Archived: Westminster Homecare Limited (Chelmsford)

Westminster Homecare Limited (Chelmsford) is a domiciliary care agency that was providing

personal care to 114 people living in their own home at the time of the inspection.

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

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.

There were systems for assessing and managing risk to help make sure all were kept safe from foreseeable risks. People received safe care and staff understood safeguarding procedures. Recruitment practices were safe, and there was enough staff, which meant people received the calls they needed.

There were systems in place to make sure people received their medicines safely. The service analysed accidents and incidents to prevent reoccurrence and keep people safe from harm.

We have made a recommendation about improving guidance for people with variable mobility needs.

Staff had the right skills and experience to meet people's needs. A comprehensive induction and training programme was completed by all staff. Assessments were carried out to ensure people's needs could be met. Staff understood people's likes, dislikes and preferences and people told us they were offered choices about their care.

The provider ensured there was effective oversight and governance of the service and any concerns in relation to the quality of support were identified and acted upon promptly.

Rating at last inspection

The last rating for this service was requires improvement (published 05 July 2018)

Why we inspected

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

Enforcement

Since the last inspection we recognised that the provider had failed, without reasonable excuse, to comply with a condition of their registration namely a registered manager condition (Section 33 Health and Social Care Act 2008). This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

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.

This announced inspection took place between 17 and 20 April 2018.

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. The service did not have a registered manager in place. However, a new manager had been recently appointed and were applying to CQC to become the registered manager. They worked closely with the operations support manager, who had until recently been the manager of the service.

At our last inspection in February 2017 we rated the service as requires improvement in all areas. We asked the provider to submit an action plan and monthly reports to show what they would do and by when to improve the service to at least a good rating. At this inspection, we found the provider and manager had taken action as required. However, whilst many areas of the service had improved to good, further time was needed to ensure the improvements were sustainable and so we continued to rate the service requires improvement overall.

The operations support manager had set up extremely good systems which were driving improvement and changing the culture of the service. Senior staff had good oversight of the support staff provided, and the service was better organised than at our last inspection. There were effective checks on the quality of the service with prompt action taken when concerns were found. Although we found some areas still needed improving, we had increased confidence that the systems were in place to continue to resolve concerns.

The provider had enabled senior staff to address the concerns we had found at our last inspection by reducing the pressure to meet targets and increase numbers of people using the service. However, the provider was responsible for the style of care plans staff used and had not ensured the plans presented information about people’s needs and risks in a clear manner.

We found the service had not mitigated the risks to people’s safety when they were discharged back to the community from hospital. The manager assured us they would address our concerns to improve communication with staff and ensure a more coordinated response to the risks around hospital discharges.

New systems had led to the increased safety of people at the service since our last inspection, such as the enhanced checks on the support people received with their medicines. Staff had been retrained in the administration of medicines and, whilst there continued to be some concerns in this area, the measures to drive improvement and safety were proving effective.

Risk assessments had improved, though information about how to minimise risk was not presented to care staff in a clear manner. Staff worked well as a team to support people who were at risk of abuse.

There were enough staff to meet people’s needs. New people only joined the service when there was capacity within the staff team to support them safely. Rotas and visits were better coordinated so that people were supported in a more consistent and structured manner.

Staff had access to improved training and support. They were better skilled to meet the needs of people with complex needs, including people with dementia. People received support to access health and social care professionals where needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice, though there was scope to improve recording around how people’s capacity was assessed.

Although we had concerns about the style of care plans, we found people were cared for by a more consistent staff team who knew them well. The support had become more personalised and less rushed than at our last visit to the service. People and staff told us they had more time to have a chat and meet people’s needs in a less hurried way. Staff treated people with dignity and respect. A senior member of staff had been trained in supporting people at their end of life and ensuring people received coordinated care at this time.

People felt able to complain and were confident their concerns would be addressed. People and their families had varied opportunities to provide feedback about the service they received. Their views were taken into account and used to review the support staff provided to ensure it met their needs.

A registered manager was in post 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 had been absent for over 28 days on the day of our inspection. The service was being run by two area managers with the assistance of senior staff from the service, and from a neighbouring branch of the service.

We last inspected this service on 18 and 19 July 2016 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of four regulations, relating to person-centred care, safe care and treatment, staffing and good governance. At our previous inspection we had found there were not enough staff to meet people’s needs in a timely way and people did not consistently receive safe care in line with their preferences. The manager had not adequately carried out necessary checks to ensure that the service met people’s needs. Following the inspection in July 2016, the service sent us a plan to tell us about the actions they were going to take to meet the above regulations.

At this inspection in 21 and 22 February 2016, we found four continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person-centred care, safe care and treatment and good governance. 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.

At this inspection we found there had been some improvements since our last visit. There had been a focus on staff recruitment so there were more staff available to meet people’s needs. Training had been improved and staff were being enabled to develop their skills, particularly in the area of dementia care.

As we had found at our last visit, where people had established staff, they received care which was of consistently good quality. However, poor coordination combined with inadequate care plans meant risk was not well managed and staff did not have sufficient information to manage people’s needs safely and in a person centred manner. Unsatisfactory oversight by the manager meant they had not fully addressed on-going concerns.

Poor scheduling of staff rotas meant that some visits were missed and people did not receive the support their required. There were not effective systems to monitor missed visits and the impact on people. Risk assessments were out of date or inaccurate and did not provide staff with the necessary information to reduce risk.

Whilst improved processes for the administration of medicine were being introduced these were not fully established and staff did not have sufficient information about the support people needed with their medicines.

There had been a positive focus on improved training for all staff and this was leading to improvements in overall skills. However, where people had specific needs, staff did not always have access to specialist training and information.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 and report on what we find. The service had started improve measures in relation to assessing people who may lack capacity but this was still at an early stage. Staff offered people choice and had a working understanding of supporting people who lacked capacity, however they did not have adequate information in relation to people’s needs in these instances.

Where staff knew people well they supported them positively to maintain good health and wellbeing and access resources as necessary. However, lack of information about how people’s health conditions affected them meant staff did not have enough guidance on how to best meet their needs.

Some people were supported by staff who were caring and knew them well. They became anxious if these staff were not there as replacement staff did not always know about their needs and preferences. Measures to improve care plans were not functioning well and when people’s needs changed their care plans were not revised. As a result, staff, people and their families were often confused about the level of care being provided.

When people complained they received a response from the manager and improvements were made to the service. However, there were limited efforts made to gather to feedback about people’s individual circumstances and so opportunities for understanding peoples experience of care were lost.

A number of new staff had been appointed to resolve concerns we had raised at our last inspection and measures to check on the quality of the service had been put in place but these were not yet operating effectively and any improvements were not yet shown to be sustainable. Communication between the registered manager and the provider had not been open and effective and as a result concerns had not been dealt with in a timely manner. When the provider became aware of concerns at the service they were pro-active about putting things right.