Borough of Lewisham

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.

Borough of Lewisham is also known as First Choice Social Care & Housing Ltd and is a care agency providing personal care and support to people living in their own homes. At the time of our inspection 16 people were using the service. Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with 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 gave us mixed views about the quality of care they or their relative received. We found the electronic call monitoring [ECM] data showed that some people experienced significant delays in receiving consistent care. We found insufficient travelling time led to late or missed care call visits. The provider operated an active recruitment process to recruit care staff.

The provider had systems in place to manage people’s medicines. People had their medicines administered by staff that had been trained and assessed as competent and safe. However, the medicines administration records were not as robust as they could be.

The provider had systems in place to monitor the service and the quality of care. The registered manager regularly reviewed the quality of care people received in line with the provider’s recommendations. However, the auditing systems did not pick up the concerns we found. The provider implemented a new care management system which is accessible to staff on their mobile phones.

The provider had an established safeguarding policy and procedures in place used to protect people from the risk of harm and abuse. Staff completed training on abuse and knew what actions to take to report any concerns they had about people’s well-being.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 6 May 2020).

Why we inspected

We received concerns about people who had experienced missed and late care visits. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe 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.

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 see what action we have asked the provider to take at the end 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 and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to good governance and staffing at this inspection.

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

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. If we receive any concerning information, we may return to inspect.

Borough of Lewisham is also known as First Choice Social Care & Housing Ltd and is a domiciliary care agency. It provides personal care and support to people living in their own homes. There were 33 people using the service at the time of this inspection.

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.

People's experience of using this service

People had their medicines managed well. Electronic medicine administration records (eMARs) and medicines audits were completed and the samples we viewed were accurate .

There were robust monitoring systems in place to ensure people’s records we updated and accurate so staff had enough information to provide safe care.

People told us there were enough staff to provide care and support to them. However, we found that people did not always receive their care on time because staff rotas were not consistently planned well. We made one recommendation about ensuring people receive their care in a consistent and timely way.

The provider’s safeguarding processes guided staff to recognise and report any allegations of abuse. The registered manager referred all allegations of abuse to the local authority team for investigation.

People had assessments completed by staff to identify their care needs and potential risks to their health and well-being. Management plans were put in place to manage and reduce any risks and concerns.

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 managed their social activities themselves and staff supported them to be ready to attend them. People’s dietary needs were met by staff who understood their meal preferences and nutritional needs.

People said staff were helpful kind and caring. The provider asked people for their feedback of the service and gave positive responses about the care they received and the management of 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 and update

The last rating for this service was requires improvement (report published on 11 March 2019) and there were multiple breaches of regulations. We found concerns related to the quality of records related to recruitment, management of medicines, people receiving their assessed care and staff support.

The provider completed an action plan after the previous inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service is registered to provide personal care for people living in their own homes. It provides a service to older adults and younger disabled adults. At the time of the inspection there were 43 people using the service.

At the previous inspection on 14 April 2016, we rated the service ‘good’. At this inspection we found the service did not meet the standards we inspected. We found that medicines were not always managed safely, records were not always kept up to date, recruitment of staff was not always safe, staff did not always have opportunities to meet with colleagues and people did not always receive their assessed care.

The service has a registered manager. The registered manager was away on holiday at the time of this inspection. The registered manager did provide us with information and sent us documents to support this inspection, remotely. An operations manager was providing interim leadership and management of the service in the registered manager’s absence. 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.

There was a recruitment process in place, but some pre-employment checks were not returned before staff worked with people.

There were systems in place for the management of medicines that staff were familiar with and followed. However, medicine administration records were not always completed as required and therefore we could not be assured that people always received their medicines as prescribed.

People’s care records and staff recruitment files were not always accurate or up to date.

Staff told us that although they felt supported by the registered manager they did not have many opportunities to meet with colleagues.

Staff did not always provide care and support for people in line with their assessed care requirements.

Staff followed the provider’s safeguarding processes to protect people from harm and abuse. Appropriate actions were taken by staff to report and manage allegations of abuse.

Potential risks to people were identified, and a plan was put in place to manage and mitigate them.

There were established systems in place for staff training, supervision and appraisal. There was enough staff deployed to support people and meet their assessed needs.

People had enough food and drinks available. Staff prepared meals they enjoyed which met their nutritional needs and preferences.

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.

People gave staff their consent to care and support and to make decisions about how they wanted their care carried out.

People received appropriate care and treatment from health care professionals when their needs changed.

Staff were described by people as kind, caring and compassionate. People said that staff protected their privacy while supporting them. People attended activities and social events as they chose.

Each person had an assessment of their needs and had a care plan that detailed the individual support they needed.

People could make a complaint about the care and support they received through the service’s complaints process.

At the time of the inspection, no one required end of life care. Staff had training in end of life care to give them the knowledge and skills to care for people when this support was required.

There were systems in place for monitoring and reviewing the quality of care. People were supported to provide their feedback about the service. Staff understood their role and were happy working at the service.

We have found three breaches of regulations for the management of medicines, recruitment of staff and records. We have made one recommendation about communication with staff.

Further information is in the detailed findings below.

The service has 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 last time we inspected this service in September 2014, we found a number of breaches in the 2010 regulations. This included care and welfare of people who use services and in records. People did not have their care needs reviewed regularly to ensure care received was in line with their current needs. Some people did not have risks to their health and well-being identified or a plan in place to manage them. People’s care records were either incomplete or had missing information regarding their care needs. We asked the provider to send us a plan about how they will improve the service to meet the regulations. The provider sent us the improvement plan as requested.

During this inspection, we saw evidence of improvements. We found people’s care records were reviewed regularly and risk assessments identified risks to people and plans were in place to manage them. Records we viewed were updated and accurate.

Staff knew how to protect people they cared for from harm and abuse. The registered provider had safeguarding policy and procedures in place to guide staff to raise and manage an allegation of abuse. Risks to people’s health and well-being were regularly assessed and managed by staff. Staff managed people’s medicines safely and as prescribed.

People received support from sufficient numbers of staff to ensure they received their care safely. The registered provider had a robust recruitment practice in place.

Staff obtained skills through training to enable them to care for people effectively. Staff had regular supervision and appraisals that provided them with the opportunity to discuss their training and professional practice needs.

Staff received training and had an awareness of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA supports people who lack the ability to make specific decisions for themselves. Staff were aware of how to care and support people that protected their rights within the principals of MCA. People consented to care and were supported to make choices and decisions about the way they wanted to receive care.

Staff treated people with kindness and compassion while their dignity and privacy was respected. People’s care and support needs were managed by staff who knew them and their preferences well. People’s health care needs were managed by staff effectively. Staff sought advice and support from appropriate healthcare services when needed. People had access to meals which met their individual preferences and nutritional needs. Staff prepared meals which people requested and enjoyed.

People had assessments of their needs and they contributed to and were able to develop care plans to meet those needs. People were able to make choices in the care they received. The registered provider had a process in place for people to make a complaint.

There were systems in place for the registered provider to monitor, review, and make improvements to the quality of care provided. People and their relatives gave feedback to the registered manager and records showed people rated their care as good or excellent. The registered manager was aware of their responsibilities as registered manager with the Care Quality Commission.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People who used the service were protected from the risk of abuse. Staff had received training in safeguarding adults. The registered manager could describe the signs of abuse, the strategies in place for preventing abuse, and what steps they took to escalate concerns. They co-operated with the relevant local authorities to investigate any allegations of abuse.

Appropriate checks were undertaken before new staff began work. For example, the service carried out Disclosure and Barring Service (DBS) checks and followed up on people's references.

Care was not always planned and delivered in a way that ensured people's safety and welfare. Some care records were incomplete, records were missing, and risk assessments had not always been carried out. Not all of the care records had received a timely review to ensure care was being provided in line with people's current needs.

Is the service effective?

Before people received any care they were asked for their consent and the provider acted in accordance with their wishes. The provider acted in accordance with legal requirements where people did not have the capacity to consent.

Is the service caring?

Some of the people using the service and their relatives were satisfied with the care they received. One relative we spoke with told us, "The care workers are lovely. They have a chat. I'm comfortable leaving [my relative] with them."

However, some people were not satisfied with the quality of the care. They told us staff arrived late, did not stay for the correct length of time, or did not complete tasks in accordance with their care needs. One relative said, "Staff are not thorough. They just do the absolute minimum." One person told us, "They don't do their job properly and are regularly late."

Is the service responsive?

There was a complaints policy in place. The details of this policy were included in the guide given to people when they started to use the service. The provider had recorded three complaints since the last inspection. In all cases the registered manager had carried out an investigation and made changes to the service, as required.

Notes of incidents were kept in each individual's communication book. The registered manager told us they reviewed these and made appropriate changes in response.

Is the service well led?

The provider had systems to assess and monitor the quality of service that people received. This included obtaining feedback from people using the service in an annual survey and engaging staff in supervision and meetings. However, the majority of the people we spoke with told us they had little or no contact with the management staff and were not asked to review or otherwise give feedback about their care.