Hopscotch Women’s Centre

Hopscotch Asian Women's Centre provides care services to people living in their own homes. The service specialises in supporting people from the Asian community and people living in South Camden. At the time of this inspection, approximately 67 people were receiving personal care. The service provided care to people between 18 to 65 years, some of whom are living with dementia, physical disabilities, learning disabilities and mental health conditions.

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

Since our last inspection in January 2020, the service continued to make improvements across all service delivery areas. The service received positive feedback from all stakeholders who were complimentary of staff, the managers and their efforts to provide good care to people.

The service still needed to continue their work on improving managing medicines, to ensure staff provided this support safely and according to the national guidelines.

Risks to providing personal care were assessed and plans to manage such risk were available to staff. Additional work was needed to ensure that risks regarding specific health care conditions were assessed and plans to manage such risks were available to staff.

The service ensured that people were protected from the spread of infections by following government guidance and ensuring staff were tested regularly and provided with the necessary equipment to control infections.

The service assessed people's needs in detail and in line with current good practice guidance.

Care plans were robust, detailed, person-centred and of a good standard and reflected people's preferences and needs.

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 service recruited staff safely, and staff received sufficient training and support to carry out their role as care workers safely and effectively.

The service involved staff and people using the service in conversations about its provision and how to improve it. Staff contributed their ideas during supervisions, random spot-checks or staff meetings. People shared their experience through the complaint's procedure, care review meetings and participation in quality monitoring telephone calls. Staff and people told us the managers listened to them and were responsive to any suggestions for improvement.

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 23 March 2020). 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 the provider remained in breach of regulation 12 in relation to medicines management.

Why we inspected

We undertook this focused inspection to check the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led, which contained those requirements and recommendations we made at our last visit.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has reminded the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Hopscotch Asian Women's Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a continuous breach in relation to managing medicines at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Hopscotch Asian Women's Centre provides care services to people living in their own homes. The service specialises in supporting people from the Asian community and people living in South Camden. At the time of this inspection there were approximately 48 people using the service. The service provided care to people between the ages of 18 to 65 years some of whom are living with dementia, physical disabilities, learning disabilities and mental health conditions.

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

Since our last inspection in June 2016, the provider began improvements across all areas of the service delivery. Warning notices issued by CQC under regulations 12 and 17 had been met. Firm foundations were established for further work on improvements to ensure the service provided safe and effective care that met the Health and Social Care regulations. The service needed to continue their work on improvements to demonstrate these were fully established and sustained over a significant period of time.

Systems relating to the management of medicines needed further improvement. The provider needed to ensure information about medicines used by people matched across various care documentation and that medicines audits were fully effective.

Risk to people’s health and wellbeing had been assessed. Further improvements were needed to ensure staff had clearer and more detailed guidance on how to manage risk to people.

Quality audits were taking place. Further work was needed to ensure there was a clear system and structure around these audits so that these could be used for further review, reference and evidence of progress made by the service.

The service had introduced new safeguarding procedures to ensure safeguarding concerns had been dealt with promptly and by appropriate members of the management team. The service needed more time to ensure these procedures were fully established and always followed by staff.

Aspects of support for care staff needed further improvement. Managers and staff told us supervisions and spot checks had been taking place, however there were limited records to evidence this. Supervision process needed further improvement to ensure all aspects of effective supervision including performance management, training and development and personal support had been discussed. Further improvements were needed to ensure improved team work and support amongst staff team at the service. We made recommendations about supervisions and team work.

The service had introduced new procedures around managing people’s money. We saw these were followed by staff and the manager carried out financial audits to ensure people were not subjected to financial abuse. Overall people and relatives said they felt safe with staff providing care.

There were safe recruitment procedures in place to ensure only suitable staff were employed. There were sufficient staff deployed to support people. People told us the same care staff usually visited them. Appropriate infection control measures had been followed by staff when supporting people. There were systems in place to analyse and learn from accidents and incidents to minimise the possibility of them reoccurring.

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.

Overall people using the service, their relatives and external professionals thought staff were sufficiently trained to support people effectively. Newly employed staff received an induction to the service and mandatory training. The provider was in the process of completing appraisals of staff performance.

People were supported to live a healthy life. People’s health and care needs had been assessed to ensure care staff provided care that was required. Staff provided people with sufficient food and drink that met their needs and personal preferences. When needed staff supported people in contacting healthcare professionals to ensure they received support when their needs had changed.

Care staff were caring and people and relatives said they were happy with care provided by staff who visited them. People and relatives felt involved in decisions about people’s care. They confirmed staff asked people what their daily needs were and asked for people’s consent before providing the support. People’s care plans had detailed description of what personal care and support was required. Staff respected people’s privacy and dignity when providing personal care.

People’s care plans described people’s personal histories, needs, preferences and interests and how people were able to communicate. This meant staff were provided with a range of important information about people they were supporting. Care plans would benefit from further details on how people would like to receive their care. The senior management team assured us this would be addressed. Care plans had been reviewed and updated.

The customer care and responding to queries and concerns from people using the service and their relatives had improved overall. Information gathered during the inspection indicated that members of the senior management team were acting promptly when issues arose. The service received no formal complaint since our inspection in June 2019.

The provider maintained a service improvement plan and staff across all levels of the service delivery had been working consistently towards addressing issues identified during our last inspection. The service was working closely with the local authority to ensure improvements to the service delivery were effective.

Following this inspection, the senior management team were receptive to our feedback and willing to undertake further improvements to ensure the service met the Health and Social Care regulations.

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 rated Inadequate (published 22 August 2019). This service has been in Special Measures since August 2019. The provider completed an action plan after the last inspection to show what they would do and by when to improve. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report. We identified two continuous breaches and made three recommendations about safeguarding training for staff and providing effective supervision and support for staff. You can see what action we have asked the provider to take at the end of this full report.

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.

Hopscotch Asian Women's Centre provides care services to people living in their own homes. The service specialises in supporting people from the Asian community and people living in South Camden. At the time of this inspection there were approximately 55 people using the service. The service provided care to people between the ages of 18 to 65 years some of whom are living with dementia, physical disabilities, learning disabilities and mental health conditions.

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

During this inspection we found that shortfalls identified during our last inspection had not been fully addressed. Since our last inspection the agency had undergone a major managerial change. There was a new chief executive, new manager and two new care co-ordinators. The new management team had started acting on improvements. However, further work was required to ensure improvements were sufficient, effective and sustained. The management team needed to improve the overall oversight of the service provision and to take prompt action when issues and concerns were identified.

Shortfalls we identified related to risk assessment, management of medicines, protecting people from abuse and scheduling and monitoring of care visits. Further areas for improvement related to effective support and monitoring of staff, consent, person centred care, communication and acting on concerns and overall monitoring of the service.

People were not always protected from avoidable harm. The provider had not ensured all risks to the health and wellbeing of people had been sufficiently assessed. Staff did not always have clear guidelines on how to minimise these risks.

Medicines were not always managed safely and as required by the current national guidelines. Staff competencies in medicines support and administration were not assessed. Therefore, the provider could not evidence that staff were competent in this area. However, we noted some improvements in how the medicines administration charts (MAR) were used.

The agency’s systems to safeguard people from abuse were not robust enough to ensure people were always protected. The managerial oversight of handling people’s money by staff was not comprehensive. Safeguarding concerns were not always dealt with promptly to ensure people were safe.

The monitoring systems related to staff punctuality and attendance at care visits was not always affective and people were at risk of not receiving their support when needed.

People were not supported to have maximum choice and control of their lives. The systems in the service did not support this practice. Staff involved people in making decisions about their day to day care. However, care plans did not guide staff on what decisions people who did not have capacity could make and which they needed support with.

The agency’s complaints system was not effective in identifying, receiving, handling and responding to complaints from people using the service, people acting on their behalf or other stakeholders. This meant people were at risk of receiving care that did not meet the standard required by regulations.

Not all members of the management team had received training to help them to carry out their duties well. The provider assured us that this would be addressed immediately.

People’s care plans needed more comprehensive and person-centred information about some areas of the care provided. This included nutrition, skin care, accessible communication, end of life choices and specific care needs and medical conditions.

Staff received training and support in the form of supervision and spot checks of their direct work in people’s homes. However, there was no evidence to show that issues, concerns or areas for improvement identified during staff checks and supervisions had been acted on.

We also found some positive examples of systems used by the agency to ensure people were protected from avoidable harm. These included safe recruitment practice, infection control and management of accidents and incidents.

People’s diversity had been respected to ensure people from different cultures and walks of life received respectful and dignified support.

Although we found widespread shortfalls, most people using the service spoke kindly about staff who supported them. They said staff were caring and had a genuine interest in people. However, the general feedback received from various stakeholders was that the agency needed to improve their customer service and responsiveness to people’s changing needs and concerns and complaints raised by them. This was to ensure people’s needs were met. The new senior management team assured us they were keen to make the required improvements promptly.

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 11 July 2019). This service has been rated requires improvement for the last three consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hopscotch Asian Women's Centre on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to risk assessment, management of medicines, safeguarding people from abuse, consent, person centred care, managing and acting on complaints and Good governance. We made four recommendations on monitoring care visits, supporting people with nutrition, effective skin care and customer care.

Please see the action we have told the provider to take at the end of this report.

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 from 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 rating, 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.

Hopscotch Asian Women's Centre provides care services to people living in their own homes. The service specialises in supporting people from the Asian community. At the time of this inspection there were 55 people using the service. The service provided care to people between the ages of 18 to 65 years some of whom are living with dementia, physical disabilities, learning disabilities and mental health conditions.

At the time of our inspection, the service did not have a registered manager in post. The previous registered manager left in February 2018. 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 and associated Regulations about how the service is run. The service had recruited a new manager who was in post since February 2018. They told us they were in the process of applying to be formally registered with Care Quality Commission.

At our last inspection on 14 March 2017 we identified one breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured that staff received appropriate training and professional development as was necessary to enable them to carry out the duties they were employed to perform. At this inspection we found this issue had been addressed. We saw that staff had received appropriate training or were scheduled to have training in the near future. Because many staff had a limited level of spoken and written English, an interpreting service had been provided to help staff to better understand and learn the training context. Staff received regular supervisions and appraisals to help them to carry out their professional duties.

From April 2018, the service had entered a new contract with the local authority for providing additional hours of care and support to people wider than the Asian community, which includes all different cultures and backgrounds. This meant the number of people receiving support from the service would significantly increase. During this inspection we found a number of shortfalls in the service delivery. Prompt improvements were needed to ensure the service was fully equipped to provide safe and effective support to people who used it. The main areas of improvement needed were related to medicines management, assessment of risk to health and wellbeing of people who used the service, dealing with complaints, meeting people’s nutritional needs, keeping robust records on care provided to people and analysing and taking actions following people’s feedback on care provided.

We found that the new manager and the service’s director were committed to implementing changes and introducing improvements to the service. A number of improvements had begun prior to our visit and was related to staff allocation, training and supervision. Since our inspection, they also provided evidence about further developments commenced at the service and which were triggered by feedback provided by us during our visit.

At this inspection we found the service had not managed people’s medicines safely and there was risk that people would not receive their medicines as required. There was no up to date information on what medicines had been prescribed to people and medicines administration had not been recorded systematically. Although staff had received appropriate training, staff competencies in medicine management had not been assessed.

We found that risk to health and wellbeing of people who used the service had not always been fully assessed and staff were not always provided with sufficient guidelines on how to care for people in a safe way.

Staff supported people to meet their dietary requirements. However, when people’s needs around eating and drinking were more complex staff had not always been provided with sufficient information on how to support people safely and effectively.

The service had dealt with complaints received from people. However, there were no contemporaneous records available to show that the complaints process had been followed, how the outcomes of complaints had been achieved and that the actions agreed following complaints had been followed.

Staff received training in safeguarding adults and they had a good understanding around the various types of abuse. There were no current safeguarding concerns related to the service and people told us they felt safe with the staff who supported them. However, we found that the service needed to improve the processes around the handling of people’s money to ensure staff and people who used the service were not at risk of potential financial exploitation.

The service had not carried out their own assessment of needs and preferences for care and treatment of people who used the service. Each person had a care plan that guided staff on personal care that needed to be provided to people. However, there was limited information on people’s life stories and how they would liked to be cared for. Care plans had not been provided in the form that people could understand, therefore, people could not review them or recap what type of care they agreed to.

All of the people who used the service had signed their consent to care and treatment. However, it was not always clear if people understood what they were signing and if they had the capacity to make these particular decisions about their care and treatment.

The service operated appropriate recruitment practice and people were safe from unsuitable staff. There were sufficient staff deployed to support people and to ensure all calls were covered.

The service had followed safe infection control procedures. People were supported to have access to health professionals when required.

Staff supporting people were kind and showed compassion and understanding towards people they supported. People spoke positively about staff and the majority of people were pleased with the support they received.

The service provided care to people predominately form an Asian background. However, they were also open to supporting people from all cultural and religious backgrounds. People thought staff were understanding and respectful towards people’s individual ways of living and being. When possible, staff supported people in accessing the local community and doing things they liked.

People using the service and their relatives spoke positively about the service and the care that the service provided. People said staff listened to them and involved people in decisions about their care. People thought staff respected their dignity and privacy when providing personal care.

Staff were provided with a number of forums in which they discussed matters related to the service provision and received an update on the latest developments within the service. The provider was also in the process of formulating a staff handbook which would provide staff with guidance on tasks and requirements related to staff professional role.

We found six breaches of Health and Social Care Regulations. We made one recommendation which related to handling of people’s money.

At our last inspection on 18 February 2016 we found that the provider was not meeting all the standards that we inspected. We identified breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not have appropriate systems in place to asses, monitor and improve the quality of the services provided. Staff did not receive appropriate support, training, professional development, supervision and appraisal as was necessary to enable them to carry out their role effectively. At this inspection we found that the provider had only partly addressed these concerns.

Hopscotch Asian Women’s Centre provides care services to people living in their own homes. The service specialises in supporting people from the Asian community. At the time of this inspection there were 56 people using the service. The service provides care to people between the ages of 18 to 65 years some of whom are living with dementia, physical disabilities, learning disabilities and mental health conditions.

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.

At the last inspection the provider had not provided staff with appropriate and adequate training in order for them to carry out their role effectively. During this inspection we found that although some improvements had been made the service had still not fully addressed this issue. Where staff were providing care to people with specific specialist needs, they had not been provided with the relevant training required in order to deliver safe and effective care.

Staff told us that they felt supported in their role and received regular supervision as well as an annual appraisal.

Feedback received from people and relatives was positive. People and relatives were happy with the care and support that they received from care staff especially taking into consideration that they were able to speak and communicate with each other in their preferred choice of language which was predominately Bengali.

The service carried out assessments of people’s needs and requirements prior to a package of care commencing. The assessment noted people’s needs and requirements, choices and wishes. It also identified all risks associated with the person’s care and health needs. However, although all risks had been identified, for certain specific risks associated with epilepsy, brain injuries or behaviour that challenges, there was no further information or guidance provided to staff in order to mitigate or reduce the risks to ensure people’s safety.

People and relatives told us that they felt safe in the presence of the care staff that supported them. All staff that we spoke with demonstrated a good understanding of safeguarding, what it meant and the actions they would take if abuse was suspected.

Safe medicine management processes were in place to ensure that people were supported safely with their medicines, where this support had been identified.

The provider had robust recruitment processes in place to ensure that staff who were employed were safe to work with vulnerable adults.

Rotas were managed appropriately ensuring that travel time was incorporated between each call. People and relatives confirmed that staff generally always arrived on time and spent the allotted time of the call. Where staff were running late the service ensured that people and relatives were called informing them of staff running late. Staff also confirmed that rotas were managed well and that they had sufficient time to travel between calls.

Care plans were detailed and person centred and clearly reflected the care and support that people required and also took into account people’s choices and wishes on how they received their care.

Senior managers as well as care staff were able to demonstrate a sound understanding of the Mental Capacity Act 2005 (MCA) and also explained that they always obtained consent before undertaking any task. Documents seen also confirmed that people had consented to their care and where people were unable to consent, this had been clearly documented and a relative or next of kin had signed on the person’s behalf.

People and relatives told us and records confirmed that they had numerous opportunities to regularly provide feedback about the care and support that they received to allow the provider to make improvements where required.

Since the last inspection the provider had implemented a number of auditing processes which looked at care plans, medicine administration records and daily recording charts. Where issues were noted these were checked by the registered manager and action plans were in place to address the issue or concern in order for the service to learn and make improvements.

A complaints policy was available to everyone receiving a package of care as part of the service users guide which was given to people at the start of a care package. Complaints were managed as per the provider’s policy and all records pertaining to the complaint were appropriately recorded.

The provider supported people with their health care needs where this need had been identified. We saw referrals that had been made and on-going communications with health and social care professionals on behalf of people where necessary.

We identified a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to ensuring that all staff had the qualifications, competence and skills to provide effective care and support. You can see what action we told the provider to take at the back of the full version of the report.

A registered manager was in place 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.

Staff were not always appropriately trained and the service could not demonstrate that staff were competent and skilled to support people safely. The training matrix showed how less than half of care workers employed had received medicines training and it was later confirmed that only three out of seventeen staff trained to support people with medicines had received refresher training.

Staff had received induction training; Only 19 out of 47 staff had completed mandatory dementia training. Staff did not always receive supervision and appraisal on a regular basis. Staff had not received adequate training and support to enable them to carry out the duties they were employed to do.

Spot checks on staff to check their competence and performance around service delivery were not carried out on any consistent basis. Although there was a service user survey carried out in 2015, the response was very poor with only five people returning their forms. The service was not able to determine the quality of the experience for people who used the service .There was evidence that people were asked for their views on the service provision via telephone interviews. The service was unable to demonstrate how issues raised were followed up with the relevant member of staff or any action taken. Audits of staff records or care records to ensure the quality of the care being provided was of a good standard were not carried out.

People were concerned that issues around staff being sent to them who were unfamiliar with their care were not responded to effectively. Staff sometimes did not stay for the allotted time. We made a recommendation that robust systems should be put in place to respond to concerns and issues in a timely manner to ensure the satisfaction of people using the service and their relatives.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person.

There were sufficient numbers of staff available to keep people safe. Care workers told us they had sufficient time in which to complete their visits and their schedule included travelling time between clients.

Thorough recruitment checks were carried out before staff started working at the service. We looked at staff records and saw how there was a safe and robust recruitment process in place.

Staff prompted people to take there medicines from blister packs. They recorded this on a Medicine Administration Record (MAR) in line with providers policy and procedures.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to support people who lacked the mental capacity in line with the principles of the act and particularly around decision making.

Some people were supported by staff with eating and drinking and this was detailed in people’s care plans. People were supported to access GP appointments as well as access to other health services to ensure they were able to maintain good health.

People and their relatives told us they were involved in developing their care and support plan and identifying what support they required from the service and how this was to be carried out.

We saw that people’s records included a personal care support timetable. This included a comprehensive outline of the person’s care needs. There was clear guidance for staff about how to support the person according to their needs and wishes.

There was a system in place for addressing formal complaints and ensuring feedback was given to the complainant.

At this inspection there were breaches of regulations in relation to staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.