Archived: Careworld London Limited

Updated 14 August 2019

The inspection:

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

The inspection was prompted in part by anonymous information of concern received in February 2019 in relation to safeguarding concerns and quality issues. We shared this information with the local authorities who had also found a number of quality concerns during their own monitoring visits related to unsafe medicines management, missed visits and poor governance. We followed up these concerns during this inspection.

Inspection team: This consisted of three inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of service.

Service and service type: Careworld London Limited is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people, younger disabled adults and children. At the time of the inspection the service was supporting 327 people in the London Boroughs of Hackney, Newham and Tower Hamlets. Not everyone using Careworld London Limited receives a 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 manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: The inspection was unannounced. The provider was aware that we would be returning after the first day to complete our inspection.

Inspection activity started on 5 March and ended on 25 March 2019. We visited the office location on 5, 6 and 7 March 2019 to see the registered manager, office staff and to review care records and policies and procedures.

What we did:

Before the inspection we reviewed the information the CQC held about the service. This included notifications of significant incidents reported to the CQC. We looked at the previous inspection report and the action plan the provider submitted after the previous inspection. We also spoke with the local authority safeguarding and commissioning teams and used their feedback to inform our planning.

During the inspection:

• We reviewed 21 people’s care plans and medicines records

• 16 staff recruitment files

• Staff rotas and electronic call monitoring (ECM) data

• Complaints and safeguarding investigations

• Audits and records related to the management of the service

• We looked at a variety of policies and procedures developed and implemented by the provider

• We spoke with six staff members. This included the registered manager, the head of operations, the operations manager, the human resources manager and two care coordinators. We also spoke with an external consultant that had been recruited by the provider after the local authorities had highlighted concerns at their February 2019 visits

• We called 82 people using the service and managed to speak with 22 of them and 21 relatives

After the site visit, we contacted 60 care workers but only heard back from 11 of them. We also contacted seven health and social care professionals who worked with people using the service for their views and feedback.

Updated 14 August 2019

About the service: Careworld London Limited is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults, younger disabled adults and children. At the time of the inspection the service was supporting 327 people in the London Boroughs of Hackney, Newham and Tower Hamlets.

People’s experience of using this service:

¿ Poor practice and ineffective governance systems had resulted in people missing visits and receiving late care calls, which had not been followed up. One person said, “They come at different times and don’t stay the full time. A lot of the time they don’t turn up. I’m constantly having to chase it up and never get a call back.”

¿ The service had ineffective systems in place to protect people from harm. The assessment of risk and medicines management across the organisation was inadequate. Advice and best practice guidance that we had shared with the provider at the previous inspection had been ignored.

¿ People were put at risk as the management team lacked clear oversight and knowledge of what was happening across the service. People continued to receive support from staff who had been suspended pending safeguarding investigations.

¿ The quality of care people received had deteriorated since the previous inspection.

¿ The culture of the service lacked openness, honesty and transparency. The management team were dishonest and provided inaccurate information, which placed people at harm as serious incidents were not acted upon.

¿ People and their relatives highlighted how the lack of communication impacted upon the service they received. One person said, “I call them and they never respond. It is now over a week since they were supposed to call and they haven’t.”

We found three continuing breaches of regulations in relation to safe care and treatment, good governance and notifiable incidents. We found two new breaches of regulations in relation to safeguarding people from abuse and improper treatment and failure to display their ratings. You can see what action we told the provider to take at the end of the full version of this report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (Report published 9 October 2018).

Why we inspected: This was an unannounced focused inspection due to information of risk and concern we had received. At the previous inspection, we found breaches of three regulations and served two warning notices.

Enforcement: We have kept this service under review while we took action to cancel the providers registration as a result of breaches in regulations resulting in people receiving inadequate care.

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