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Inspection carried out on 8 December 2017

During a routine inspection

PillarCare agency provides support and care for people in their own homes across a number of London boroughs, predominantly in the north, west and south west London.

This inspection was at short notice, which meant the provider and staff did not know we were coming until 48 hours before we visited the service. At the last inspection on 24 November 2015 the provider met all of the legal requirements we looked at and was rated good.

At this inspection we found the service remained Good.

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 a small number of younger disabled adults.

Not everyone using PillarCare agency receives a 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.

At the time of our inspection the provider was also the registered manager. A registered manager is a person who has registered with the CQC 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 using the service and their relatives told us they felt safe. People were looked after by staff who knew them well and gave them the time and attention they required.

Any risks associated with people’s care needs were assessed, and the action needed to minimise risks was recorded and were updated regularly. Staff were aware of the potential risks that people may face.

Staff respected people’s privacy and dignity and their individual preferences. The people using the service were mostly of the Jewish faith although people of other faiths were also cared for. People were not discriminated against due to their heritage, cultural or religious beliefs, illness or disability.

Staff told us they received training to support them with their role when they joined the service and on a continuous basis, to ensure they could meet people’s needs effectively. Staff training records confirmed this and there was an emphasis on staff obtaining qualifications in health and social care.

The service was diligent with ensuring that the requirements of the Mental Capacity Act (2005) were complied with and proper consultation took place to help protect people’s human rights.

People were encouraged and supported to maintain their independence with no more than the necessary support from staff that was required to help them retain their independence.

People received regular assessments of their needs and the service worked co-operatively with people’s families and other health and social care providers.

People who used the service, relatives and stakeholders had opportunities to provide their views about the quality of the service. The provider worked well to ensure that people were included in decisions about their care. People’s views about how the service was run were respected and taken seriously.

Further information is in the detailed findings below.

Inspection carried out on 24 November 2015

During a routine inspection

PillarCare agency provides support and care for people in their own homes across a number of London boroughs, predominantly in the North of London. At the time of our previous inspection on 12 December 2015 the service was rated as requires improvement. His was due to not having undertaken detailed risk assessments for people using the service, a lack of suitable staff support and training, care plans in some cases not being reviewed regularly and no suitable systems were in place to seek views of people using the service other than annually. At this inspection we found that the service had made improvements in all of these areas. At the time of this inspection there were 15 people using the service.

At the time of our inspection the provider was also the registered manager. A registered manager is a person who has registered with the CQC 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 using the service told us they felt safe. People told us they were looked after by staff that knew them well and gave them individual attention.

Staff respected people’s privacy and dignity and their individual preferences. There were people of different nationalities using the service and people were not discriminated against due to their heritage, cultural or religious beliefs, illness or disability.

We found that staff received training to support them with their role when they joined the service and on a continuous basis, to ensure they could meet people’s needs effectively.

People told us they were supported to maintain their independence and maintain their life skills with no more than the necessary support from staff that was required to help them retain their independence.

People received regular assessments of their needs and any identified risks. The service worked co-operatively with external agencies and people’s families.

People using the service, families, staff and professionals who we had contact with spoke positively about the quality of care that the staff team provided. People thought the service was well organised and that their needs were met.

Inspection carried out on 12 December 2014

During an inspection to make sure that the improvements required had been made

This inspection was short notice which meant the provider and staff did not know we were coming until shortly before we visited the service. At the last inspection on 7th February 2014 the provider met all of the requirements we looked at.

At the time of our inspection the provider also acted in the role of the 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.

From the telephone discussions we had with people using the service, relatives and care workers we found that people were usually satisfied with the service. People were confident about approaching the registered manager and staff to talk about the things that they wished to and people felt that there was openness in the way the service communicated with them.

We saw that there were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) to ensure that people who could not make decisions for themselves were protected. It should be noted that the agency would not have responsibility for making applications under this legislation, however, they would have responsibility for ensuring that any decision on MCA 2005 were complied with. That applications must be made to the Court of Protection. Whether any applications had been made to the Court of Protection and If so, whether the provider was complying with any Court Order. We saw from the records we looked at that the service was applying these safeguards appropriately where applications had been made and approved, however care staff lacked knowledge about these areas.

We found that people’s health care needs were usually assessed, and care planned and delivered in a consistent way. People who used the service had a variety of support needs and from the six care plans that we looked at we found that the information and guidance provided to staff was clear. Any risks associated with people’s care needs were usually assessed, with the exception that the risk assessments did not always cover areas of risk reduction measures. For example, risk assessments did not cover the risk reduction measures for people who were at risk of developing a pressure sore. We also found that in some cases the risk assessments that were in place could be updated more regularly.

During our review of care plans we found that these were usually tailored to people’s unique and individual needs. We found that most, but not all, care plans were being reviewed regularly.

The service provided us with information about the level of qualifications amongst the 38 care workers currently employed. 14 care workers had already achieved health and social care qualifications and four had begun study for the National Vocational Qualification (NVQ 2). We were provided with a list of courses that staff had undertaken in the last year although the provider could not confirm at the time of the inspection how many staff had undertaken these courses or when they were completed. We found that the registered person had not provided sufficient support for staff by arranging suitable opportunities for staff supervision.

We found that staff respected people’s privacy and dignity and worked in ways that demonstrated this. From the conversations we had with people, and records we looked at, which showed us that people’s preferences had been recorded and that staff worked well to ensure these preferences were respected.

Records which we viewed showed that people were able to complain and felt confident to do so if needed. We saw that where people had raised issues that these were taken seriously and dealt with appropriately. People could therefore feel confident that any concerns they had would be listened to.

People who used the service, relatives and other professionals who had regular contact with the service told us that they provided their views about the quality of the service to the registered manager or other staff. There was an annual quality assurance survey being conducted at the time of this inspection, however, there was no other way of monitoring the service performance more regularly than this. 

We found the service was not fully addressing aspects of care such as compiling fully appropriate risk assessments, supporting and supervising staff or ensuring that staff were appropriately aware of the Mental Capacity Act 2005. 

You can see the action that we have told the provider to take at the back of this report.

Inspection carried out on 7 February 2014

During a routine inspection

We spoke with six relatives of people receiving care from PillarCare staff. They all reported a high level of satisfaction with the services, both from the managers and the care staff. They said their relatives were happy with their care staff and had been treated with consideration and respect. When needs changed the agency had responded promptly to requests for a change in care or in hours. People would recommend the service to friends and regarded the service as “efficient and good”. They said the original assessment of needs, likes and dislikes was thorough. One person described finding the service as a “blessing”.

People were enabled to carry on living at home because PillarCare staff managed their care safely and encouraged people to be as independent as they wished and carry on with activities with assistance. People were involved in drawing up their own care plans. Staff had been trained to meet individual needs and told us they were well supported by the management team.

People we spoke with described the staff as "very good, kind and caring”. In recent written feedback people rated the service as at least “good”. People using the service and their representatives were encouraged to give their feedback and contact the service to discuss any concerns and for updates. Appropriate information about people's medical and social needs was recorded when they first started using the service and risks assessments were undertaken to ensure people's safety. There were plans in place for what to do in an emergency which staff were aware of.

Staff had been trained in safeguarding. They knew how to recognise signs of possible abuse and how to report any concerns (including to the local authority). People told us their relatives were safe using the service.

Inspection carried out on 18 February 2013

During a routine inspection

We spoke with two people who used the service and four relatives. One person told us "They are on the ball" and another person said "I consider myself very fortunate with the service I receive." A relative described the carers as "excellent" and said "all care is on an individual basis." We visited the office and spoke with management and looked through the care plans of five people who use the service and four members of staff. We found that the care plans and risk assessments were up to date and reflected the individual needs of the people who used the service. We found that care workers were able to access training regularly to ensure their skills were up to date. One care worker told us that "they are really supportive and helpful." There were regular surveys which ensured quality assurance and provided opportunities for people who use the service to feed back information which is used to develop the service.

Inspection carried out on 11 August 2011

During a routine inspection

We did not talk with people on this occasion. We looked at a number of questionnaires that had been completed by people who use the service. These had been collated by an independent company commissioned by the agency to survey people and analyse the findings. Overall, people were satisfied with the care they were receiving and were complementary about the staff and the quality of their care.