Archived: Age Concern - Tower Hamlets

Age Concern – Tower Hamlets is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to the whole population. Not everyone using Age Concern – Tower Hamlets receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of the inspection, it was providing a service to two people.

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

A relative or friend told us that their loved one was safe with the carers, but the service was not run safely. The provider had not always identified risks to people who used the service or developed guidance for staff about how to reduce risks where these were identified. The provider had not always reviewed and updated people's risk assessments to reflect their changing needs.

People were at risk of not getting their medicines as prescribed because the system to check medicine records was not effective and medicines were being administered by staff who had not been trained or assessed as competent to carry out the task.

The provider lacked robust systems and processes to ensure the quality and safety of service. The registered manager had recently expanded their other services and did not have enough time or support to continue providing the same quality of service found at the last inspection. The relative or friend of a person using the service did not feel confident their concerns would be listened to and acted upon. Not all staff had received training needed to support them carrying out their role.

Where full care records were in place they were personalised to reflect people's preferences. Staff developed caring relationships with people and supported their diversity and independence. People were supported to eat and drink in line with their preferences and were supported to access healthcare services if required.

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.

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

Rating at last inspection

The last rating for this service was outstanding (published 7 April 2017). At this inspection we found the rating had not been sustained and the provider was in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches in relation to safe care and treatment, staffing and training, and good governance at this inspection. We have made a recommendation in relation to person - centred care.

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

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.

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.

The service was safe and people who used the service were protected from harm. Staff were knowledgeable about safeguarding and what to do if they had any concerns and how to report them. Safeguarding training was given to all staff, including the CEO and as part of the training there was a competency test.

Risk assessments were thorough and personalised to individual needs and risks. Staff knew what to do in an emergency situation.

Staffing levels were meeting the needs of the people who used the service and staff demonstrated that they had the relevant knowledge to support people with their care. Staff were given mobile phones with an application installed to record their attendance at people's home which contained personalised information they needed to support people. People who used the service and their relatives told us their care workers had enough time to carry out all tasks and care workers told us they had sufficient time between calls.

Recruitment practices were safe and records confirmed this.

Medicines were managed and administered safely and audited on a regular basis.

The service was exceptionally well led. The registered manager for the service had a good relationship with staff and the people using the service and their relatives. There was open communications between all parties and care workers told us they felt supported.

The registered manager was passionate about dementia care and caring for older people. They were involved in working in partnership with other organisations and also in the development of extra services they could provide to people who used the service and in the community.

The service had quality assurance methods in place such as spot checks and an annual survey.

Newly recruited care staff received an induction and shadowed senior members of staff. Training for care staff was provided on a regular basis and updated when relevant. Care workers told us the quality of training was good.

Care staff demonstrated an understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was recorded in people’s care plans.

People were supported with maintaining a balanced diet and the people who used the service chose their meals and expressed their preferences accordingly.

People were supported to have access to healthcare services and receive on-going support. Care workers told us they accompanied people to healthcare appointments when necessary.

Positive relationships were formed between care workers and the people who used the service and care staff demonstrated how well they knew the people they cared for. People who used the service and their relatives told us that care workers were caring.

The service supported people to express their views and be actively involved in making decisions about their care.

The service promoted the independence of the people who used the service.

Care plans were detailed and contained relevant information about people who used the service and their needs such as their preferences and life history. Care plans were reviewed annually, with any changes being recorded.

Concerns and complaints were encouraged and listened to and records confirmed this. People who used the service and their relatives told us they knew how to make a complaint.