Borough of Lewisham

Updated 7 June 2023

The inspection

We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.

Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.

Inspection team

The inspection was carried out by one inspector, one pharmacy inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since their last inspection. We sought feedback from the local authority and health and social care professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used information gathered as part of monitoring activity to help plan the inspection and inform our judgements. We used all of this information to plan our inspection.

During the inspection

We spoke with the registered manager. We also spoke with 4 people and 6 relatives. All staff were sent a questionnaire and we received feedback from 6 of them. We reviewed a range of records including electronic call monitoring data (ECM) for 21 people receiving a service between September to November 2022. We looked at 11 people’s care records. We reviewed variety of records relating to the management of the service, including medicines administration records, policies and quality of the service.

This performance review and assessment was carried out without a visit to the location’s office. We used technology such as video calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation. Inspection activity started on 30 November 2022 and ended on 18 December 2022.

Updated 7 June 2023

About the service

Borough of Lewisham is also known as First Choice Social Care & Housing Ltd and is a domiciliary care agency providing personal care and support to people living in their own homes. At the time of our inspection 21 people were using the service, some who were living with dementia, a physical disabilities and some people were living with a mental health needs.

At the time of the inspection care and support was delivered in the London boroughs of Bexley, Kingston, Middlesbrough council and Slough borough council.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

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

People and their relatives gave us mixed views about the quality of care they or their relative received. People told us that they liked their regular care worker but found replacement care workers were not always aware of their needs.

There were concerns about the validity and accuracy of the electronic call monitoring (ECM) data. There were higher than expected numbers of manually logged care calls and incidents of care workers logging in at two different locations recorded at the same time. An ECM system is where care workers log in and out of their calls, and the information is recorded. The ECM data showed continued concerns about the timeliness of care calls. We found staff were not deployed in a safe way and they did not always have allocated travelling time in between care calls which led to late and missed calls.

The provider did not have effective systems in place to manage people’s medicines. There were continued concerns about the quality and accuracy of people’s medicines administration records and medicines care plans because these did not always contain sufficient information about how people took their medicines. This was not in line with the national guidance including the National Institute of Clinical Excellence (NICE) guidance Managing medicines for adults receiving social care in the community.

The provider monitored the service and the quality of care. However, the auditing systems did not pick up the concerns we found. Risks to people were not fully and safely managed and people’s care and support was not always delivered in a person-centred way.

The provider had an established safeguarding policy and procedures in place used to protect people from the risk of harm and abuse. However, the registered manager did not understand their responsibility to report safeguarding incidents to the CQC.

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 22 October 2022).

Why we inspected

We carried out an announced focused inspection of this service between the 6 and 30 June 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We also checked whether the Warning Notice we previously served in relation to the concerns we had about staffing levels at the service (Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014) had been met and 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 of Safe and Well-led which contain those requirements.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the relevant key questions 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 Borough of Lewisham on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to safe care and treatment, good governance and staffing at this inspection. We found a new breach of Fit and proper persons employed.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.