Romford

This service is a domiciliary care agency based in the London Borough of Havering. The service provides personal care to adults in their own homes. 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.

The service was supporting 16 people with personal care at the time of the inspection.

People’s experience of using this service and what we found

Risk assessments had been carried out to ensure people received safe care. Pre-employment checks such as references had been sought to ensure staff were suitable to support people. Systems were in place to monitor staff time-keeping and prevent infections.

Staff had completed essential training to perform their roles effectively. Reviews had been carried out to ensure people received personalised support and care. The staff worked well with external health care professionals. People were supported with their needs and accessed health services when required.

Quality assurance systems were in place to identify shortfalls and take prompt action to ensure people always received safe care. Feedback was sought from people and relatives to make improvements to the service.

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 previous rating for this service was Requires Improvement (published 30 May 2019) and there were breaches of regulation. CQC had issued requirement notices for Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

We undertook a focused inspection to review the key questions of Safe, Effective and Well-Led to check if the service was compliant with the requirement notices issued at the last comprehensive inspection and to see if improvements had been made.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Romford 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.

The service is based in the London Borough of Havering. The service provided personal care to adults living in their own homes and also at a supported living site. At the time of our inspection, the service provided personal care to 22 people.

People’s experience of using this service:

Risks were not always robustly managed. We found care plans did not contain suitable and sufficient risk assessments to effectively manage risks to people. This placed people at risk of not being supported in a safe way at all times. Care plans were not person centred as plans did not included changes in people’s circumstances. Reviews of care plans were not effective as this had not captured the change in people’s circumstances. Audits had not identified the shortfalls we found during the inspection.

The service prompted people to take their medicines. However, we found topical cream administration had not been recorded. Incidents had not been reviewed effectively and lessons not learnt to minimise risk of re-occurrence. We made a recommendation in these areas.

Staff had completed essential training to perform their roles effectively. The staff worked well with external health care professionals and people were supported with their needs and accessed health services when required.

People continued to receive care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

We identified two breaches of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response can be found on the bottom of the full report.

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

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 18 May 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Previous Breaches:

At this inspection, sufficient improvement has not been made and the provider is still in breach of regulations specifically with Regulation 12 (Safe Care and Treatment) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) 2014

Why we inspected:

This was a planned inspection based on the rating of the last inspection.

Follow up:

We will speak with the provider prior to 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 any concerning information is received, we may inspect sooner.

The 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. At the time of our inspection, the service provided personal care to nine people in their homes. This was the first inspection of the service since it registered with the CQC.

The service 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run. The registered manager was not available on the day of the inspection and the director supported us with the inspection.

Risks were not always robustly managed. We found care plans did not contain suitable and sufficient risk assessments to effectively manage risks. This placed people at risk of not being supported in a safe way at all times.

The director told us they only reminded people to take their medicines. Assessments had been carried out on how to support people with medicines. However, there were discrepancy on one person's medicine records on the level of support they would require.

Staff had been trained to perform their roles by the provider’s in-house trainer. However, the qualification held by the trainer was not recent. Therefore important updates on certain areas may not have been covered when training was delivered.

Pre-assessment forms had been completed in full to assess people’s needs and their background before they started using the service. However, regular reviews of people’s care had not been carried out and care plans had not been updated when a person’s condition had changed. Some care plans did not include the support people would require in relation to their current circumstances. We made a recommendation in this area.

Effective quality assurance systems were not in place. Spot checks had been carried out to observe staff performance. However, aside from the spot check audits, no other audits such as checking care plans and risk assessments had been carried out that may have identified the shortfalls we found during the inspection. Therefore necessary action was not always taken to rectify them.

People and relatives were positive about the regular carers that supported people. However, some people and relatives raised concerns in relation to staff attitude when supporting people and the knowledge of carers that provided cover for people’s regular carers.

Accurate and complete records had not been kept to ensure people received high quality care and support.

Staff were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally.

Pre-employment checks had been carried out to ensure staff were suitable to provide care and support to people safely.

There were arrangements in place to ensure staff attended care visits on time. Staff told us they had time to provide person centred care and the service had enough staff to support people.

Staff had received training on the Mental Capacity Act 2005 (MCA) and staff were aware of the act. Consent had been obtained from people for the service to support them with personal care.

People were being cared for by staff who felt supported by the management team.

People had access to healthcare if needed.

People’s privacy and dignity were respected by staff. People and relatives told us that most staff were caring and they had a good relationship with them.

Staff, relatives and people were positive about the management. People’s feedback was sought from surveys.

We identified three breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk assessments, training and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.