Archived: Westminster Homecare Limited (Enfield/Waltham Forest)

During the inspection we spoke with seven people who used the service and five relatives. We spoke with the manager, the operations manager and a total of 15 staff including a care co-ordinator, a quality assurance officer, a recruitment officer, a field care supervisor and an administration officer.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People we spoke with told us that they were well treated by staff. One of them stated, 'My carers treat me with respect. I feel safe with them.' Another person stated, 'I have no complaints. I am satisfied with my carers.'

The service had a safeguarding policy and procedure. Staff had been provided with safeguarding training. They were aware of action to take in response to safeguarding incidents or allegations. Staff were aware of potential risks which may be faced by people who used the service. Risk assessments of people had been documented in their care records together with guidance on action to take to protect people.

The service had co-operated with the local safeguarding team and action had been taken in response to suggestions made for improving the service. We noted that there were deficiencies in the administration of medicines and a compliance action is being made in respect of this.

Is the service effective?

Feedback from people who used the service and from correspondence received from relatives and those involved in their care indicated that the service was effective and responsive to the needs of people. One relative wrote, 'I would like to thank all the carers who attended to X for doing a fantastic job and taking very good care of X. X is very pleased with all the carers.' A person who used the service said, 'They do what is agreed in the care plans. The service is much better than before. They are on time. I have no complaints."

The registered provider may wish to note that the representatives of a small number of people complained that people did not always receive adequate care. The manager explained that the service had experienced difficulties in meeting its care commitments at the beginning of the year, but the situation had improved.

Is the service caring?

We saw correspondence and feedback from relatives of people and a professional involved in their care which complimented staff for being caring towards people. The professional involved stated, 'We are extremely happy with the care provided for Y. Y loves the carers and say they should have a gold medal.'

People informed us that staff treated them with respect and dignity. The care records of people contained details of their choices and preferences and the manager stated that effort had been made to ensure that these were responded to. The manager informed us that the provision of services and care were regularly reviewed and if there were problems or suggestions made, they would respond. This included providing specific carers who spoke the same language as people who used the service and following up on complaints promptly. This was evidenced in the complaints records examined.

Is the service responsive?

People informed us that staff were attentive and responsive when people had any concerns. The manager informed us that the provision of services and care were regularly reviewed and if there were problems or suggestions made during those reviews, they would respond. We noted that complaints made by relatives and professionals involved had been responded to. This included ensuring that carers who were doubling up to attend to people travelled together. We further noted that the agency had voluntarily suspended taking on new care packages due to the increase of referrals from the local authority and the extra pressure placed on the service. When we needed information regarding the care provided and the management of the agency, this was promptly provided.

Is the service well-led?

The manager and the nominated individual who were present were knowledgeable regarding their roles and responsibilities. There were arrangements for monitoring the quality of care provided. A satisfaction survey carried out the previous year indicated that the majority of people were satisfied with the care provided.

The Care Quality Commission had received six alerts since February 2014 which alleged that care staff were unreliable at turning up or had attended to people late. In these instances, people's welfare had been affected significantly. We noted that the service was still encountering these problems. The service had 388 service users.

Records demonstrated to us that people who started using the service were now having their needs assessed, and a care plan set up, in a timely manner.

Most medication records were now completed accurately. We found that systems were in place to identify poor practice and overall, medicines were being safely managed.

Quality monitoring systems were now being completed accurately and complaints were being responded to in a timely manner. Improvements had been made to the provider's systems of regularly assessing and monitoring the quality of service that people received.

Most staff now had performance appraisals, and there was evidence of further training of office-based staff. We found that suitable arrangements were in place for the support of staff in relation to their responsibilities of providing care to people.

We spoke with nine people who use the service and their representatives. They had a range of comments about the service. Some people praised the service and the care provided. Comments included, 'so far it's very good.' However, some people were unhappy with the reliability of care visits, with comments such as, 'weekends are diabolical because the second carer regularly does not turn up.'

Our checks established instances of late and missed visits to people's homes. We could not be assured that there were enough skilled and experienced care workers available to undertake care visits. This may have failed to safeguard the health, safety and welfare of people using the service.

We found that systems of quality monitoring and risk management were not being effectively implemented. This included the response to people's complaints about the service. This failed to protect people against the risks of inappropriate or unsafe care.

People who started using the service did not always have their needs assessed, and a care plan set up, in a timely manner. This failed to ensure that each new person receiving care was protected against the risks of unsafe or inappropriate care.

We found that people receiving medication assistance as part of their care package were not protected against the risks associated with the unsafe use and management of medicines. Records were not consistently kept, and there was evidence of the support failing to assist people to take their medicines as prescribed.

Staff appraisals were not up-to-date, and the training of office-based staff was not sufficient for their role. This put people at risk of receiving care that was not safe or at an appropriate standard.

We are taking action to ensure the provider becomes compliant with the regulations.

People who use the service and their representatives told us that most of the time they got the overall care and support they needed. Several people were very complimentary about their regular care workers. Comments included, 'I am very lucky and I am very happy.'

We found, however, that when some people started using the service, their needs were not assessed promptly so that care plans could be developed to help meet their needs. This failed to properly protect people against the risk of unsafe or inappropriate care.

We found the provider's operation of systems to assess and monitor service quality was not effective at protecting against the risks of inappropriate care. These included systems to identify missed visits to people, and taking action to make sustained improvements in response to staff and people's comments about the service particulary in respect of poor communication.

We also found that the provider had not notified us as required about a number of safeguarding processes this year.