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Archived: Kingston Upon Thames Inadequate

We are carrying out a review of quality at Kingston Upon Thames. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary

Overall summary & rating


Updated 3 September 2020

About the service

Kingston-Upon-Thames 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 older adults. At the time of the inspection, there were two people receiving the regulated activity of personal care.

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

People were not always protected against avoidable harm as the nominated individual failed to ensure risk management plans were robust. People’s medicines were not managed in line with good practice. Incidents and accidents were not always recorded, and lessons were not learnt when things went wrong. People were protected against the risk of cross contamination as there were infection control measures in place. People were protected against the risk of harm and abuse and staff received safeguarding training to keep people safe. People received care and support from staff that had undergone pre-employment checks.

People did not receive a service that was well-led. The service continued to be without a registered manager. There continued to be widespread failings in the management of the service. The service continued to be delivered from an un-registered location. Audits undertaken failed to identify issues found during the inspection. The nominated individual failed to ensure there was continuous learning and improvement of the service. Records confirmed people’s views were sought and there was evidence the service worked in partnership with other healthcare professionals.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was inadequate (published 7 April 2020).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make further improvement. Please see the Safe and Well-led sections of this full report.

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 Kingston Upon Thames on our website at


We have identified breaches in relation to safe care and treatment, good governance and registration requirements at this inspection.

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 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.

Special Measures

The overall rating for this service is 'Inadequate' and the service remains 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

Inspection areas


Requires improvement

Updated 3 September 2020

The service was not always safe.

Details are in our safe findings below.



Updated 3 September 2020



Updated 3 September 2020


Requires improvement

Updated 3 September 2020



Updated 3 September 2020

The service was not well-led.

Details are in our well-Led findings below.