Archived: Mayfair Homecare - Westminster

At this inspection we found that the service was now meeting regulations and we have changed their rating to ‘Good’.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides care and rehabilitation services to older adults and support to people with mental health needs in the London Borough of Camden and the City of Westminster. At the time of our inspection the service was providing personal care to 83 people. Not everyone using Mayfair Homecare-Westminster 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.

The service had a registered manager, who had been in post since November 2017 and completed their registration in February 2018. 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 told us they were treated with kindness and respect by staff. People’s views were sought through reviews and telephone monitoring. Accurate assessments of people’s needs were carried out yearly and care plans were designed to meet these needs. Care plans were concise and contained accurate and important details about the care people required and wanted. Care workers demonstrated they had delivered care as planned through accurate recording. People had consented to their care in line with the Mental Capacity Act 2005 (MCA).

Suitable recruitment systems were operated by managers to make sure that staff were suitable for their roles. There were good systems in place to make sure care workers arrived on time and that people were protected from the risk of missed or late calls. Care workers received the correct training and supervision to carry out their roles. Managers undertook spot checks and care worker assessments to make sure that care and support were delivered effectively and in a caring manner. This included carrying out additional checks where there were concerns about staff performance.

We had previous concerns about how medicines were managed, but at this inspection we found people’s support with medicines was correctly planned and managed by care workers. Regular checks were carried out by managers to make sure that this was carried out safely. We identified two areas where the provider could further improve medicines management in line with best practice guidance and have made a recommendation about this.

Care plans detailed the support people needed to eat and drink and people’s dietary preferences. There was evidence people received varied diets. People knew how to complain and when this happened complaints were appropriately investigated and responded to, although the provider did not always record whether people were satisfied with the outcome.

Managers had carried out a comprehensive audit of the service, including of people’s care files and the recruitment and oversight of staff. Care workers told us they felt well supported by managers. There were systems in place to monitor staff training, background checks of care workers and people’s reviews. Where audits identified issues these had been correctly addressed. This had resulted in clear improvements in the management and operation of the service.

We undertook this announced inspection on 27 and 31 July 2017 to check whether the provider had followed their action plan and now met legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Mayfair Homecare – Westminster on our website at www.cqc.org.uk.

‘Mayfair Homecare – Westminster’ is a domiciliary care agency formerly known as ‘Sevacare – Wesminster’. The agency provides support to older people, people with physical disabilities and people with mental health conditions in the London Borough of Camden and the City of Westminster. At the time of our inspection there were 78 people using the service.

The location had a registered manager. 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.

We found that the provider now met regulations in terms of how they assessed and managed risks. However, we found that the provider was not meeting this regulation with regards to the safe management of medicines. The provider had acted on our recommendation with regards to monitoring the punctuality of care workers.

Since our last inspection the provider had followed their action plan, which involved providing additional training to assessors on how they managed risks and reviewing existing risk assessments and management plans to ensure they accurately addressed people’s needs. This included measures such as assessing people’s homes for safety, checking that equipment used for moving and handling was safe to use and providing information to staff on risks to people from diagnosed health conditions such as diabetes and dementia.

At our last inspection we made a recommendation about how the provider monitored the punctuality and attendance of care workers, as there was some evidence of late calls and a lack of systems to monitor this. At this inspection we found the provider was implementing a call monitoring system which was now in use for the majority of people who used the service. This showed that most care workers now arrived on time.

At our last inspection we also made a recommendation about how the provider checked that records relating to medicines were up to date. At this inspection we found that medicines were not always safely managed. This was because there was often inconsistency between how medicines administration recording (MAR) charts were completed by care workers and in some cases there were gaps in these records which were not suitably addressed by audits. Some MAR charts did not contain clear administration instructions for care workers to follow and sometimes care plans and risk assessments did not accurately reflect the support people received.

We found one breach of regulations relating to the safe management of medicines. You can see what action we told the provider to take at the back of the full version of this report.

Sevacare - Westminster provides a domiciliary care and rehabilitation service to 140 people in the London Boroughs of Camden and Westminster. Since our last inspection, Sevacare - Westminster has stopped providing care to people in the London Borough of Islington, and is now only supporting people in Westminster on a private basis. Shortly after this inspection, the service changed its name to Mayfair Homecare - Westminster.

The service had a registered manager in place. 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.’

Most people told us that they were satisfied with their care workers and their consistency. People told us that they were treated with respect and felt listened to. The provider followed up concerns about people’s health, and had a policy in place to respond when people did not answer the door to care workers.

The provider carried out a detailed assessment of people’s care needs and possible risks to their health and safety. There were risk management plans in place for people, but sometimes these did not reflect their needs, and there was some inapplicable information on these. The provider did not always assess the risks associated with certain health conditions, or ensure that equipment was safe for use. Most people were satisfied with the timeliness of care workers, but there was no system for monitoring this in detail, and in some cases we found that care workers were late for calls.

There were measures in place to ensure that care workers were competent for their roles. This included a detailed training programme and regular observations and spot checks of care workers whilst they delivered care. Care workers received adequate training and supervision to ensure that they were able to administer medicines competently, but in some cases information on people’s medicines was not in date, and it was not always clear who was responsible for administering medicines. When medicines were given on an “as required” basis, there was no clear protocol for care workers to follow. Although there were systems of audit in place for people’s care logs and medicines, these did not always detect errors with care plans and risk assessments.

People were asked if they were satisfied with their care and care plans were reviewed regularly. Care plans contained detailed information about how people needed and liked to receive their care, although in some cases these did not fully reflect the care people currently received. There were systems in place for recording people’s consent to their care, but in some cases people’s capacity to make decisions had not been assessed, and the provider did not always ensure that people had the appropriate legal authority to consent to care on behalf of others.

We have made a recommendation about how the service document’s people’s capacity to make decisions and how the service monitors the timeliness of calls. We found one breach of regulation regarding safe care and treatment. You can see what action we told the provider to take at the back of the full version of this report.

We undertook this focused inspection on 28 and 30 June and 5 July 2016 to check that they had followed their plan and to confirm that they now met legal requirements. 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 'Sevacare – Westminster' on our website at www.cqc.org.uk.

Sevacare Westminster is a service which provides personal care to people in their own homes who live in the boroughs of Westminster, Camden and Islington. At the time of our inspection the service was supporting 408 people.

The service did not have a registered manager at the time of the inspection, this was because the previous registered manager had left the service in March 2016. 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. At present both Islington and Westminster branches were operating under a single registration. The provider had applied to register the Islington branch separately, this meant that both branch managers had applied to become registered manager.

We saw that the provider now had measures in place to ensure that staff were suitable for their roles, and that this was reviewed regularly. Therefore the provider was now meeting this regulation. At our previous inspection we found that the recording and auditing of medicines was not suitable to ensure that people had safely received their medicines. We saw that the provider was now meeting this regulation and had made significant improvements in recording medicines. We still found that some medicines such as creams and nasal sprays were not recorded accurately, and that care plans did not clearly indicate who was responsible for supporting people with their medicines.

At our previous inspection, we found that care plans did not reflect the support people received, and that call logging systems were not used effectively. There had been a significant improvement in the use of these systems, and punctuality had improved where this was being used. Staff in Islington had sufficient travel time to attend their calls, but many staff in Westminster and Camden did not. There was still significant lateness of visits in Camden and Westminster. The service had altered people's visit times in order to meet their needs and preferences, however care plans had not been updated to reflect this. There was insufficient information on people's cultural needs to ensure staff could meet these.

We found that risk assessments did not contain sufficiently detailed plans to ensure that risks to people were safely managed. This included managing the risks to people of falling and ensuring that equipment was safe to use.

We found that audits were still not of a sufficient level of detail to highlight times when people's support had not been correctly recorded, and this did not ensure that care plans were up to date and reflected people's need.

We have made a recommendation about how the provider records the use of some medicines. We have found breaches in relation to safe care and treatment, person centred care 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.

Care workers protected people's privacy and dignity and treated them with respect. One person said they were 'very, very happy' with the service.

People told us that their needs had been assessed when they first started receiving care and that these assessments had been ongoing.

People we spoke with had confidence in the skills of their care workers. People told us they were able to give views about the service and felt listened to. People said they knew how to raise concerns if there were any but they had not felt the need to do so.