Camden Chinese Community Centre

The Camden Chinese Community Centre [Housebound Project] is a domiciliary care agency. It is an organisation that provides services for members of predominately but not only the Chinese community. The organisation provided a range of socially inclusive services, such as, social welfare, recreational and leisure activities, outreach work for people living in Camden and surrounding boroughs. The organisation's housebound service provided personal care to people living in their own houses and flats in the community. Support was provided for older people, people who have mental health difficulties and people with a physical disability. At the time of our inspection, the housebound service provided care to 17 people. Care staff employed by the service spoke Cantonese and other southern Chinese dialects.

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

Since our last inspection the service had continued improving. The management team and the staff worked consistently to ensure the service met requirements of the health and social care regulations. This was reflected in consistently positive feedback from people who used the service, their families, staff and external health and social care professionals. They said the service had undergone a lot of changes which benefited all stakeholders. Further improvements were on the way. These, for example, related to how changes to people’s care were recorded so staff had easy access to current information about people’s needs, how staff recorded care provided to people and recording of audits for further review and reference.

There were systems in place to help to protect people from abuse and harm. Each person had individual risk assessments covering a range of risks relevant to people. These had been reviewed and updated when required. Medicines were managed safely and in accordance with national guidelines. Staff followed effective infection control measures. There were effective safeguarding procedures in place and staff received training so they could recognise signs of abuse. Staff were recruited safely and there were suitable staff deployed to support people.

People’s needs had been assessed to ensure they received the support they needed and wanted. People and when appropriate their family members participated in the care planning and reviewing process. They told us the service had been responsive to people’s changing needs and it was easy to make changes to the care and support provided when needed. People were supported to live a healthier life. Their nutritional needs and preferences were fully considered when providing support with food and drink. Staff supported people to have access to social and healthcare professionals when needed.

Staff were appropriately trained to ensure they had skills and knowledge to provide safe and effective care. Staff skills and competencies had been assessed by members of the management team. Staff had been regularly supported and monitored through regular supervision, yearly appraisal and spot checks in people’s homes.

Staff felt supported by their managers. They thought they could contribute to the development of the service provision and their suggestions and opinion mattered.

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.

All people and relatives were satisfied with the care provided by the service. People and relatives described staff as kind and caring. They told us staff were considerate of people’s needs, sought their permission before providing care and always involved people in decisions about people’s daily care. Staff knew how to protect people’s dignity and privacy.

Staff had wide-ranging knowledge about people, what care they needed and what was important to them. People were usually visited by the same care staff who knew them well. Each person had a person centred care plan which described in detail what people’s care needs and preferences were. Care plans included information about people’s cultural, communication, language and religious needs. Staff were provided with guidance on how people wanted to be supported. Care plans and other documentation related to the service provision were provided in Chinese and English to ensure Chinese and English speakers could understand it.

People and relatives were encouraged to give feedback about the service they received from the Camden Chinese Community Service. This was done through managers being in regular contact with people who used the service and their relatives and yearly service users’ satisfaction surveys. There was an effective complaint procedure in place and people and relatives told us concerns had been promptly responded to people’s satisfaction.

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 24 June 2019). The provider completed an action plan after the last 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.

People’s experience of using this service:

Some improvements had been made to assessment of risk to health and wellbeing of people who use the service. However, more improvements were still required to ensure that all risks and risk management strategies relating to individual people were appropriately documented.

Improvements had been made to ensure people’s medicines were managed safely and according to current national guidelines. Additional improvements were required to ensure information about people’s current medicines was always up to date across all relevant documentation.

Staff received training in the principles of the Mental Capacity Act. Improvements were still required to ensure the agency fully worked within the principles of the Act.

People were safeguarded from abuse. Improvements had been made to how the service handled people’s money. Additional improvements were needed to ensure money handling agreements between the service and people or their representatives were always clearly defined.

Improvements had been observed in relation to the clarity of the roles and accountability within the managerial structure at the service. The registered manager understood their responsibility in relation to managing the regulated activity of personal care.

The provider introduced a range of quality assurance systems and checks to monitor the service delivery. These will be checked during the next inspection to ensure systems introduced were sustained over a period of time and were effective.

There were other safety measures in place to ensure people were protected from harm. The provider’s recruitment procedure was safe and protected people from unsuitable staff. Staff followed appropriate infection control practice. There was a system in place for reporting, analysing and monitoring of accidents and incidents.

There were suitable staff deployed to support people. Staff were provided with enough time to travel between care visits so these could take place as planned.

Staff received mandatory training to ensure they had skills and knowledge to support people. Staff also received ongoing support in the form of spot checks of their direct work with people, regular supervision and team meetings.

People’s care needs and preferences had been assessed and reflected in people’s individual care plans.

Staff supported people to have a nutritious and healthy diet that met their needs and personal and cultural preferences.

People were supported by staff to have access to healthcare professional’s when needed.

People using the service, staff and external health professionals thought the service was well managed.

The managers at the Camden Chinese Community Centre were receptive to the feedback we provided during the inspection.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment. We also made two recommendations relating to the management of medicines and the Mental Capacity Act. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Requires Improvement (Report published 18 February 2019)

Why we inspected: We carried out a comprehensive inspection of this service on 21 and 22 November 2018 and found breaches of regulations. We issued the service with a warning notice in respect of two of the breaches we found. These were in relation to the assessment and management of risks to the health and safety of people using the service and poor management of people’s medicines. There was also a breach in relation to the service not having effective systems and processes in place to assess and monitor the quality and safety of the services provided, to mitigate risks to the health, safety and welfare of people using the service and to ensure that records relating to service users were accurate and complete. Additionally, the management structure was not clear. We undertook a focused inspection on the 16th May 2019 to check whether the service had met the warning notice and to confirm that they now met legal requirements. We inspected the safe, effective and well led domain only at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Camden Chinese Community centre on our website at www.cqc.org.uk.

Follow up: We asked the provider to submit to the Commission an action plan to show how they will make changes to ensure the rating of the service improves to at least Good. We will continue to monitor the service and we will revisit it in the future to check if improvement have been made.

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

Although positive feedback was received we found shortfalls in how the service was run. The issues identified during our previous inspection, related to risk assessment had not been addressed to the standard required by the Regulations. The issue related to time allowed for staff travel between calls had not been addressed. The standard of care planning at the service had improved, however, it required further work to ensure people received fully personalised care.

During this inspection we identified further shortfalls demonstrating the service was not meeting the standards required by the Regulations and current national guidelines.

We found that medicines had not been managed safely and in line with current national guidelines.

Staff received training in safeguarding people, however, the service had not had effective systems in place to protect people and staff form potential financial exploitation.

The service did not operate effective systems to ensure it met the requirements of the Regulations. Some limited systems were in place to help provide a safe service and these included management of accidents and incidents, infection control and staff recruitment. The service provision had not been regularly monitored to provide safe, effective and high standards of care.

Staff had received training in the number of areas to help them carry out their roles. However, the service’s approach to training was not systemic in ensuring staff were fully trained and competent in all the areas of the service provision. Staff skills and competencies had not been checked and staff direct work with people had not been observed to ensure they provided safe, effective care that was in line with the current national guidelines.

Where people lacked capacity, people’s files had limited information about which decisions people could make and how staff could support them in deciding about aspects of day to day care.

People were asked for feedback about the service via a recently completed annual customer satisfaction survey. The outcomes had been analysed and an action plan created to address highlighted issues. We saw that formal complaints made to the service had been promptly looked into and action was taken to resolve

There were sufficient staff deployed to support people. When possible, people were visited by the same staff which helped continuity of care and development of friendly relationships between people and the staff supporting them.

People were supported to eat a balanced diet that met their individual needs. Staff helped people to have access to respective health and social care professionals when people’s health deteriorated and their needs had changes.

Staff were encouraged to participate in monthly team meetings where a variety of topics related to care delivery had been discussed. In general, staff felt supported by their colleagues and the management team at the service.

Staff supporting people were compassionate and caring. They were able to demonstrate a good level of understanding around the needs of people they supported. The management team and staff spoke kindly and with dignity about people. People felt their privacy and dignity was protected by staff during the provision of personal care.

The service has been rated as Requires Improvement. More information is in the full report.

Rating at last inspection: Requires Improvement (Report published on 16 January 2018)

About the service: The Camden Chinese Community Centre [Housebound Project] is a domiciliary care agency. it is an organisation that provides services for members of predominately but not only Chinese community. The organisation provided a range of socially inclusive services, such as, social welfare, recreational and leisure activities, outreach work for people living in Camden and surrounding boroughs. The organisation’s housebound service provided personal care to people living in their own houses and flats in the community. The support was provided for older people, people who have mental health difficulties and people with a physical disability. At the time of our inspection the housebound service provided care to 16 people from the Chinese community. Care staff employed by the service spoke Cantonese and other southern Chinese dialects.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: We found four breaches in Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued two warning notices about the Regulation 12 and 17.

We have made three recommendations related to calls scheduling, supporting people with limited capacity to make decision about this care and a person-centred care planning.

You can see what action we asked the provider to take at the end of this report.

Follow up: We asked the provider to submit to the Commission an action plan to show how they will make changes to ensure the rating of the service improves to at least Good. We will continue to monitor the service and we will revisit it in the future to check if improvement have been made.

The Camden Chinese Community Centre (Housebound Project) provided home care to thirty people from the Chinese community.

The support was provided for older people, people who have mental health difficulties and people with a physical disability. Care staff employed by the service spoke Cantonese and a number of southern Chinese dialects.

The service had a registered manager in place. 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 service provided traditional support based on trust between staff and the management team. However, they were not fully operating as required by the Regulations. There were areas of the service delivery that required immediate improvement to ensure the service provided high quality of care that was in line with most current standards of good practice.

The service did not have their own risk assessments and risk management plans in place to provide staff with detailed information about the people they were providing care to. There was a risk people could receive support that was not safe.

The service did not draw up plans of care together with people who used the service. Available care plans did not contain full information about how people would like to receive the support, their likes, dislikes and personal preferences.

There were enough staff deployed to support people, however, relatives told us care visits had not always taken place as scheduled as care staff had not been given enough time to transfer between visits.

There were many positive aspects about the service. We found that the overall care and support provided was of a good standard and people were happy with it. This included the continuity of care provided by staff many of whom had worked for the service for many years. They took pride in supporting people.

The service helped to protect people from abuse. Staff were aware of the principles of safeguarding adults and they knew what to do if they thought a person could be at risk of harm from others. The service’s safe recruitment procedures ensured that only suitable staff were supporting people. Staff followed the service’s procedures to ensure medicines were managed correctly and that people were safe from the avoidable risk of infection.

Staff received regular training as well as managerial and peer support. They spoke positively about the support provided and they thought it enabled them to work with people effectively. People using the service and family members confirmed the staff were sufficiently trained and had the knowledge to care for people.

The service supported people predominately from the Chinese community. However, they were aiming to care for people from other ethnic groups, and they were in the process of recruiting appropriate staff to enable this.

People were supported to receive sufficient food and drink of their choice and have a diet that met their individual needs.

Staff supported people to have access to external health professionals when people’s needs had changed or when their health deteriorated.

Staff asked people for their consent before providing care. People who did not have the capacity were supported by staff to make decisions about their care that were safe, unrestrictive and in line with their human rights.

People received care from staff that were kind, patient and proactive in supporting them. People were usually visited by the same staff, who knew them well and who were matched with people based on certain attributes such as personal background and Chinese dialect spoken. This helped people to create friendly and meaningful relationships with staff who cared for them. Staff respected people’s privacy and dignity at all times and ensured people were comfortable when receiving personal care.

Staff supported people to stay in touch with Chinese culture as well as following their interests and doing things they liked to do. People were helped to access various community services that otherwise would not be easily available to them due to their frail health and limited ability to communicate in English.

People using the service and some care staff had limited ability to communicate in English. However, the service had systems in place to ensure effective communication between people, staff and external health and social care professionals. These included translation support when required as well as all respective documents being produced in more than one language to ensure they were accessible to English and Chinese speaking individuals.

People were asked for feedback about the care and support provided by the service. This was done through monthly satisfaction questionnaires completed by people and a yearly Service Users Consultation Event taking place at the service. The service had a complaints procedure, however, no formal complaints had been raised by people or their relatives since our last inspection in October 2015. Additionally, the registered manager or a member of the management team had conducted quality monitoring visits to observe staff practice and discuss various aspects of care provided to people.

The service received positive feedback from external health and social care professionals who praised staff for their commitment to supporting people, caring attitude and professionalism when providing care to people who used the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We noted people were satisfied with the care they received. They told us the care they received was 'good'. One person said they were 'very happy with the service provided'. People told us staff arrived and left on time. They said staff completed the tasks before leaving. Staff communicated with people in Cantonese. This ensured that communication between staff and people who used the service was effective.

The agency had a safeguarding policy. We noted staff had attending safeguarding training and were aware of what to do to safeguard people from abuse. The agency had a recruitment procedure which ensured that the staff employed were appropriately vetted in terms of their skills, knowledge and suitability to be able to provide care and support that met people's needs.

Records were kept securely in lockable filing cabinets in a room. We noted people's records and the agency's policies, including the complains policy, were written in Cantonese. This ensured that the written information was accessible to people who used the service.

People using the service told us they were treated with respect and dignity. People felt safe in the service and they could talk to the other people using the service or care workers. They also indicated that care workers knew their needs. One person said: "[A care worker] knows who is here, who is well, who is not well. [The care worker] arranges for us to go to hospital [if we are not well]".

We noted that the agency actively sought people's views regarding the quality of the service. People indicated staff rang or visited them to ask if they were receiving care that met their needs. We noted that people were asked to complete a feedback form as part of the agency's annual quality assurance system. This ensured that people were able to comment on the quality of the service they received.