Servesoul - Camden Office

Servesoul – Camden Office is a large domiciliary care agency that provides support to people in their own homes. It provides a service to predominantly older adults. At the time of our inspection there were 150 people using the service. People using the service lived in two London Boroughs in north and south London.

Not everyone who used the service received personal care. The Care Quality Commission (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

Staff had received training about safeguarding and knew how to respond to, and report, any allegation or suspicion of harm or abuse.

People’s care plans and risk assessments included information about their care and support needs and preferences. However, risk assessments did not always provide evidence that common risks, for example fire safety, had been considered. The provider had made changes to the risk assessment format which they showed us on the second day of the inspection and they told us that this will be implemented.

The recruitment procedures were designed to ensure that care staff were suitable for the work they would be undertaking. We viewed a sample of recruitment records for care staff employed since our previous inspection and found that background checks were being carried out.

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.

People and their family were involved in decisions about their care, which was evident in the care plans we viewed and from the feedback we received from people using the service and relatives. Since the easing of COVID-19 restrictions, the provider had begun to re-introduce face to face spot checks and meetings with people during visits to people’s own homes.

Information about people’s religious, cultural and communication needs was included in their care plans.

People were asked about their views of the care and support that they received using telephone calls, feedback questionnaires and during visits to people at their own home.

Some things worked well but there were risks that this could be undermined as management oversight was not diligent enough to prevent avoidable mistakes being made. Improvement was required to the oversight to ensure that risk assessments were being completed fully in some cases. Statutory notifications to CQC, that are required by law, had improved but consistency in submitting these notifications was still not being sustainably achieved.

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 22 October 2021).

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about notifications not being made in good time and a recent death of someone in their own home due to a fire. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with risk assessments not evidencing that all common potential risks were considered in most cases. Information held by the service was held on different sites and not readily accessible when requested. For these reasons we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

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 will continue to monitor the service and will take further action if needed.

We have identified one breach of regulation in relation to safe care and treatment (regulation 12) and have made a recommendation in respect of achieving consistent and sustainable improvement to making statutory notifications to CQC.

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 from the provider to understand what they will do to improve the standards of safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Staff had received training about safeguarding and knew how to respond to, and report, any allegation or suspicion of harm or abuse. This had improved since our previous inspection in September 2020.

The care and support provided to people was person centred. People’s care plans and risk assessments included information about their care and support needs and preferences. Care staff had the necessary guidance about the support each person required and how people preferred to be cared for.

The recruitment procedures were designed to ensure that staff were suitable for the work they would be undertaking. However, we found that the provider could do more to evidence attempts to contact previous employers if care staff had come to the UK having previously worked in health and social care in other countries.

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.

People and their family were involved in decisions about their care, which was evident in the care plans we viewed and from the feedback we received from people using the service and relatives. During the COVID-19 pandemic reviews had stopped being held face to face and these had to be done using other means, such as telephone calls and online virtual meetings using computer. Since the easing of restrictions, the provider had begun to re-introduce face to face spot checks and meetings with people during visits to people’s own homes.

Information about people’s religious, cultural and communication needs was included in their care plans.

People were asked about their views of the care and support that they received using telephone calls and handwritten feedback questionnaires, and more recently during visits to people at their own home. The provider expected people to be asked for feedback every two months, although during the pandemic people had been contacted more regularly to check how they were doing. It was evident that views were sought and that this was now increasing in frequency once more.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 11 November 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

At our previous focused inspection, we had identified breaches to Regulation 12 (Safe care and treatment) and Regulation 13 (Safeguarding service users from abuse and improper treatment). At this focused inspection we found that the provider had taken the necessary action to address these failings. We had also considered whether grounds for enforcement action existed for a breach of Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. We decided that it was not in the public interest to proceed as the provider had acknowledged the failure and had provided CQC with assurances about what they needed to do to address it.

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 Safe and Well-led which contain those requirements.

You can read the report from our last focused inspection, by selecting the 'all reports' link for Servesoul on our website at www.cqc.org.uk.

Follow up

We will continue to monitor intelligence we receive about the service.

Servesoul – Camden Office is a large domiciliary care agency that provides support to people in their own homes. It provides a service to predominantly older adults. At the time of our inspection there were 102 people using the service. Most people using the service lived in a particular north London borough with a quarter living in two other boroughs in south London.

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:

Staff had received training about safeguarding and knew how to respond to, and report, any allegation or suspicion of harm or abuse. However, a safeguarding concern that arose in May 2020 had not been referred to CQC. This was subsequently notified to CQC by the provider but only after the issue was raised during this focused inspection. The local authority later closed the concern as they believed the service had taken steps to address the learning points from the incident.

The care and support provided to people was usually person centred. People’s care plans and risk assessments were detailed and included information about their care and support needs and preferences. Care staff had the necessary guidance about the support each person required and how people preferred to be cared for.

The service’s recruitment procedures were designed to ensure that staff were suitable for the work they would be undertaking.

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.

People and their family were involved in decisions about their care, which was evident in the care plans we viewed and from the feedback we received from people using the service and relatives. During the Covid 19 pandemic reviews had stopped being held face to face and these had to be done using other means, such as telephone calls and online virtual meetings using computer.

Information about people’s religious, cultural and communication needs was included in their care plans.

People were asked about their views of the care and support that they received using telephone calls and handwritten feedback questionnaires. The provider expected people to be asked for feedback every two months, although this had been a little haphazard during the pandemic, it was evident that views were sought.

Rating at last inspection:

The last rating for this service was good (published 14 November 2017).

Why we inspected:

We undertook this focused inspection to follow up on specific concerns which we had received about the service in relation to safeguarding, care practice and management of medicines. A decision was made for us to inspect and examine these potential areas of risk and how this may impact upon other people using the service.

We have found evidence that the provider needs to make improvements. Please see the key questions of safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Servesoul on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment) and Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. Changes to the needs for medicines support had not been recorded on medicines records for one person and potential changes to a person’s care and support needs had not been notified to the commissioning local authority. In addition, an allegation of abuse had not been notified to CQC as required by regulation.

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

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 continue to monitor intelligence we receive about the service until we return to inspect as part of our re-inspection programme.

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

This is the first inspection of the service since initial registration in November 2016.

A company director was also the registered manager. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 had a care plan which contained information about the person and their care needs and requirements. As part of the care planning process, senior staff carried out risk assessments which covered the home environment, moving and handling and health and safety.

Care staff were able to identify types of abuse and were clear about the actions they would take if they had any concerns.

The registered manager and care staff had a good understanding of the Mental Capacity Act 2005 and how this impacted on the provision of care and support. Care plans demonstrated that mental capacity assessments took place. Action that was needed as a result of people lacking capacity was taken.

Care staff told us, and documents confirmed, that they received training in the safe administration of medicines. The registered manager and deputy manager monitored medicines recording and administration and there were robust systems in place to ensure this was managed safely.

The service had safe recruitment processes in place which included obtaining references and the completion of a criminal record check prior to the care staff commencing their employment. Care staff we spoke with told us that they felt supported in their role and received regular supervision. As care staff had all been working at the service for a little over six months annual appraisals had not yet taken place although the registered manager told us this would occur when they were due.

Care staff, when they first started working at the service, received an in-house induction and training in all mandatory subjects which included first aid, safeguarding, moving and handling and medicine administration.

Spot checks took place in order to monitor the care and support provided to people along with regular reviews of people’s care and support needs. No missed or late visits had occurred.

The service had a complaints policy which was given to people using the service and relatives. The registered manager reported that they had not received any complaints.

As the service was relatively new, operating quality assurance questionnaires had not as yet been completed. However, being a small service there was regular contact with people by the registered manager and deputy manager.

As a result of this inspection we found that the provider met all of the key lines of enquiry that we looked at. Please refer to the main body of this report for further details.