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Archived: Concept Care Solutions - 1st Floor Middlesex House

Overall: Good read more about inspection ratings

1st Floor Middlesex House, 29-45 High Street, Edgware, Middlesex, HA8 7UU (020) 8731 5972

Provided and run by:
Concept Care Solutions Limited

Important: This service is now registered at a different address - see new profile

All Inspections

7 December 2016

During a routine inspection

We undertook an announced inspection of Concept Care Solutions – 1st Floor Middlesex House on 7 December 2016. Concept Care Solutions – 1st Floor Middlesex House is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to people of all ages and different abilities. The service provides a range of domiciliary care services which include domestic support, administration of medicines, personal care and live in care. At the time of inspection the service provided care to approximately 60 people.

At our last inspection on 14 December 2015 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the service not having effective arrangements in place for the management of medicines and not maintaining accurate and complete records. During the inspection on 7 December 2016 we found the service had taken necessary action to address the breaches of regulations identified at the previous inspection.

There was a registered manager in post at the time 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 who used the service and relatives informed us that they were satisfied with the care and services provided. People told us they were treated with respect and felt safe when cared for by the service. They spoke positively about care support workers and management at the service.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and detailed potential risks to people and details of how to protect people from harm.

At the previous inspection in December 2015 we found a breach of regulation because the service did not have effective arrangements in place for the management of medicines at the time of the inspection. During the inspection in December 2016 we found that the service had taken appropriate action since the last inspection and there were suitable arrangements for the administration and recording of medicines. Where agreed, people told us that they had received their medicines from care support workers. Records indicated that staff had received training on the administration of medicines. We also found that the service had a comprehensive and effective medicines audit in place to monitor and identify any errors in respect of medicines administration and recording.

People and relatives told us their care support workers mostly turned up on time and they received the same care worker on a regular basis and had consistency in the level of care they received.

People were cared for by care support workers that were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities. Staff confirmed that they received regular supervision sessions and appraisals to discuss their individual progress and development. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety, first aid and moving and handling. Staff spoke positively about their experiences working for the service and said that they received support from management.

At the previous inspection in December 2015 we found a breach of regulation because care support plans were difficult to follow and information about people’s support was not always clear and consistent. During the inspection in December 2016 we found that the service had made improvements to care support plans and had addressed this breach of regulation. Since the last inspection the service had reviewed care support plans and these were now clear and were in a new format. Care support plans included more detail about people and their care needs. They also included clear instructions for care support workers.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). They were aware that when a person lacked the capacity to make a specific decision, people's families, staff and others including health and social care professionals would be involved in making a decision in the person's best interests. The service had a Mental Capacity Act 2005 (MCA) policy in place. Care plans included information about people's mental health and their levels of capacity to make decisions and provide consent to their care.

Care support workers had a good understanding and were aware of the importance of treating people with respect and dignity. They also understood what privacy and dignity meant in relation to supporting people with personal care. Feedback from people indicated that positive relationships had developed between people using the service and their care support worker and people were treated with dignity and respect.

The service had a complaints procedure and there was a record of complaints received. Complaints we examined had all been responded to appropriately. People and relatives we spoke with during this inspection expressed that they had confidence in the service and were satisfied that if they needed to complain about something, their concerns would be taken seriously and dealt with accordingly. It was evident from the feedback received from people and relatives that the service listened to people’s concerns and took the appropriate action.

People using the service spoke positively about the service and told us they thought it was well managed. There was a clear management structure in place with a team of care support workers, field supervisors, office staff and management. Systems were in place to monitor and improve the quality of the service. We found the service had obtained feedback about the quality of the service people received through review meetings and satisfaction surveys. Records showed positive feedback had been provided about the service. The service also undertook a range of checks and audits of the quality of the service and took action to improve the service as a result.

14 December 2015

During a routine inspection

We undertook an announced inspection of Concept Care Solutions – 1st Floor Middlesex House on 14 December 2015.

At our last inspection on 28 October and 13 November 2014 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the service not providing consistent care for people who used the service, failing to record and respond to complaints appropriately and not having adequate systems in place to accurately monitor the quality of services provided. Following the previous inspection, the service sent us an action plan detailing improvements that the service was going to make. During this inspection on 14 December 2015 we noted that the service had made improvements in respect of the breaches previously identified. However this inspection found that there were new breaches in respect of proper and safe management of medicines and information in people’s care records were not always clear and consistent.

Concept Care Solutions – 1st Floor Middlesex House is a domiciliary care service. It provides personal care to people in their own homes in Hertfordshire. At the time of our inspection, the service was providing care to 88 people.

The service had a registered manager in post at the time 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.

We checked the arrangements in place in respect of medicines. Staff had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that there were gaps in these. The registered manager confirmed that the medicines had been administered. We found that medicines administered to people were not consistently documented and found a breach of regulations in respect of this.

People’s care needs assessments were detailed however support plans were task focused and were not person centred. Some support plans were difficult to follow and information about people’s support was not always clear and consistent. Information in support plans were inconsistent as some contained more detail than others. We found a breach of regulations in respect of this.

Risks to people were identified and managed, however risk assessments did not clearly reflect all the potential risks to people. This meant that risks might not be appropriately managed which could result in people receiving unsafe care.

People who used the service told us that they felt safe around care staff and this was confirmed by relatives we spoke with. Systems and processes were in place to help protect people from the risk of harm and the majority of staff we spoke with demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Through our discussions with staff and management, we found there were enough staff to meet the needs of people who used the service. We saw evidence that necessary employment checks were carried out before staff started working at the service.

Our previous inspection in 2014 found that the service was not following the Mental Capacity Act 2005 (MCA). We noted that the service had taken action since the last inspection and had made improvements in respect of the MCA. During our inspection on 14 December 2015, training records confirmed that the majority of staff had received training in the MCA.

The previous inspection identified that people did not have a regular care staff to provide their care and there were complaints about lateness of care staff. During this inspection, people told us that they there was consistency in respect of care staff and they usually had the same care staff. They also told us that staff were punctual and had no concerns about lateness. It was evident that the service had made positive improvements in respect of this.

The previous inspection also found that people did not feel confident that their concerns would be listened to and acted on by the service. There were also concerns that the service did not record and respond to complaints accurately. Our inspection in December 2015 found that the service had a comprehensive procedure for receiving, handling and responding to comments and complaints. Further, feedback received from people and relatives indicated that the service listened to people’s concerns and took the appropriate action. The service had a system for recording complaints and we saw evidence that complaints had been dealt with appropriately in accordance with their policy.

People were cared for by staff who felt they were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities. Training records showed that staff had completed training in areas that helped them to meet people’s needs. All staff spoke positively about the training they received and said that the service focused on ensuring staff received continuous training. There was evidence that staff had received regular supervision sessions and yearly appraisals and this was confirmed by staff we spoke with. All staff we spoke with told us that they felt supported by their colleagues and management. They were positive about working at the service.

People and relatives we spoke with told us that they felt the service was caring and had no concerns in respect of this. The service had a policy on “dignity in care” which focused on supporting and promoting people’s self-respect. The policy provided staff with practical guidance on how to ensure people were respected and their privacy was respected whilst also promoting self-esteem and autonomy. Care staff were aware of the importance of respecting people’s privacy and maintaining their dignity.

Our previous inspection found that the service did not have an adequate system in place to accurately monitor the quality of services provided. During the inspection in December 2015, we found that since the last inspection the service undertook a range of checks and audits of the quality of the service and took necessary action to improve the service as a result.

There was a comprehensive quality assurance policy which provided detailed information on the systems in place for the provider to obtain feedback about the care provided at the service. The provider carried out monthly monitoring visits, unannounced staff spot checks and quarterly satisfaction surveys.

We found breaches of the regulations relating to the proper and safe management of medicines and person-centred care in that information in people’s care records were not always clear and consistent. You can see what action we told the provider to take at the back of the full version of the report.

28 October and 13 November 2014

During a routine inspection

We inspected Concept Care Solutions – 1st Floor Middlesex House on 28 October 2014. 48 hours’ notice of the inspection was given to ensure that the registered manager could be present. We also visited the service on 13 November 2014 in order to attend a staff meeting and talk with staff.

Concept Care Solutions – 1st Floor Middlesex House is a medium sized domiciliary care service. It provides personal care to people in their own homes in south and west Hertfordshire. At the time of this inspection a service including personal care was provided to 105 people.

At our last inspection in May 2013 the service was meeting the regulations we inspected.

There was a registered manager at the time 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 had differing views on the quality of the services they received. People told us that their regular care workers knew their needs and provided a good service. One person said, “My carer is brilliant. They know what they’re doing.” However all the people we spoke with told us that there were too many changes of care worker and they did not always know who was coming to assist them. When their regular care worker was not available the service did not let them know of changes and care workers were frequently late. One person told us that they used to have a good care worker who was reliable and very helpful, but, “Since they left I don’t know who is coming and when. Sometimes I get people I’ve never seen before, who don’t know what they’re doing and don’t know how I need to be helped.” People felt that care workers did not have information on their specific needs and wishes. One person said that they did not have a regular care worker and, “they don’t know my requirements before they come.” This was in breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not follow the Code of Practice of the Mental Capacity Act 2005 (MCA) to make sure that people who did not have the capacity to make decisions for themselves had their legal rights protected. Care plans did not include assessments of people’s capacity for making decisions about their care and treatment. People did not sign care plans to show that they had been involved in planning their care. The registered manager was not able to give us information about people whose affairs were dealt with by the Court of Protection, or who had restrictions on their liberty because they did not have capacity to make decisions about their care and support. We have made a recommendation about following the MCA Code of Practice.

Complaints were not recorded and responded to effectively. A representative of the local authority which commissioned care for the majority of people using the service told us that they had received 17 complaints about the service between June and October 2014, and eight of these had not been responded to. When we looked at the complaints records we found that only six complaints had been recorded during this period. Most people we spoke with told us that the service did not listen to any concerns and did not respond to complaints. One person said, “I complain to the office, but nothing seems to happen. I don’t believe they listen to my concerns.” This was in breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities).

Regulations 2010, which corresponds to regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The process of quality monitoring did accurately monitor and address areas where improvement was needed. The provider sent quality questionnaires to people regularly and told us that they took actions as a result of this feedback to improve communication with people using the service. However seven of the ten people we spoke with commented on poor communication with the office. Records of concerns such as late and missed calls were not accurate and care plans were not up to date and accurate. The provider did not have accurate information on actions that were required to improve the quality of the service. This was in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us that they felt safe and trusted their regular care workers. Staff were knowledgeable in recognising signs of potential abuse and how to report any concerns. They also told us how they would deal with any emergency in order to keep people safe. During the previous 12 months three allegations of abuse were investigated and substantiated. The provider took actions to discipline the staff involved and established a system for regular staff supervision to ensure that staff were aware of procedures to keep people safe.

Staff told us that they received regular training so that they knew how to meet people’s needs and support them appropriately. They said that care plans provided them with information on each person’s needs. A representative of the NHS clinical commissioning group (CCG) for Hertfordshire told us that they had reviewed the care provided for people they referred, and everyone they commissioned care for was happy with the care they received.

Care plans provided information for people who needed assistance with preparing meals and with eating and drinking. However one person told us that care workers did not know how to prepare basic food or to use a microwave oven. We have made a recommendation about training on basic food preparation.

The service did not have a consistent and effective management team. There had been four care managers in post since our last inspection in May 2013. People told us that they did not have confidence in the management of the service. Seven of the ten people we spoke with commented on poor communication with the office. One relative said, “The agency is just not good at organisation, which is where a lot of the problems are.” Another person said, “I don’t know who to talk to at the office, I don’t know who is in charge.” However most staff members told us that they had good support from the managers. For example one person said, “You ask and they do help, they will always call you back.”

The Statement of Purpose for the service did not provide clear information on the services provided and the provider’s aims and objectives. We have made a recommendation about revising the information that the Statement of Purpose contains.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and corresponding regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

10, 16 May 2013

During an inspection looking at part of the service

We spoke with family members of people who were not able to speak with us themselves. One relative said, 'Our regular care workers are mostly very good, and one (named care worker) is brilliant.' Another person told us that the office was now much better at keeping in touch and letting them know if a care worker would be late.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The relative of one person said that the information in their care plan was 'generally pretty good.'

There had been no further occurrence of safeguarding concerns. Staff told us that they knew the procedures for reporting any concerns. The provider had appropriate arrangements in place to manage medicines safely.

The training records showed that all the staff had appropriate training to ensure that they could meet the needs of the people who use the service and maintain their safety. Some changes were made to the training to ensure that it covered the practical aspects of the care that people received.

The provider took account of complaints and comments to improve the service. For example, one person had commented on the inconsistency of care workers who visited them. They had been allocated regular care workers, and improvements had been made in allocating rotas to ensure that as far as possible everyone using the service had regular care workers to assist them.

14, 19, 21 December 2012

During a routine inspection

The relative of a person using the service said the care worker was 'very good, very kind, patient, takes good care of (my relative), I like the way she treats (my relative). They couldn't have picked anyone better.' Another relative said, 'They know you and know what you're capable of. I wouldn't be able to cope without them.'

Most of the people and relatives we spoke with said care workers did not arrive on time and there were occasions when no care worker arrived, especially when they had started using the service. Several people told us they did not have regular care workers, and care workers had no information on the person's needs when they came for the first time.

Comments and complaints people made were not responded to appropriately.

We found that care plans provided limited information on how to meet people's needs, and were not updated following reviews. One person had no care plan to provide information for care workers on the assistance that they needed.

We found evidence that prescribed medicines were not given to people safely.

Staff records showed that the provider did not have effective recruitment and selection processes in place, and that staff did not receive training and support to enable them to deliver care and treatment safely and to an appropriate standard.

The provider was not regularly assessing the quality of the services provided. Audits of records did not show the omissions that we found in care plans and staff records.

8 March 2011

During a routine inspection

We spoke to people who were very satisfied with the care and support they receive and said that, in general, the staff are good. People told us had no concerns about the way the support is provided but some did have some about the timekeeping of the staff. People told us they had reported poor timekeeping and they said they would make the agency aware of any serious complaints. However, some said they would not report minor concerns as they preferred not to.

People told us that staff provided the personal care to them, or their relatives, in a way which respected their dignity, and staff were gentle and kind. One person said that staff had been very accommodating in meeting their needs.

People told us that the office staff kept in touch with them, and most said they had recent visits from the senior staff to discuss their needs and carry out reassessments.