Westminster Homecare Limited – West London

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People confirmed that lessons were learned if things went wrong and changes were made to improve the service and avoid recurrences. They said they were comfortable raising concerns and knew who to contact if they needed to do this. One person’s representative told us, “Sometimes it’s not as smooth as one likes but they [staff] sort it as quickly as they can. I’m quite pleased with it all.”

The provider had effective systems and processes in place, which helped enable learning from previous incidents where people may have been at risk. We saw the provider’s systems and processes promoted people’s safety as a priority, whilst not limiting their choices. People were supported and empowered to make informed choices and take calculated risks as safely as possible. We saw that incidents and complaints were reported, recorded and investigated appropriately and changes were made where needed, to improve the care service.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

A member of staff told us that whenever a person returned home from hospital, they received the discharge information via the electronic system on their phone and then updated the person’s care records. They said that someone from the office would also visit and do a full assessment.

A person’s representative told us there was continuity between different services. They explained, “It is not really a fixed care plan, because things change. [Name] also has another care agency to do some things, but we use Westminster for help when I’m away.”

The provider had effective systems and processes in place to make sure that solid relationships with healthcare professionals were established to help maintain people’s safety. We saw evidence in people’s care records, which demonstrated effective communication and ‘joined up working’ throughout people’s care journeys. We also saw that the provider's policies, procedures, and processes were in line with current, relevant legislation.
 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff consistently demonstrated their understanding of the importance of reporting any concerns about people. A member of staff told us, “Oh yes, any bruise or skin mark I always report and take a photo on the app.” Another member of staff told us how, during a visit, they found a person had very little fresh food in the house. The staff member said they immediately informed the office and went shopping for the person that afternoon.

People using the service and their representatives said they felt safe. A person’s representative told us, “The best thing is that my relative is safe. They have the same 2 carers who arrive in the mornings and at lunch time.” Another representative said, “Yes [Name] is safe with them; I’ve never had any concerns about abuse.”

The safeguarding policies and procedures followed current and relevant legislation and the provider had effective systems and processes to help ensure people were protected from abuse and neglect. Staff described safe processes for handling people’s money when doing their shopping. For example, they supported people to write their shopping list, then recorded the amount of cash they received. When staff returned with people’s shopping, they provided them or their representative with receipts and the correct change. Photos of receipts were also uploaded onto the electronic care system.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.The provider had effective systems and processes to assess and minimise risks that were identified for people using the service. Risk assessments were person centred and covered areas such as people’s mobility, daily living and personal care requirements. Staff told us that risks to people were assessed and plans were created collaboratively with people and their representatives to help manage those risks in the least restrictive way possible.

Staff said if they had concerns, or noted changes, with people’s mobility they reported these to the office, who then made a referral to the relevant healthcare professional. Staff said people’s risk assessments and care plans were detailed, informative and accurate.

We saw that people’s care plans contained up to date information and guidance for staff about the action they should take to manage identified risks and keep people safe. There were clear processes, which staff followed when they needed to report concerns, incidents and accidents. These processes helped enable the provider to have oversight of risks and ensure they were mitigated as much as possible. We saw there were regular audits and people’s care plans were updated as soon as there were any changes or new risks were identified.

People who used the service and their representatives told us that staff respected people’s own homes. They said they had completed needs assessments and risk assessments when they began using the service. These assessments also included health and safety for themselves, as well as staff, within their individual home environments.

Staff said people’s home environments were risk assessed and, where necessary, office staff referred any concerns to social services. A member of staff told us, “A person who was new to us was a bit worried as it [their home] was a bit cluttered. They had just downsized to a smaller place and there was more stuff than space allowed.” This member of staff explained how they had listened to what the person wanted and reassured them that they would help them get things sorted.

The provider had effective systems and processes to identify risks and hazards in people’s home environments. Environmental risk assessments were completed with people using the service and, where needed, risk management plans were compiled to help mitigate identified risks as much as possible.
 

We received mixed responses from staff, people using the service and their representatives regarding punctuality. Some staff told us they were often late for their visits, mostly because of needing to rely on public transport. Staff said they always called the office, so that people using the service could be informed. However, some people using the service said they weren’t always told when the care staff were running late. Some people said the communication had been better when care staff had been able to contact them directly, but this had declined since the change in procedures. A person’s representative told us, “The allocator needs to give people more time to get from A to B or change who they care for. Carers have said to us how hard it is to get from one to the other as they don’t have enough time. They need to take into consideration that many carers come by bus.”

However, when reviewed the Electronic Call Monitoring (ECM) data given to us by the provider, regarding the reliability and punctuality of staff, we saw most of the calls did have travel time factored in. Overall, there was a low percentage of late calls or calls that were shorter than scheduled. We also spoke with the registered manager, who explained and evidenced how they monitored this situation and took appropriate action to address any shortfalls. We were assured that people had not come to any harm as a result of any late calls, the management team were continually reviewing the situation and making improvements where possible and, on the whole, the service’s system was logistically sound.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff told us they felt there were enough care staff employed by the service and most staff supported the same people on a regular basis. Staff said they covered for each other when there were any absences, such as holidays or sickness.

Staff described a thorough recruitment process, which included completing an application form, interviews, references and police checks. Staff told us they completed an induction at the beginning of their probationary period. All the staff we spoke with said the training provided was of a good standard. They said most training was completed electronically, but there were face-to-face sessions for the practical elements of moving and handling, medicines administration and first aid. Staff said there was refresher training and their training needs were discussed during supervisions.

Staff told us that senior staff and management completed unannounced spot checks for quality assurance and competency. A member of staff told us, “Yes they do spot checks. They wait for you and they don’t announce them.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People using the service and their representatives told us the care staff were clean and hygienic and followed appropriate infection control procedures, which helped keep everybody safe. People using the service and their representatives confirmed that staff washed their hands and used appropriate personal protective equipment (PPE), such as gloves and aprons.

People made comments such as, “There is enough PPE”; “They [staff] bring their own aprons and gloves” and “They wear aprons and wash their hands.”
 

Most people using the service and their relatives gave positive feedback about the support they received with medicines. One person told us, “My [relative]’s medication comes in a dosette box which they [staff] open. My [relative] takes out their medication and the staff watch them take it.”Another person said, “[Name] takes anti-dementia medication; I am not aware of any mistakes.” A third person explained, “There is a MAR chart for medication. Sometimes my [relative] won’t take their medication. They [staff] do try again and if my [relative] still refuses, then they [staff] ring us.”

However, some people’s relatives had raised concerns about medicines errors and omissions. We reviewed the circumstances regarding these and had a discussion with the registered manager and the regional head of operations. We also looked at a range of evidence and documents provided by the registered manager. This assured us that the registered manager was maintaining full oversight of the medicines systems and took appropriate action to ensure investigations were completed, improvements were made, lessons were learnt and recurrences were prevented as much as possible.

Staff involved people in planning, including when changes happened. Staff told us they completed medicines administration training, which was both online and face to face. Staff also confirmed that office staff carried out spot checks and competency check for medicines. Staff said they completed regular refresher training and explained that, if a mistake was made, additional training needed to be completed.

Staff said prescribed creams and ointments were recorded as administered. Staff told us they would not administer any medicine which was not on the Medicines Administration Record (MAR) and everyone said they would contact the office if they had any concerns or uncertainties.

Several staff mentioned the difficulty of working with family members who sometimes administered medicines when it was the care staff’s responsibility to do so. They said they always raised this with the office to address, as they recognised the potential risk of errors if both parties were administering people’s medicines.