Southwark African Family Support Services (SAFSS) - 54 Camberwell Road

This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection they were providing services to six people, and two of these were receiving support with personal care.

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 were being supported to take their medicines by care staff, but there were no medicines risk assessments or care plans in place. Proper records of the support people were being given with their medicines were not being kept. The service's medicines policy had not been updated to bring it in line with guidance or refer to current regulations.

Staff were not being recruited safely. Legally required pre-employment checks had not been carried out to ensure that staff were of good character and suitable to provide care and support to people.

The registered manager was unable to participate in the inspection, and had delegated the running of the service to the manager. Although some improvements had been made since the last inspection, the service did not have robust governance or quality assurance systems in place.

People and their relatives spoke highly of the care they were receiving. One relative said, “The carers who come in are brilliant… the care is on point.” We were told that people had regular, experienced staff who understood their needs.

Care staff usually attended visits on time and communicated well on occasions when they were running late. A relative said, “They have never left us in a bind.”

Risks to people’s safety had been assessed and documented in an appropriate level of detail.

People told us they felt safe and they were cared for by staff who whose training was up to date, and understood how to protect them from abuse and report any concerns.

People and their relatives told us that if things went wrong they would be comfortable in contacting the office and felt confident they would be listened to.

Staff told us they were supported by the service manager and had regular supervision and appraisal.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (published 25 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for four consecutive inspections.

Following our last inspection, we served warning notices on the provider. We required them to be compliant with Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 26 May 2020.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches of the regulations relating to the safe management of people’s medicines, safe recruitment and the good governance of the service at this inspection.

We have issued a Warning Notice for Regulation 17 (Good governance).

Follow up

The overall rating for this service is ‘Requires improvement’ and the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Southwark African Family Support Services (SAFSS) - 54 Camberwell Road is a domiciliary care service providing personal care to four people at the time of the 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

The provider and the manager had taken some steps to improve the service. They had provided an action plan to address the warning notice that was issued following the last inspection. However, not all the requirements of the warning notice had been met.

The provider was still not fully assessing and mitigating risks to people’s health and safety. Risk assessments had been put in place, but these were not detailed enough to fully mitigate known risks. The provider was still not managing people’s medicines safely. The provider was not always conducting appropriate checks before hiring staff to work with people. People were not always supported by staff who had the appropriate training to conduct their role.

People were supported by care workers who understood how to prevent the risk of abuse and how to prevent 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 and in their best interests; the policies and systems in the service supported this practice. The provider conducted regular spot checks and appraisals of staff performance.

People’s care records did not contain personalised details with regard to their communication, healthcare, nutritional or other needs. There was no recorded information for care workers in how to manage people’s needs in the event of an unexpected death.

The provider was still not effectively monitoring the quality of care being provided. As a result, the issues we found were not identified by the provider.

People’s relatives gave mixed feedback about the care workers but told us they received the support they wanted. They were confident any complaints or concerns would be responded to appropriately. People were supported with their recreational needs where this formed part of their package of care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (published 6 November 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 16 December 2019.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to safe care and treatment, providing person- centred care, ensuring fit and proper persons are employed and good governance 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

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 six 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, 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 of 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.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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 and what we found

The provider did not properly assess and mitigate risks to people’s health and safety as they did not have clear risk assessments in place. People continued to have insufficient information recorded on their medicines care plans despite care workers prompting them to take their medicines. Care workers did not complete medicines administration records charts (MARs) to record medicines they prompted people to take.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were not being supported in accordance with their valid consent. People’s care was not always given in line with current standards as the provider was not working in accordance with the requirements of the Mental Capacity Act 2005. There was a lack of monitoring and clear recording of the support care workers received and as a result, we found one care worker had not received a supervision session for a year and the provider could not demonstrate when care workers had received medicines administration training. People’s care plans did not always contain enough information about their likes and dislikes in relation to food or their medical history.

People’s care plans did not contain any personalised details about their needs. People were not appropriately supported with their communication needs as care plans did not contain enough information. The provider could not demonstrate they had properly considered communicating with people in different written formats such as easy read. The provider was not supporting anyone with their end of life care needs and told us they had no intention to do so. They did not keep a record of people’s needs in the event of a sudden death. The provider was not effectively monitoring the quality of care being provided. As a result, the issues we found were not identified by the provider.

The provider had appropriate processes in place to safeguard people from the risk of abuse and care workers understood their responsibilities. The provider had an appropriate accident and incident policy and procedure in place. The provider conducted appropriate pre- employment checks of prospective staff and ensured there were enough care workers to provide people with support. Staff had a good understanding about appropriate infection control procedures.

People gave good feedback about their care workers and told us they received the support they wanted. People’s care records contained some information about their religious and cultural needs as well as whether they had any particular requirements from their care workers in meeting these. People told us care workers respected their privacy and dignity. People were supported to maintain their independent living skills.

People told us they were given choices in relation to their care and care workers followed these. The provider had a clear complaints policy and procedure in place. Care workers gave good feedback about the manager and the provider worked well with other professionals.

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 19 June 2018) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations. We made a recommendation about care planning and people’s communication needs.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to consent, safe care and treatment and good governance 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 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.

At the last comprehensive inspection on 3 February 2016 the service was rated as Good.

Southwark African Family Support Services is registered as a domiciliary care agency. The service provides personal care to people living in their own homes. The Care Quality Commission (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 the inspection 15 people in the boroughs of Southwark and Wandsworth were using the service. All of the people using the service were funded by the local authority and were able to choose their service provider through the use of personal budgets.

The service had a registered manager in post who was available during both days of our 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.

People told us they felt safe. Staff understood how to recognise and report signs of abuse in line with safeguarding procedures. The provider did not always follow safe recruitment processes to make sure that the staff employed to work in the service were suitable to do so. There was enough staff deployed so that people were provided with sufficient care and support.

People's medicines were not always managed safely. Staff had received the required medicines training, however their competency had not been regularly assessed to ensure they were supporting people safely.

Risk assessments had not been always been reviewed and lacked guidance for staff to follow. Some people’s care plans needed to be reviewed to ensure the provider could be responsive to any changes in their needs. People’s care records did not always contain sufficient information about people’s individual needs and preferences.

People and their relatives told us they were treated with dignity and respect and were supported by kind and caring staff. People were involved in the decisions and choices they made about their care. People’s cultural and individual needs were identified during their assessments and met by the provider. Records demonstrated the provider was working within the principles of the Mental Capacity Act 2005 (MCA).

Staff had received on going supervision, however there were gaps in their annual appraisals to support them with any learning and development needs. Staff had received sufficient training to further develop their skills. Changes to people’s healthcare needs were identified and people had access to healthcare services. People were supported with their nutritional needs however their records did not always contain sufficient information about how staff supported them.

People knew how to raise a complaint and told us they were satisfied with their care. However, one person told us they felt their concerns would not be acted on. Staff arrived for their care visits on time and people were kept informed if they were running late for their care calls. There was enough staff deployed to support people with their care and support.

The provider did not always have effective systems in place to assess, monitor and improve the delivery of the service. The provider had not routinely sought feedback from people to check on the standards of care delivered to people in their homes. We received mixed views about how the service was run. Staff spoke favourably about how the service operated.

We made one recommendation about care plans. We found three breaches of regulations in relation to safe care and treatment, fit and proper persons employed and good governance. You can see what action we asked the provider to take at the back of the full version of this report.

This announced inspection took place on 3 February 2016. Southwark African Family Support Services provides personal care to people living in their own homes. At the time of this inspection, the service was providing support to 15 people in the London boroughs of Lambeth, Southwark and Wandsworth.

Southwark African Family Support Services was last inspected on 16 June 2014. The service met all the regulations we inspected at that time.

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.

People in the service received safe care and support. Staff had identified people’s needs and risks to their well-being and had up to date plans in place to keep them as safe as possible. People were safe from the risk of abuse and neglect. There were sufficient staff available to meet people’s needs.

The services assessed people’s individual needs and planned the delivery of their support. Staff carried out reviews with people and their relatives to ensure their support reflected their current needs. Staff knew people’s hobbies, interests and preferred routines.

The service complied with the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) when supporting people. People were asked for their consent to the care and support they received.

Staff told us the registered manager was approachable and supportive. Staff received regular supervisions and appraisals. Staff used feedback from these sessions to improve their practice. Staff received training to equip them to meet the needs of people.

People told us staff were polite and treated them with respect. People were treated with dignity. Staff involved people and their relatives in assessing and planning for their care and support. People received care that reflected their preferences and choices.

People received support to access the healthcare services they required. Staff supported people with their eating and drinking.

The registered manager obtained people’s views about the service and used their feedback to make improvements. People and their relatives gave positive feedback about the service. People felt confident to raise a concern and understood how to use the service’s complaints procedure. The registered manager investigated and resolved complaints as appropriate.

The provider had effective audit systems in place to monitor the quality of service provided to people. The registered manager conducted regular checks on the support and care provided to people and made improvements if necessary.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and staff supporting them and from looking at records. We spoke to three of the of 14 people using the service at the time of our inspection, three relatives and two members of staff.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were trained to support people safely. There was a safeguarding policy in place and staff understood the types of abuse that could happen and how to report any concerns they had. Risks were assessed for people; and actions were always taken to address any risk promptly. There was a plan for how staff should respond to unforeseeable emergencies. Incidents and accidents were recorded and reviewed.

Is the service effective?

People's care was planned and delivered in a person centred way. The provider involved other healthcare professionals in the planning and coordination of people's care and treatment. Staff followed care plans and responded to changes in people's needs and they were flexible in meeting the needs of people. People were involved in the planning their care and support.

Is the service caring?

Staff understood the needs of people they supported. People using the service told us that they were treated with dignity and respect. People told us that staff encouraged them to do as much as possible for themselves and gave them choice. One person said, 'Staff are nice and caring.' Staff knocked on people's doors before entering. Staff communicated with people in the way they understood.

Is the service responsive?

The provider liaised effectively with other health and social care professionals to ensure the service responded to people's needs. Care plans and risk assessments were reviewed and updated as required. People's views, needs were taken into account when allocating the time of their visits. People were matched with staff that had skills, experience and understanding of their needs including cultural and religious requirements.

Is the service well-led?

The provider worked well with other agencies in meeting the needs of people using the service. There were quality assurance systems in place to identify, assess and monitor the quality of service provided. We saw records of complaints and actions taken to address them. People using the service and their relatives told us that management take complaints and comments seriously and sort things out quickly.

There were effective recruitment and selection processes in place and appropriate checks had been made of staff when they started working for the provider.

Care staff said they were able to talk to the care coordinate if they had any concerns, but we found no evidence that they had regular individual meetings with a line manager or that they had received recent training.

We found no evidence that the provider was monitoring the service as set out in their quality assurance policy. There were no regular reviews of care to assess whether the service was meeting people's needs or to check that the care worker was carrying out the tasks set out in the care plan. They were not regularly finding out the views of people using the service or their representatives.