Archived: London Care-Crayford

About the service

London Care-Crayford is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection, 270 people were using the service.

Not everyone who used the service received personal care. 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

People benefitted from an improved service. However, some staff were not provided with enough time to travel between calls at evenings and weekends. We have made a recommendation about the deployment of staff.

People were kept safe from avoidable harm and were cared for by staff who were well-trained and understood how to protect them from abuse. Staff were knowledgeable about safeguarding vulnerable people and knew how to raise any concerns.

Risks to people’s safety had been assessed and documented and staff understood their roles keeping people safe.

People received support with their medicines, from staff who were appropriately trained and assessed as competent in this area.

People were overwhelmingly positive about the care they received from a regular staff team who knew people well. Staff supported people in a caring and dignified way, and promoted people’s independence.

Staff understood their responsibilities for good record-keeping and used the provider’s electronic record keeping system, which managers monitored in real-time, reducing the risk of errors.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 January 2020) and there were multiple breaches of regulation. The provider had 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

We carried out an announced comprehensive inspection of this service on 29 May 2019. Breaches of legal requirements were found and a Warning Notice was served in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the inspection to show what they would do and by when to improve their complaints handling, the effective deployment of staff, and the governance of the service.

We carried out an announced targeted inspection of this service on 05 December 2019 to check whether the Warning Notice we had served at the last inspection had been met. We found that the service was still in breach of that regulation.

We undertook this focused inspection to check they had followed their action plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved 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-Crayford 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-Crayford is a domiciliary care agency that provides personal care to older adults, adults with physical disability or mental health needs living in their own homes or flats. At the time of this inspection 238 people were using the service.

People’s experience of using this service

People and their relatives could not always access important information about the care and support. People informed us they did not always have a rota and did not know which care worker was planned to support them at what time. Relatives said they did not have access to daily notes about the care and support delivered, therefore, they could not always monitor and confirm the care and support delivered was in line with the care and support planned for. Handwritten records were not always readable and consistent including medicines records and consent forms.

Some people told us they continued to experience late calls and. Where two staff were required to support people, both staff were not always arriving at the same time. People continued to experience poor care and support during staff absences and some people said they did not have regular staff supporting them or their loved ones.

People said verbal complaints about staff attendances were not always addressed effectively. The provider’s quality assurances system did not identify all the shortfalls we found.

However, other people said they felt the service had improved slightly and they no longer experienced missed visits. The planning of staff rotas had improved. Records showed that where people required two staff to support them, both staff were planned to start and finish the visit at the same time. Travel time was planned in-between visits and care workers were no longer planned to deliver single visits in between double-up visits.

There was an electronic call monitoring system in place, but this had not been operated continuously over a sustained period of time to evidence its effectiveness and impact on the quality of care people received.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Care-Crayford on our website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was requires improvement (published 22 July 2019).

Why we inspected

We carried out an announced targeted inspection of this service on 5 December 2019, to follow-up on a warning notice served on 20 June 2019 for the breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this targeted inspection to check the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Question Well-led which contain those requirements of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

This targeted inspection does not change the ratings of the previous comprehensive inspection of the service. Therefore, the overall rating for the service remains requires improvement.

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.

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 put at risk of receiving unsafe care and support because staff were not always deployed effectively and the systems in place were not operated effectively to ensure staff delivered safe care and support. Complaints were not always handled in line with the provider’s policy and records including care plans and medicines records were not always managed safely.

People were supported to take their medicines safely, but records were not always maintained. The service worked in partnership with health and social care services but did not always follow their recommendations to improve.

People were protected from the risk of abuse and avoidable harm. Lessons learnt from accidents and incidents were used to prevent reoccurrences. Staff followed appropriate infection control practices and robust recruitment checks were carried out for staff before they started working at the service.

Before people started using the service their needs were assessed to ensure they could be met. People received care and support from staff who were supported through training and supervision. People were supported to access healthcare services and eat healthily. 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 were supported by staff that were kind, caring, respected their privacy and dignity and promoted their independence. People and their relatives were involved in making decisions about the care and support they received. Staff understood the Equality Act and supported people in a caring way.

People were supported to participate in activities that interest them. People’s communication needs had been assessed and met. Feedback from people was gathered to improve on the quality of the service. The management team understood their responsibility to be honest open and transparent with people when things went wrong.

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

Rating at last inspection (and update) – The last rating at this service was requires improvement (Report published 3 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection telling us what they would do to improve the service. At this inspection we found enough improvements had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the ‘Safe’, ‘Responsive’ and ‘Well-led’ key question sections of this full report.

Enforcement: We have identified breaches in relation to deployment of staff, handling of complaints, management of records, maintaining effective systems and processes to monitor the quality and safety of the service and to drive improvement.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The service had 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.

At our comprehensive inspection on 15 and 16 May 2017, we found breaches of legal requirements in relation to safe care and treatment and good governance. At this inspection we found that some improvements had been made. However, systems introduced to improve staff punctuality were not always effective due to poor staff rostering and people continued to experience late and missed calls.

At this inspection we found further breaches of legal requirements in relation to the deployment of staff and the systems in place to monitor the quality and safety of the service were not always effective in driving improvements.

The provider had a complaints policy and procedure in place which included guidance on what people should expect in response to any concerns or complaints raised. formal complaints were dealt with appropriately; however, people were not satisfied with how verbal complaints were dealt with. Medicines were administered as prescribed by healthcare professionals; however, they were not always recorded as administered on people’s medicines administration records as expected.

The provider sought feedback from people and relatives through regular monitoring visits, telephone quality checks and an annual survey to ensure the service was meeting people’s needs. The last survey conducted in July 2017 showed people had been experiencing positive outcomes; however, they had identified areas for improvement in relation to communication with office staff and staff punctuality. The provider had systems in place to continuously learn and drive improvement.

Risks to people had been identified, assessed, and appropriate management plans were in place to reduce or prevent the risk of harm. Where accidents and incidents occurred, they were recorded appropriately and investigated. Senior staff reviewed incident records and the lessons learnt were used to prevent future occurrences.

There were robust recruitment practices in place to ensure pre-employment checks were completed before staff started working at the service. The provider had policies and procedures in place to protect people from the risk of abuse. Staff knew their responsibilities and had reported appropriately to the local authority and CQC where there had been concerns about abuse. People were protected from the risk of infection because staff followed the provider’s infection control procedures.

Before people started using the service, they were assessed to ensure the service could meet their needs. People were supported to eat and drink sufficient amounts for their health and wellbeing.

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. Staff knew of the importance of the Mental Capacity Act 2005 (MCA) and how it applied to their roles.

Staff were supported through induction, training, supervision and appraisals to ensure they had the knowledge and skills required to perform their roles effectively. The provider liaised with other health and social care professionals to ensure people received consistent, joined-up care and support. Where required, people were supported to access healthcare services for safe care and treatment.

People were treated with compassion and provided with choice. People’s privacy and dignity was respected and their independence promoted. People were consulted about the care and support that was put in place for them to ensure it met their needs. People were provided with information about the service so they knew the types of services available and the standard of care to expect.

People’s needs had been assessed and care plans developed to ensure appropriate guidance was in place for staff to meet their needs. People were stimulated with conversations and things that interested them and supported to access the local community and attend day centres. The provider adhered to the Equality Act and staff understood people’s diverse needs and supported them without discrimination.

There was a clear staff and management structure in place and staff knew their roles and responsibilities. The provider worked in partnership with key organisations such as the contract and commissioning teams and healthcare professionals to plan and deliver an effective service.

In July 2016 London Care Limited were awarded a contract to be one of three main home care providers in Greenwich. London Care Limited took over some care packages from Care Matters and MiHomecare in Greenwich. They also joined up with Kent Social Care Professionals Ltd – Bexley SCP. London Care moved to the Crayford office in April 2017 and was registered with the CQC on 28 April 2017. This was the first inspection of London Care-Crayford. This inspection was prompted by concerns raised by the local authorities that commission services from the provider. These concerns related to late and missed calls and a data protection incident.

At this inspection we found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014 in relation to safe care and treatment and good governance. Some people were not receiving care and support in a safe way in line with their assessed needs. The provider's out of hour’s system was not operating effectively at the time of this inspection. Some people using the service were not receiving their care on time and they were not contacted by the office to advise them when staff would be late. Some staff said that the on call system at the weekend did not always work and they did not always receive support from management or the office staff when they needed it. You can see what action we told the provider to take in relation to the above breaches at the back of the full version of the report.

We found that the provider had action plans in place for making improvements at the service and to ensure that people using the service would receive their packages of care when they were supposed to. The branch managers confirmed that there had been no missed calls since the service was registered with the CQC on 28 April 2017. We were not able to fully assess the impact of the provider’s action plans on people's care at the time of inspection as they were newly implemented and had not been completed. We will check on this at our next inspection.

The provider had policies and procedures in place relating to confidentially and data protection. Information on these topics was available for staff in the care workers code of practice. Staff we spoke with told us they were aware of these procedures, they were aware of the recent incident and had been reminded by managers about the importance of protecting people’s personal information. We found that appropriate action had been taken by the provider prior to and following the data protection incident.

The service had a registered manager in post. The registered manager was not present during 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 and associated Regulations about how the service is run. The regional manager told us the registered manager was leaving and one of the two branch managers would be applying to the CQC to become the registered manager for the service. The other branch manager would continue to support the new registered manager in running the service.

The provider had appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Procedures were in place to support people where risks to their health and welfare had been identified. Appropriate recruitment checks took place before staff started work.

The branch managers and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they had received training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.

People were provided with appropriate information about the service. People and their relatives said staff were caring and helpful and their privacy and dignity was respected. They had been consulted about their care and support needs and care plans were in place that provided information for staff on how to support them with these needs. There was a matching process in place that ensured people were supported by staff that had the experience, skills and training to meet their needs. People were aware of the complaints procedure and said their complaints would be listened to, investigated and action would be taken if necessary.

The provider recognised the importance of monitoring the quality of the service provided to people. They carried out unannounced spot checks to make sure people were being supported in line with their care plans.