Archived: Westminster Homecare Limited (Cheltenham)

Westminster Homecare Limited (Cheltenham) is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection 52 people were supported with their personal care needs.

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

Significant improvements had been made to the service and we found the service had met the breaches of regulation from the last inspection. On this inspection, we found that people’s care was personalised, and their care records provided staff with accurate information about their support requirements and risk management plans. Improved communication and on call arrangements ensured relevant information was appropriately shared between staff. People were supported to retain their independence and be involved in decisions about their care. End of life care processes were available to support people during their final stages of life.

Staff knew how to protect people from avoidable harm and abuse and where to report any concerns regarding people's safety and welfare. Accidents and incidents were reported and monitored for any trends. Safe systems were used to manage people’s medicines. New detailed protocols for ‘as required’ medicines had been implemented. Some people required support with their nutrition and hydration.

Extra control measures had been implemented to help prevent the spread of infection and the coronavirus. People confirmed that staff maintained good infection control practices, wore appropriate PPE and hand sanitation.

People and their relatives all complimented the staff and told us their approach was consistently caring and compassionate. There have been no missed calls since our last inspection and people who used the service stated staff were punctual or they were informed if staff were running late.

Improvements had been made to the training, support and deployment of staff. Staff knew people well and monitor their health. They referred people to healthcare services when their needs changed.

People and relatives told us their decisions and views were always respected. Staff practice complied with the principles of the Mental Capacity Act. 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 services supported this practice. Further training was going to be implemented to upskill senior staff to complete comprehensive MCA assessments around specific decisions.

A new registered manager had been recruited since our last inspection. Staff praised the registered manager for their support and dedication in making improvements across the service. The provider carried out regular quality assurance checks and visits to the branch to ensure the service met their regulatory requirements. The registered manager had a good oversight of the service and completed regular checks and audits to monitor the quality of care being delivered and to receive feedback from people and staff.

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 1 January 2020) and there were multiple breaches of regulation. The provider 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 undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the Key Questions Is the service Safe, Effective 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 changed from requires improvement 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 Westminster Homecare Limited (Cheltenham) 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.

Westminster Home Care is a domiciliary care agency. 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. At the time of the inspection the service was supporting 44 people, 43 of whom were receiving personal care.

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

Systems to protect people from abuse and risk were not always effective. Care visits to people had at sometimes been missed. This had placed people at risk. Some visits were shorter than allocated times which meant some care tasks had not been completed. Where people required two carers to transfer them safely using equipment, these visits were sometimes carried out by one carer. This placed the person and the carer at risk.

Medicines had not always been managed safely. Some people had missed their prescribed medicines administration. Audits to check the safe management of medicines had not taken place which meant any errors would not be identified in a timely manner and put right.

Accidents and incidents had not been accurately recorded therefore the service may not learn from analysing themes and trends.

Staff told us there were not enough of them to cover all care visits. Staff were having to work very long hours to ensure these visits were covered when there was a lack of experienced agency staff.

Staff required mandatory training or refreshers in areas such as safeguarding. One to one supervision, appraisal, competency spot checks and induction reviews were out of date.

Not all care plans had been reviewed within the providers timescales. Quality monitoring of the service being provided and audits had not been completed in a timely manner.

People had care needs assessments undertaken and care plans developed. People told us they had very good regular carers and had built strong relationships with them. Staff told us they enjoyed their work and people were treated with respect and dignity.

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.

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

Rating at last inspection

The last rating for this service was good (published 25 May 2017).

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 sections of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care and good governance of the service, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

At the last inspection in July 2015, the service was rated Good. At this inspection we found the service remained Good.

The registered manager had been absent due to illness. 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 operations manager had been working closely with the quality assurance co-ordinator to manage the service. A new manager had recently been appointed and was applying with CQC to become jointly registered to manage the service. They shared with us their visions and values for the service.

People’s care was individualised and reflected their personal preferences, routines and wishes about how they wished to be supported. People and those important to them discussed their care needs and were involved in reviews of their care and support. Their health and well-being was promoted by highlighting any changes in their needs and liaising closely with health care professionals. When changes were made their care records were updated and staff were informed. Information was provided to people about the service they could expect to receive. Accessible formats, such as audio or easy to read, could be provided if needed.

People were supported by staff who understood their needs well. Staff were kind and caring. They had positive relationships with people and enjoyed the time they had together. Relatives commented how important the social aspect of their visits were as well as attending to people’s care needs. People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice. People were offered choices; staff did not make assumptions and involved people in aspects of their support whenever they could. People’s rights were upheld and staff knew how to recognise and report suspected abuse. Any hazards had been assessed and risks were minimised.

People benefited from staff who had been through a recruitment process which made sure they had the aptitude and skills to support them. Staff had access to a range of training and support to help them develop in their roles. Care was taken to make sure wherever possible people had the same staff supporting them. Their visits were scheduled to fit in with people's lifestyles as far as possible. If staff were late they were informed about this and people knew how to contact the management team if they had a query.

People’s views were sought to help drive through improvements to the service. A range of quality assurance audits monitored the standard of the service provided. Actions identified where improvements were needed and these were monitored to ensure they had been completed. People said, “We really are delighted with the service and are so grateful” and “They are excellent. Very caring. It seems to have got better. They know what they are doing.”

Further information is in the detailed findings below.

People we spoke with said staff treated them respectfully and politely. People told us, "staff are very good, lovely" and "they treat me respectfully, always cheerful". We found that people were given information about the service to help them make choices about the care and support provided.

People's needs were reflected in their care records promoting their wishes and preferences for the way in which they wanted to be supported. One person said, "they are very flexible. I can't fault them at all, an excellent service". Another person told us, "I am so lucky, it's handy if I get regular carers, they get into my routine".

People were protected from the risk of abuse. The provider had taken steps to identify the possibility of abuse and to prevent it occurring. One person told us, "you feel safe with the carers, I am comfortable with them".

People said that staff had a good understanding of their needs. Effective recruitment and selection checks were in place to make sure that staff had the skills, aptitude and competency to support people.

Quality assurance processes provided the opportunity for people and staff to express their views about the service. People told us 'excellent, couldn't ask for better' and 'I am very satisfied, they have been a great help to me, marvellous'.