London Care (Ensham House)

London Care [Ensham House] provides personal care and support to people living in an extra care housing scheme. This consists of 45 individual flats within a staffed building with some communal areas. At the time of our inspection there were 35 older people using the service. A separate organisation manages the building. 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

At the last inspection the service provided was not always safe for people to use and staff to work in as suitable numbers of staff were sometimes not available to meet people’s needs. The service was not always well-led. Shortfalls identified by the quality assurance (QA) system were not being addressed and shortfalls of the care planning systems placed people at the risk of harm.

At this inspection most people and their relatives said there were enough staff who provided safe care and support in a friendly, caring way that met their needs. Risks to people were assessed, monitored and reviewed. This enabled them to take acceptable risks, enjoy their lives and live safely. Accidents, incidents and safeguarding concerns were reported, investigated and recorded. There were appropriately recruited staff to meet people’s needs. Medicines were safely administered by trained staff.

At this inspection the quality assurance and care planning system ensured people received their calls on time and for the full duration.

The service had an open and honest culture and there was a clearly defined vision and values that staff we spoke with understood and followed. This was done in a caring, kind and sympathetic way. The QA systems and audits identified issues, and they were addressed. Areas of responsibility and accountability were identified, with staff prepared to take responsibility and report any concerns. There were well-established working partnerships with health care professionals. Records including people’s daily logs and care plans were up to date, as well as staff information. People praised the caring and responsive approach of the registered manager and staff.

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 requires improvement (published 1 October 2021) and there were multiple breaches of regulation.

Why we inspected

We undertook this focused inspection to check they 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 of Safe and Well-led which contain those requirements. A decision was made for us to inspect and examine the risks associated with these issues.

Care Quality Commission (CQC) has introduced focused inspections to follow up on previous breaches and to check specific concerns.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

As no concerns were identified in relation to the key questions Effective, Caring and Responsive, we decided not to inspect these questions. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. 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 London Care [Ensham House] on our website at www.cqc.org.uk.

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.

London Care [Ensham House] provides personal care and support to people living in an extra care housing scheme. This consists of 45 individual flats within a staffed building with some communal areas. At the time of our inspection there were 36 people using the service. A separate organisation manages the building. 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

The service provided was not always safe for people to use and staff to work in as suitable numbers of staff were sometimes not available to meet people’s needs. People said that most staff did their best to meet their care needs but this was hampered, as there were not enough of them. Sometimes they did not receive support at the agreed time, or their time was cut short as other people’s needs also had to be met. During weekends responsibility for leading the staff team was given to one team leader and senior staff. Whilst being experienced the team leader and senior staff had not undertaken leadership and staff management courses appropriate to their responsibilities. Risks to people were assessed, monitored and reviewed. Some people expressed the opinion that their needs had not been accurately assessed and could not be met, by the service. This had been made worse by the COVID-19 pandemic. People had their needs assessed, reviewed and received person-centred care, from available staff. The service reported, investigated and recorded accidents and incidents and safeguarding concerns. Trained staff safely administered medicine to people. The health care professional did not always feel the service was safely run, due to staff shortages.

The service was not always well-led. Quality assurance systems (QA) and audits identified visit issues, in up to date records, although action taken to remedy the situation was not successful. The culture of the service was open and honest with the registered manager acknowledging that there were issues with recruiting staff. There was a clearly defined vision and values that staff understood and followed, in a kind, sympathetic and caring way. Areas of responsibility and accountability were identified, with staff willing to take responsibility and report concerns, in a timely fashion. Although complaints were recorded and investigated, people told us that when they raised concerns changes were not always made to improve their care and support. The service had well-established working partnerships with health care professionals, although the healthcare professional expressed concerns that the service was not always well-led. Due to the COVID-19 pandemic, lockdown and self-isolation, the registered manager and staff said it had been difficult promoting people’s participation and reducing social isolation. This had continued due to a lack of staff. Records including people’s daily logs and care plans were up to date, as well as staff information. Registration requirements were met.

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 Good (published 4 July 2018).

Why we inspected

This inspection was prompted in part due to ongoing concerns received that there weren’t enough staff available to meet people’s needs, ineffective management including audits not always identifying issues in relation to late visits, medicine record keeping, lack of feedback from people and their relatives and action taken from it, people’s care and safety not being appropriate to their needs and that action taken was not always clear. A decision was made for us to inspect and examine the risks associated with these issues.

Care Quality Commission (CQC) has introduced focused inspections to follow up on previous breaches and to check specific concerns.

We undertook a focused inspection approach to review the key questions of Safe and Well-led where we had specific concerns about staffing numbers and audit management.

As no concerns were identified in relation to the key questions is the service Effective, Caring and Responsive, we decided not to inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to good governance and staffing 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 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.

At our previous inspection on 17 & 24 August 2017 we found the provider was not meeting regulations in relation to the outcomes we inspected and we issued a warning notice in relation to Good Governance. At this inspection, we found the provider had met the breaches we found at the previous inspection.

At the last inspection, the service was rated Requires Improvement.

At this inspection, the service was rated Good.

London Care [Ensham House] provides personal care and support to people living in an extra care housing scheme. This consists of 45 individual flats within a staffed building with some communal areas. At the time of our inspection there were 43 people using the service. A separate organisation manages the building. Not everyone using London Care [Ensham House] receives 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.

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 registered manager was relatively new and had been in post since January 2018. People using the service, relatives and staff were positive about the impact he had and the improvements he had made since he had started. This include changes to the allocation of staff on their daily shifts which they felt were more responsive to people’s needs.

People told us they felt safe living at the service and that care workers were kind and caring towards them. People received appropriate support in relation to their medicines. They told us they felt supported in relation to their health and nutritional support needs. However, a common theme in our conversations with people were that care workers were rushed and did not support them much above and beyond the basic level of care.

People lived independent lives and any restrictions in place were in line with the Mental Capacity Act 2005, in their best interests.

Staff told us that their rotas had improved and there were enough staff to support people. They spoke positively about the training and supervision they received. The training covered areas of care that were deemed mandatory and supervision was based around staff performance and in areas relevant to their roles such as medicines.

The provider had robust recruitment checks in place and carried out appropriate checks to ensure suitable staff were employed. At the time of the inspection, there were upcoming changes being considered for the makeup of the senior team within the service.

An assessment of care needs was completed before people came to use the service which looked at the risks to people and how they could be made safe. Care and support plans included goals and outcomes that people wished to achieve and how people could support and assist them to achieve their goals.

Records such as complaints, incident and accident monitoring and medicine administering records were completed appropriately.

The provider had an appropriate system in place to check the quality and safety of the service people received. The regional manager undertook periodic audits that included general information and focussed on a specific topic, such as medicines or people’s personal care and support records. We saw that the overall compliance scores were improving as each audit was undertaken.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breaches found. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for London Care (Ensham House) on our website at www.cqc.org.uk.

There was a registered manager 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.

London Care (Ensham House) provides personal care and support to people living in an extra care housing scheme. This consists of 45 individual flats within a staffed building with some communal areas. At the time of our inspection there were 39 people using the service. A separate organisation manages the building. The flats comprised of a lounge/kitchen, bedroom and a bathroom and were individually furnished. There is a pleasant and secure garden with access from the ground floor. Each person was issued with a fob for access to the building.

At our previous inspection we found that some risk assessments were not completed properly and medicines management was not always appropriate. Care plans were not always up to date. We found that staffing levels often fell below the expected levels and staff did not always receive regular supervision. We also found the provider did not always document their response to complaints and although quality assurance check were in place, the provider did not always act upon the feedback or the action points identified.

At this inspection, we found that improvements had been made in relation to staffing and person centred care.

Care workers told us they received regular supervision. Staff files had evidence of more regular staff supervision and the provider had a system in place to monitor when care worker’s next supervision was due.

Care records had been reviewed and updated which helped to ensure they were current.

There had been some improvements in how complaints were being managed, however we still found some discrepancies between what was recorded on paper and that of the online reporting system in relation to action taken against complaints.

People also told us that they received their medicines appropriately; however we still found gaps in Medicine Administration Record (MAR) charts that we saw.

The provider could not demonstrate that areas of concern identified through their governance procedures were being acted upon in a timely manner. We found a continuing breach of regulation relating to good governance.

Not all parts of the action plan that was submitted to us by the provider had been followed through effectively to improve the service.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what action we told the provider to take at the end of the full version of this report.

London Care (Ensham House) provides personal care and support to people living in an “extra care” housing scheme. This consists of 45 individual flats within a staffed building with some communal areas. At the time of our inspection there were 40 people using the service. A separate organisation managed the building. The flats comprised of a lounge/kitchen, bedroom and a bathroom and were individually furnished. There is a pleasant and secure garden with access from the ground floor. Each person was issued with a fob for access to the building.

There was a registered manager in post. 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.

People using the service were generally satisfied with the care they received, they told us they felt safe and that care workers respected their privacy and dignity. They said that care workers encouraged their independence and supported them to make choices.

The provider took steps to ensure people were fully involved and consented to the care and treatment they received. People were satisfied with the support they received with regards to their eating and drinking. They also said they had access to appropriate healthcare professionals if required.

We found that although risk assessments and care plans were in place, these were not always assessed and reviewed correctly. We found examples where risk assessments had not been completed correctly by staff and where care plans had not been updated following changes to people’s support needs. We also found instances where care plans had not fully captured people's individual support needs.

Some aspects of medicines management were not safe. There were discrepancies in some of the medicines stock checks and where people’s allergies were not made clear in medicines records.

Recruitment checks were robust which helped to ensure that people were supported by staff who were safe to work with them. However, we found there were not always enough staff on duty to support people using the service. There were instances where staffing levels were not at the level as stated by the provider. We also found that although staff received a thorough induction and ongoing training, they did not receive regular one to one supervision. We also received mixed feedback about the timeliness of the care workers and staff shortages from people using the service.

People told us they knew who to speak with if they were unhappy about any aspect of their care. We found that the provider did not always document their response to complaints and we found discrepancies in the paper and electronic recording of complaints.

Although thorough quality assurance checks, including audits and gathering feedback from people were in place, we found that the provider did not always act upon the feedback or the action points identified.

We found breaches of the regulations in relation to safe care, staffing, person centred care, complaints and good governance. You can see what action we have told the provider to take at the back of the full version of this report.