Archived: London Care (Poole)

Updated 4 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 12, 13 and 17 July 2017 and was unannounced. One inspector carried out the inspection.

Before the inspection, we reviewed the information we held about the service; this included notifications, questionnaires and information we had received from third parties including a local authority contract monitoring team and safeguarding team. We did not request a Provider Information Return (PIR) because this inspection was brought forward due to concerns. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We visited seven people in their homes. We also talked with five relatives, six visitors, nine care staff, three office-based staff, the registered manager and the nominated individual. We reviewed seven people’s care and medicine records in the office and the records in their homes, with their permission. We also reviewed another three people's care and medicine records in the office. We checked records about how the service was managed. These included five staff recruitment and monitoring records, staff rotas, complaints, safeguarding and training records, audits and quality assurance records as well as a range of the provider’s policies and procedures. The registered manager emailed us various policies and training information, as we requested following the inspection.

Updated 4 November 2017

This inspection took place on 12, 13 and 17 July 2017 and was unannounced. London Care (Poole) provides personal care and support to people living in three extra care housing schemes. These consist of private flats within staffed buildings with some communal areas. At the time of our inspection there were 71 people who were receiving personal care.

There were many other people who received welfare calls from London Care staff but this part of the service is not regulated and inspected by CQC.

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.

The service was registered in March 2017 and this was therefore the first inspection of London Care (Poole). London Care had been providing care at the two of the three schemes since July 2016 and at the third scheme from November 2016. When London Care started to provide care and support, they were not registered to provide this service in Poole and it was managed from another of their registered locations in London. Therefore people in some of the extra care schemes in Poole had received care and support from London Care for almost one year. Newly registered services must be inspected by CQC within 12 months of the anniversary of registration. This inspection was brought forward because we were aware that people had been receiving services for nearly a year and because we had received concerns about how the service was run.

At this inspection we found nine breaches of the Health and Social Care Regulations 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

People’s medicines were not managed safely. People’s needs had not been properly assessed and planned for regarding the help they needed to take their medicines or apply prescribed creams. This meant that people were at risk of not receiving the correct medicine, in the correct quantity, at the correct time.

Systems to manage risk and ensure people were cared for in a safe way were ineffective. Risk assessments were not always fully completed or regularly reviewed. Some risks had not been identified as such and therefore no action had been taken to reduce or manage the risk. For example, some people had items of equipment such as hoists, bed rails and oxygen condensers. The service had not carried out risk assessments to ensure that the equipment was fitted correctly and worked safely. This meant that people’s safety and well-being was not always protected.

People told us staff were kind but there were many examples of poor practice and lack of understanding with regard to ensuring people's rights to privacy and dignity were recognised and respected. For example, male staff had been sent to females who had specified that they did not wish to receive personal care from males. Some people lacked mental capacity to make important decisions but staff had not ensured that the decisions that were made on people's behalf were in their best interests and were likely to have been what the person would have chosen for themselves.

Staff had completed training in essential areas such as moving and handling and health and safety. However, they did not always have the right skills and knowledge to meet people's specific needs. For example, they were caring for people with complex health conditions or learning disabilities but had not completed training in these areas.

There were not enough staff employed to meet people’s needs. People did not receive calls at the times they needed and visits were often cut short. Where people needed two staff to support them, they were not always both available at the correct time or sometimes only one member of staff completed the visit. Steps had not been taken to ensure that staff were suitably supervised. This meant that people were not always cared for by staff who had been supported to deliver care and treatment safely and to an appropriate standard. Appropriate checks and references had not always been completed before new staff were allowed to work with people. This meant that the provider had not taken all possible steps to ensure that staff were suitable to work with vulnerable people.

People did not always receive the care they required. Care planning systems were not robust. Some assessments had not recognised specific care needs and no care plans had been created for these. For example, where people lived with diabetes, there was no care plan outlining what the condition meant to the person, how it affected them, how it may progress and any risks such as high or low blood sugars, or other possible complications. Some people’s needs had changed and care plans had not been reviewed and amended. For example, a person returned from a stay in hospital and required two staff to support them when before they had only needed one staff member. The service were not aware of this and had not planned for the changes in the person's needs. This meant that staff were providing care and meeting needs that had not been fully assessed and planned for.

Management arrangements and systems did not ensure that the service was well-led. Recruitment systems were not always fully implemented to ensure that staff were suitable to work with vulnerable people. Quality monitoring systems were not used effectively, surveys were not responded to and people were not listened to when they made complaints. Record keeping was poor; records were out of date and contained errors and omissions.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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