Archived: Jewish Care North London and Hertfordshire Home Care Service

• This service is a domiciliary care agency.

• It provides personal care to a range of adults living in their own homes, of Jewish faith, with a broad range of physical and mental health needs.

People’s experience of using this service:

• People and their relatives told us they felt safe and were happy with the care provided.

• People told us staff were able to look after them well and had the skills to care for them.

• There were enough staff to meet people’s needs; some people told us staff did not always tell them when they were running late.

• Care records promoted person centred care, but the service was not recording medicines administration and support safely at the time of the inspection. The service have made improvements since the inspection.

• Risks identified with caring for people were recorded for the majority of concerns, but the service did not always provide enough detail for staff to support people with significant mental health needs. The service has made improvements in this area since the inspection.

• People and their relatives told us they provided feedback on the service, and they thought it was well run. However, we were concerned at the lack of accurate contemporaneous recording of medicines administration records and lack of effective provider oversight of medicines management. We were of the view the service was not always well led.

• The service met the characteristics for a rating of "Requires Improvement" in two out of five key questions we inspected. We found there was a breach of the regulations in relation to governance of the service. Therefore, our overall rating for the service after this inspection was "Requires Improvement". We have also made a recommendation in relation to the staff understanding of the Mental Capacity Act 2005.

More information is in our full report.

Rating at last inspection: At our last inspection, the service was rated "Requires Improvement". Our last report was published on 27 March 2018. At the last inspection we found two breaches of the regulations related to the safe management of medicines and the governance of the service.

Why we inspected: This inspection was part of our scheduled plan of visiting services in line with the “Require Improvement” rating, to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

At our last inspection on 10 and 11 August 2016 there was a breach of the regulations related to safe care and treatment as risk assessments were not always in place to provide guidance to staff. The service had been rated as ‘Good’ overall in August 2016.

A registered manager was in post at the time of the inspection. 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.

Medicines were not always managed safely although the provider was addressing this at the time of the inspection.

Whilst there were quality assurance processes in place they did not always find the issues of concern we found at the inspection. The registered manager was well regarded by people using the service, and staff told us they felt supported and that they received sufficient training and supervision. Records confirmed staff received appropriate training for their role.

At the last inspection we found issues with risk assessments but this was addressed by the time of this inspection.

People told us they were happy with the service provided and they usually had the same carers which they valued. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, and understood issues of consent. The provider had policies and systems in place to support this practice.

Safe recruitment processes were in place so staff were considered safe to work with vulnerable people. Staff understood the importance of safeguarding and the provider referred concerns to the appropriate authority and notified CQC as required.

The provider had a complaints process in place which dealt with formal complaints, but were not always capturing day to day concerns, however the provider told us they would consider how to do this.

We found the provider was in breach of two fundamental standards. These related to safe care and treatment and the governance of the service.

You can see what action we told the provider to take at the back of the full version of the report.

The service was last inspected in January 2014 and was found to be meeting all the outcomes that were looked at during that time.

Jewish Care North London and Hertfordshire Homecare Service provide domiciliary care services to approximately 44 older people living in their own home. The service only provides personal care and support to members of the Jewish community. People are supported with a variety of health needs including supporting those living with dementia, physical disabilities and other high care needs.

A registered manager was in post at the time of the inspection. 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.

Feedback received from people and relatives was positive and people were happy with the care and support that they received from the agency.

Each person had a detailed care plan which included information about the person and the care and support that they required. A pre-service assessment had been completed along with an environmental and generic risk assessment which identified some common risks associated with people’s care and support needs. However, although the service identified individualised risks associated with people’s care, these risks were not assessed and relevant information was not available in order to mitigate those identified risks in order to keep people safe from harm.

Care plans were detailed and person centred. People’s likes and dislikes as well as choices and preferences had been recorded. A background history of the person had also been recorded which gave insight about the person and their life history.

The registered manager, assistant managers and care staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA). Training records confirmed that each staff had received training on the MCA. In addition, each care plan that we looked at had been signed by either the person receiving care or where the person was unable to sign, a relative had signed on their behalf consenting to the care and support that they were receiving.

People and relatives that we spoke with were happy with the care that they received and felt safe with the care staff that supported them. Care staff had a good awareness of what safeguarding was and the actions they would take if abuse was suspected.

The service followed safe recruitment processes to ensure that only suitable staff were employed to work with people requiring care and support. As part of the recruitment process staff underwent an in-depth induction period which covered a variety of topics including mandatory training in subjects such as manual handling, first aid and safeguarding.

Care staff told us that they felt supported in their role and received regular supervision. Records that we looked at confirmed that since the current registered manager had been in place systems were in place ensuring that care staff received regular supervision. However, previous to the current registered manager it was noted that regular supervisions were not taking place.

People were supported with their medicines by care staff. Systems and processes were in place to ensure safe management of medicines. However, where care staff were required to administer medicines we found that care staff did not complete a Medicine Administration Record (MAR) confirming which medicines and at what times these medicines had been administered. An in-house daily recording sheet was completed but this did not give information about the medicines being administered.

A complaints policy was in place as well as a complaints folder which held records of all complaints that had been received and the actions that had been taken to resolve the complaint.

People and relatives told us that staff were caring and had become part of their family. They felt they were treated with dignity and respect and their wishes and choices were always taken into account.

A number of quality assurance systems were in place which monitored the overall running of the service. We saw that the registered manager had put in place systems to monitor missed and late visits as well as conducting weekly telephone monitoring calls to obtain feedback from people and relatives using the service.

People, relatives and care staff were sent annual survey questionnaires requesting feedback on the quality of the service that they received. Staff surveys focused on how they felt working for Jewish Care and, if anything, what would they change about working for Jewish Care. The last quality survey was completed in 2015.

We identified one breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to assessing people’s personal risks associated with their care and support needs. You can see what action we told the provider to take at the back of the full version of the report.

We found that people's rights to receive information about the care and treatment they received, in order to give informed consent, were respected. People's views on service quality were routinely asked for or acted on, and risks to people from missed and late visits were identified and addressed. We also found that when some people started using the service, their needs and risk factors were assessed promptly by the agency. Individual care review visits took place in a timely manner.

We found that there were effective recruitment processes in place to help ensure that people were cared for by suitable staff who were adequately supported by the agency. Systems to assess and monitor the quality of service were effective.

Care plans were up to date and continuity of care was delivered. The provider had taken reasonable steps to protect people from the risk of abuse. People using the service told us 'I feel safe here.'

Staff were supervised and trained regularly. We found there had been delays in receiving some training. The induction programme was comprehensive. However, the manager confirmed that staff sometimes worked alone with people in the two or three months it could take for the formal five day part of the programme to start.

Surveys showed high levels of satisfaction with the service and issues had been identified and managed. Systems were also in place to identify, assess and manage risks to people using the service, protecting them from inappropriate or unsafe care.