration recording (MAR) charts in place, but sometimes these contained errors and audits of these were not sufficient to detect errors and to take appropriate action. We found two cases where the provider was not implementing risk management plans with relation to pressure sores.

The provider was now meeting regulations with regards to consent to care, as they had introduced systems to ensure that people’s consent was recorded. Where people were unable to consent to care, the provider assessed people’s capacity and demonstrated they were working in people’s best interests.

We found that audits did not always clearly address where improvements were required in relation to people’s care and people did not always receive regular reviews or quality assurance monitoring. The provider had identified weaknesses in their quality assurance systems and had designed systems to address these, but some of these were yet to be implemented.

We found continued breaches of regulations in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

This was the first comprehensive inspection since the provider registered this location in January 2017. We carried out an inspection in October 2016 at the branch’s previous location where we found that the provider was not meeting legal requirements; this was because they were not carrying out suitable recruitment checks on staff. At this inspection we found the provider had made improvements and was now meeting this requirement.

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 registered manager had been in post since February 2017 and a new branch manager had recently been appointed.

At our previous inspection in October 2016 we found that the provider was not meeting legal requirements about how they carried out pre-employment checks for some care workers. At this inspection we found that the provider was now meeting this regulation. The provider carried out checks to ensure that care workers were suitable for their roles and we checked files to make sure this was taking place.

The majority of people we spoke with told us that their care workers did not arrive on time. We found evidence that a large number of calls were late. The provider was implementing a new system to monitor and improve this. We also found that calls were not always scheduled at the time that was agreed in the care plan.

Care plans were detailed in their scope and contained personalised information about people’s needs and wishes and how they preferred to be supported. Plans included information about people’s family members and family circumstances, their work histories and preferred names. We found in some cases these needed reviewing to make sure that they met people’s needs, and that in some cases care tasks were not carried out. The provider had recently started auditing records of how care was delivered, but did not always pick up on discrepancies or ensured that care tasks were carried out as planned.

The provider had assessed risks to people who used the service and had plans to mitigate these, including mobility and falls risk assessments, assessing the safety of people’s living environments and equipment used by staff. Care workers did not administer medicines to people but prompted them to do this, but this was not appropriately recorded or checked. The provider had assessed people’s needs and understanding with regards to medicines but information about the support people received was not always consistent.

People did not always consent to their care, and the provider did not always check whether people had the capacity to make decisions or that representatives had the legal authority to consent on behalf of people. The provider had identified this as a problem, and had developed but not yet implemented a system to address this. We saw detailed information about people’s dietary needs and care workers recorded how people were supported at mealtimes. There was evidence that staff had responded to concerns about people’s health.

The provider met its responsibilities to report and investigate allegations of abuse, and had systems in place for monitoring and responding to complaints. People we spoke with knew how to make complaints, however two people told us that they had made complaints in relation to timekeeping but that this had not changed.

People told us that they were treated with respect by staff who offered them choices and upheld their dignity and privacy. Care calls were at least 45 minutes to an hour to carry out personal care. The provider did not have tools to monitor the consistency of people’s carers; in many cases this was good but some people did not receive care from consistent staff which meant some people felt staff did not know them well.

Staff received regular training and supervision in order to carry out their roles, and managers carried out spot checks. There were measures in place to monitor this and ensure that this was carried out.

We have made two recommendations about how the provider ensures that care plans reflect how care was delivered and checks that staff have enough time to travel to their appointments. We found three breaches of regulations relating to the management of medicines, consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.