Walthamstow Employment & Nursing Agency Limited

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

People and relatives told us they felt safe with the carers. The provider had safeguarding processes in place. People were protected from the risks associated with the spread 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.People signed to consent to receiving care. Where appropriate the provider obtained power of attorney confirmation.

The provider had quality assurance systems in place to identify ways of improving the service. This included obtaining feedback from people during telephone monitoring calls. They had plans to further improve the audit systems.

We made one recommendation around following government guidance in relation to COVID-19 testing for staff.

Rating at last inspection

The last rating for this service was good (published 6 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns raised by the information review in relation to keeping people safe, infection control, consent to care and quality assurance systems. A decision was made for us to undertake a targeted inspection to examine those risks.

We use targeted inspections to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from the concerns. Please see the safe, effective and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection, on 28 and 30 December 2016, the service was rated Good overall and we found one breach of the regulations. This was because although the provider had systems to audit the quality of the service provider, they did not always document the outcome of these checks. At this inspection we found improvements had been made in this area. The provider now documented the outcome of quality audit checks.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manager 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.

Staff were knowledgeable about safeguarding and whistleblowing procedures when they suspected abuse. The service used an electronic system to monitor if staff were late or missed a visit. Safe recruitment checks were carried out. People had risk assessments done to ensure safe care was provided and potential risks were mitigated. There were systems in place to ensure people were supported to manage their medicines safely. Staff were supplied with sufficient quantities of personal protective equipment to prevent the spread of infections.

The registered manager and staff were knowledgeable about their responsibilities around the Mental Capacity Act (2005) and the need to obtain consent from people. Staff received support with training opportunities. Support was given to staff through formal supervisions in accordance with the provider’s policy but staff told us they would benefit from more frequent supervisions. The registered manager told us they offered informal supervisions to staff but these were not documented. Staff were aware of people’s nutritional and hydration needs. The provider liaised with relevant healthcare professionals and supported people to maintain their health.

People and relatives thought staff were caring and respected their privacy and dignity. Staff were knowledgeable about people’s care needs and preferences. Staff demonstrated awareness of equality and diversity, promoting people’s dignity and maintaining independence.

Care plans were personalised and contained people’s histories and preferences. Staff demonstrated awareness of providing personalised care. Complaints were dealt with appropriately and in line with the provider’s policy.

The provider has systems in place to obtain feedback from people who used the service and their relatives. People who used the service, relatives and staff spoke positively about the management of the service. Staff had regular meetings to keep them updated on service development.

We have made one recommendation around supporting staff. Further information around this can be found in the detailed findings below.

There was a registered manager at the service. 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.

At the last inspection on 20 September 2013, the service was found to be meeting the legal requirements. At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

The provider checked the quality of the service provided but was inconsistent in documenting the outcomes of these checks. People and their relatives were asked for their views about the service. Staff had regular staff meetings to receive updates on the service.

The service had safeguarding and whistleblowing policies in place and staff knew what action to take if they suspected someone was being abused. Safe recruitment checks were carried out. People had risk assessments done to ensure safe care was provided and potential risks were minimised. There were systems in place to ensure people were supported to manage their medicines safely.

Staff were supported with regular training opportunities and supervisions. The registered manager and staff were knowledgeable about their responsibilities around the Mental Capacity Act (2005) and when they needed to obtain consent from people. Staff were aware of people’s nutritional and hydration needs.

People and relatives thought staff were caring and respected their dignity. Staff were aware of people’s needs and preferences. Staff demonstrated their awareness of how to provide dignified care, and encourage people’s independence.

Care plans were personalised and staff demonstrated awareness of providing personalised care. Complaints were dealt with appropriately and in accordance with the provider’s policy. The provider also kept records of compliments about the service.

At our last inspection we were concerned about training for staff in particular refresher training for medication and safeguarding had not been completed. We found that this was now being monitored effectively and relevant training had been completed and was planned for. We checked ten staff files and found them to contain appropriate recruitment checks including, right to work, proof of identity, relevant qualifications and two verified references.

We found that monitoring quality of care had improved and that there was evidence to indicate that people's views were taken into account. Complaints were dealt with in a timely manner. One person said, "any complaints are always looked into promptly." Another said, "I have seen the senior staff come and assess my carer in my home. They asked me what I thought of the care"

We looked at eight care plans and found that they were specific to the individuals needs. It was clear how much time was spent and which staff were assigned duties. Risk assessments were available and there were procedures in place to ensure that environmental risk assessments were updated by team leaders when required.

The manager told us that staff were matched to the needs of the clients. This was confirmed by staff and the care records we reviewed. Staff were appropriately qualified for their roles.

However, there were shortfalls in the way that the provider dealt with safeguarding issues which potentially put people at risk of financial abuse. The provider's management systems were inadequate. People who used the service said that staff often turned up late and this was due to the way that the rotas had been organised. Complaints were not always resolved satisfactorily and acted upon and this did not lead to improvements in the service being provided