Care Outlook (West Wickham)

Care Outlook is a domiciliary care agency which provides care to people 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 350 people were receiving personal care.

People’s experience of using this service:

Risks were not always identified or updated, and risk management plans were not always in place to manage these risks. People's medicines were not always safely managed. People and/or their relatives were not involved in planning their care and support and care plans were not always updated. Staff were not deployed to meet people’s needs in a timely manner Feedback had been sought from people about the service, but the provider did not always act upon and rectify shortfalls identified. The provider's quality assurance systems were not effective.

People told us they felt safe. The provider's recruitment process was robust, and staff were recruited in line with the recruitment policy. Assessments were carried out prior to people joining the service to ensure their needs could be met. There were appropriate adult safeguarding procedures in place to protect people from the risk of abuse. People were protected from the risk of infection. 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. The provider worked in partnership with other agencies to ensure people's needs were planned and met.

Rating at last inspection: The last rating for this service was Good (published 2 July 2019)

Why we inspected: We received concerns about late visits, neglect, and poor medicines management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 monitor the service. We have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed, and good governance.

Please see the action we have told 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 reinspection programme. If we receive any concerning information we may inspect sooner. 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.

Care Outlook is a domiciliary care agency. It provides personal care to adults and older people living in their own homes. 117 people were using the service at the time of the inspection.

Not everyone using Care Outlook receives a regulated activity. CQC only inspects the service being received by people provided with personal care; that 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 said they felt safe. There were safeguarding policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work and there were enough staff available to meet people’s care and support needs. Risks to people were assessed and staff were aware of the action to take to minimise risks where they had been identified. Medicines were managed safely. The service had procedures in place to reduce the risk of infections.

Assessments of people’s care and support needs were carried out before they started using the service. Staff received training and support relevant to people’s needs. People were supported to maintain a balanced diet. People had access to a range of healthcare services when needed. 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 had been consulted about their care and support needs. They were treated in a caring and respectful manner, and their privacy, dignity and independence were promoted.

People had care plans that described their health care and support needs and included guidelines for staff on how to best support them. People knew how to make a complaint if they were unhappy with the service. There were procedures in place to make sure people had access to end of life care and support if it was required.

The provider took people’s views into account through telephone monitoring calls, satisfaction surveys and spot checks and feedback from these was used to improve the service. Staff said they received good support from the registered manager and office staff. The registered manager and staff worked with health and social care providers to drive improvement and to deliver an effective service.

Rating at last inspection

The last rating for this service was good (published 30 December 2016).

Why we inspected

This was a planned inspection based on previous rating.

Follow up

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

We carried out this comprehensive inspection in line with our guidance to provide a new rating for the service and to check that the provider had addressed the less significant breach in relation to recruitment records identified at the last comprehensive inspection on 5 and 6 April 2016.

Care Outlook (West Wickham) provides support and personal care to people in their own homes. At the time of our inspection approximately 115 people were receiving care and support from this service. The service operates in the Croydon and Bromley local authority areas and provides packages of care for people commissioned by the local authorities and people who make private arrangements.

There was a registered manager in place. 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 was being supported to deliver the service by the branch manager.

People told us they felt safe and well cared for. Care workers and office staff had received training on safeguarding adults. They knew the signs of possible abuse and were aware of how to raise any concerns. Possible risks to people were identified and plans were put into place to reduce risk. Care workers and office staff knew how to deal with any emergencies.

People were asked for their consent before care was provided. People told us they were involved in making decisions about their care wherever possible and were supported to be as independent as they could be. Care workers were reliable and people told us that their dignity and individuality was respected. Where people were supported to eat and drink they were asked about their food and drink choices and any concerns were notified to family members or the GP.

An assessment of people’s needs was completed before they started with the service and individual plans detailed the care or support to be provided. We saw these were detailed and provided guidance for care workers on how to meet people’s needs. Care workers told us these were up to date and were amended if people’s needs changed. People knew how to make a complaint if they needed to and we saw responses were made in line with the provider’s policy.

There was effective communication between office staff and care workers. Care Workers told us the service was well led, the office staff were reliable and the management team was approachable and supportive. The provider sought the views of people about the service through direct contact by phone and visits. We found considerable improvements had been made at the service. However, there were aspects of the quality monitoring of the service that required some improvement to be judged as consistently good.

We gave the provider until 20 June 2016 to ensure they complied with the regulations in respect of risks, managing medicines and the quality monitoring aspects of the service. We carried out this focused inspection on 24 and 25 August 2016 to check that the service was now compliant with these regulations. We will follow up on the breach of legal requirements in relation to staff recruitment at a later date.

At this focused inspection we looked at aspects of the key question Safe and Well Led. This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Care Outlook (West Wickham)’ on our website at www.cqc.org.uk.

Care Outlook (West Wickham) provides support and personal care to people in their own homes. At the time of our inspection approximately 156 people were receiving care and support from this service. The service operates in the Croydon and Bromley local authority areas and provides packages of care for the local authorities and people who make private arrangements.

There was a registered manager in place. 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 this inspection we found that action had been taken to improve the identifying, assessing and recording of risks to people. Risks to people were individually identified and assessed and monitored although some improvement was still needed to ensure this was consistent across the service. Improvement had been made to the management of medicines but some improvement was still needed to ensure records were consistently accurate.

In view of the changes made we have therefore changed the rating of the key question Safe to Requires Improvement in line with the characteristics for each rating. We will check for improvements at our next inspection.

There had been improvements to the monitoring of quality at the service. Regular medicines audits were completed to monitor quality across the service. However these changes were relatively recent and we were not able to judge consistency or the reliability of these improvements at this inspection. Audits of the daily care records were not always routinely checked to ensure care and support was delivered as planned.

We have therefore not changed the rating for the key question Well Led. The overall rating remains the same. We will check on improvements at our next inspection.

Care Outlook (West Wickham) provides support and personal care to people in their own homes. At the time of our inspection approximately 192 people were receiving care and support from this service. The service operates in the Croydon and Bromley local authority areas and provides packages of care for the local authorities and people who make private arrangements.

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.

At this inspection we found that although the provider had made improvements to the recruitment system and quality assurance processes there were continued breaches of these regulations. We also found breaches of regulations in respect of safe care and treatment as risks to people were not always identified in respect of their care and treatment. Guidance was not always available for care workers on how to reduce risk. Medicines were also not always managed safely. You can see the action we have asked the provider to take at the back of the full version of this report.

People and their relatives told us they felt safe and well cared for. Staff had received training on safeguarding adults. They knew the signs of possible abuse and were aware of how to raise any concerns. There were enough staff to meet people’s needs in a safe way. Care workers told us they had enough time to travel between calls and people told us carers stayed the full length of the call.

Staff received training and told us they received enough support but some improvements were required to the arrangements for training and care workers knowledge of their responsibilities under the Mental Capacity Act 2005. People told us they were asked for their consent before care was provided. They were involved in making decisions about their care wherever possible and were supported to be as independent as they could be. They said care workers were caring and kind and that their dignity and individuality were respected. Where people were supported to eat and drink they were asked about their food and drink choices and their preferences were recorded. The registered manager told us any concerns were notified to family members. People were supported to have access to a range of health professionals if needed.

An assessment of people’s needs was completed before they started with the service and individual support plans detailed the care or support to be provided. Care workers told us these were regularly updated if there were changes in people’s needs. People knew how to make a complaint if they needed to and these were investigated in line with the provider’s policy.

The provider had addressed most of the issues identified at the last inspection. Regular spot checks on care workers were carried out to ensure care was provided as agreed. The previous branch manager had been absent from the service for long periods since the last inspection. There was a new branch manager who had recently joined the service. The provider, registered manager and branch manager showed a commitment to address the issues we identified. Care workers told us the service was well run and the new branch manager was approachable and supportive. The provider sought the views of people using the service through direct contact, by phone and visits and an annual survey.