Archived: Cera - London

Cera London is a domiciliary care agency. It provides personal care to a range of adults living in their own homes with a broad range of physical, mental health and learning disability 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. At the time of the inspection there were 81 people receiving a service that is regulated by CQC.

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

Most people and their relatives told us staff were kind and caring. However, issues of lateness, difficulties with contacting office staff, and the management of complaints were identified as issues for a significant number of people and their relatives.

The service had undergone significant changes in the last 18 months as the provider had acquired and integrated another local domiciliary care organisation. This meant a number of staff and people using the service were integrated into the new branch and management structure.

Over the past 18 months there had been significant changes in management of the service at a regional director and branch level. This had impacted significantly on the quality of care and management of the service. Although a new manager was in post and had recently acted quickly to address immediate concerns, we still found serious concerns with the management of the service. The new manager was expected to manage two domiciliary care branches despite the issues with quality we identified at this inspection.

Risk assessments did not always provide staff with suitable guidance to keep people safe. Audits of medicines had not always taken place in a timely manner and this impacted on actions to remedy errors. We were not confident that all medicines were safely managed.

Whilst the provider had systems in place to check the quality of care, we found remedial action had not always taken place. We were not confident that all complaints were followed up and resolved.

Care plans were person centred and the majority portrayed a holistic picture of people’s lives, their needs and their network of support.

Supervision, training and spot checks of staff took place.

Staff recruitment was safe, and appropriate checks were taken prior to staff starting work.

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

This service was last inspected under the name of Waterloo Care Services (provider Cera Care) and rated good. The report was published on 2 December 2019.

Since the last inspection the provider has taken ownership and integrated another existing domiciliary care service. This means some staff and people from that service have been integrated and receive care from the new service, now called Cera London.

The inspection was prompted in part due to concerns received about safeguarding allegations, and lack of consistency in the management of the service. A decision was made for us to inspect and examine those risks.

At this inspection we found breaches of the regulations in relation to the governance of the service and the safe care and treatment of people. We have also made a recommendation in relation to compliance with use of PPE.

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.

Waterloo Care Services is a domiciliary care service providing care and support to people in their own homes. At the time of the inspection there were 37 people receiving personal care support.

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

At the last inspection, we made some recommendations about staff recruitment and the quality assurance checks that were in place. At this inspection, we found improvements had been made in these areas.

There was inconsistency in some of the recording we saw in relation to risk assessments that had been completed for people. We found the risk to people’s safety was minimal as the steps that staff needed to manage the risk was included in the care plans. We have made a recommendation about this and will follow this up in the next planned inspection.

People using the service and their relatives did not have any concerns about safety, telling us they felt safe. New carers were vetted appropriately before they were recruited. People received their medicines as prescribed. Care workers followed appropriate infection control guidelines.

Care workers received a thorough induction and ongoing refresher training which meant they were able to carry out their roles effectively. The provider carried out supervisions and spot checks which helped to ensure care workers were competent. An assessment of needs was completed before people began to receive a service which meant their needs, including any assistance they needed with eating, drinking and their general health were met. People, and if appropriate their relatives were involved in planning and consenting to their care.

People told us care workers were friendly and caring, who supported them to maintain their independence and respected their privacy. People’s wishes about how they wanted to be cared for were included in the care records and the provider sought feedback from them to ensure their needs continued to be met and they were happy with the service.

Care plans were person centred and reflected people’s needs, they were reviewed on a regular basis. Where people had specific communication or end of life care needs these were included in care records. People and their relatives were encouraged to raise any concerns and any complaints received were investigated thoroughly.

The provider encouraged an open culture which included learning lessons from any complaints or incidents and accidents that had occurred. Quality assurance checks were in place to monitor the quality of service, these included feedback surveys from people and staff and mock CQC inspections. The provider worked with a number of local and national organisations to provide better outcomes for people.

Rating at last inspection

The last rating for this service was Requires Improvement (published 25 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

This inspection was at short notice, which meant the provider and staff did not know we were coming until 48 hours before we visited the service. This inspection took place on 18 and 21 May 2018 This was the first inspection of the service since initial registration in December 2016.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and a small number of younger adults living with a disability or long-term health condition.

Not everyone using Cera receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, taking medicines and eating. Where they do we also consider any wider social care provided.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the 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.

We noted improvements were required to obtaining verification of staff experience and references that demonstrated the previous experience that staff claimed to have. The provider informed us of the immediate action they had taken in response to this, which included removal of staff experience and qualifications from care staff profiles if these could not be verified.

The provider’s policy was to accept previous DBS checks for new staff if these had been undertaken within three months of staff commencing work with the agency. This was taking place.

Staff told us they received training to support them with their role when they joined the service and on a continuous basis, to ensure they could meet people’s needs effectively. Staff training records confirmed this and there was an emphasis on staff obtaining the Care Certificate. The provider’s staff supervision records were hard to follow and we have recommended that action is taken to address this. Clarification was required regarding staff understanding of supervision, which the provider informed us was being acted upon because of our feedback during this inspection.

There was a potential risk we identified in respect of staff who lived on site with the people they cared for. This risk was associated with care staff, in one case, feeling that breaks were not sufficient and they were sometimes tired. We raised this with the provider as although no negative impact upon people had resulted it was evidently a matter for pre-emptive consideration.

The provider started operating in 2016 and it has made technological innovation a core factor in service delivery. A digital platform is used which enables care staff to record care visits which can be used immediately and which people using the service can access. Similar technology is used in other areas of the service and there are plans to widen technological use to further record visit data and to introduce artificial intelligence to assist care staff and people using the service.

People using the service and their relatives told us they felt safe. People were looked after by staff who knew them and gave them the time and attention they required.

Risks associated with people’s care needs were assessed, and the action needed to minimise risks was recorded and were updated regularly. Staff were aware of the potential risks that people may face.

The service complied with the requirements of the Mental Capacity Act (2005) and consultation took place to help protect people’s human rights.

Staff respected people’s privacy and dignity and their individual preferences. The people using the service were from a variety of different cultures and backgrounds, however the majority were white British.

People were encouraged and supported to maintain their independence with no more than the necessary support from staff that was required to help them retain their independence.

People received regular assessments of their needs and the service worked co-operatively with people’s families and other health and social care providers.

People who used the service, relatives and stakeholders had opportunities to provide their views about the quality of the service. The provider worked to ensure that people were included in decisions about their care. People’s views about how the service was run were respected and taken seriously.