Vincentian Care Plus

Vincentian Care Plus is a domiciliary care agency providing care and support to people living in their own homes in the Westminster area of London. At the time of our inspection there were 117 people using the service of which 100 were receiving support with personal care tasks. Whilst we have taken into account any wider social care and support provided to people in their homes and in the community, the Care Quality Commission (CQC) carried out this inspection only in relation to the regulated activity of 'personal care'.

At our previous inspection of Vincentian Care Plus on 8, 9 and 14 May 2018 we identified continued breaches of the regulations in relation to safe care and treatment and governance. We found further breaches of the regulations in regard to safeguarding, staff training and failure to adequately display CQC ratings. The service remained in special measures because we rated the service ‘inadequate’ in the Well-led domain. We issued a warning notice in relation to poor service governance and rated the service ‘requires improvement’ overall. You can read the report from our previous inspection, by selecting the 'all reports' link for Vincentian Care Plus on our website at www.cqc.org.uk.

Following the previous inspection, we asked the registered provider to send us an action plan setting out how they intended to improve the quality of the service and meet legal requirements. We received the provider’s plan of action on 29 June 2018 stating that improvements would be achieved by the end of July 2018.

At this inspection we found the registered provider had made significant improvements to how the service was managed and how care and support were delivered.

A registered manager was in post at the service. 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.

People told us they felt safe and were supported by kind and caring staff.

Where possible, people were involved in decisions about their care. Where appropriate, relatives and healthcare professionals contributed to the care planning process.

Staff supported people to make their own decisions and sought consent before delivering care and support.

The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss.

Risks in relation to people’s safety were addressed and reviewed through the implementation of a robust risk assessment process.

People's medicines were managed safely. Staff completed medicines administration records and these were returned to the office for auditing purposes.

Staff supported people to attend healthcare appointments as required and liaised with people’s relatives, GPs and other healthcare professionals to ensure people’s needs were met appropriately.

Staff were following correct infection control procedures and had access to disposable gloves and aprons.

People were supported to eat and drink where this formed part of an agreed package of care.

Staff told us they would speak to a manager, health and social care representatives and CQC if they had concerns about a person’s health, safety or welfare.

Recruitment practices ensured the right staff were recruited to support people to stay safe. There were enough staff deployed to meet people’s assessed needs.

The provider had systems in place to ensure people being supported with shopping tasks were protected against financial abuse.

People and their relatives felt able to raise concerns and were provided with information about the provider’s complaints procedures.

Quality assurance procedures were effective. The registered manager and her team had a good oversight of the service and were committed to continuous service improvement in order to achieve good outcomes for people using the service and their relatives.

We made one recommendation in relation to communication policies and procedures.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Vincentian Care Plus is a domiciliary care agency providing care and support to people living in their own homes in the Westminster area of London. At the time of our inspection there were 155 people using the service of which 138 were receiving support with personal care tasks. Whilst we have taken into account any wider social care and support provided to people in their homes and in the community, the Care Quality Commission (CQC) carried out this inspection only in relation to the regulated activity of 'personal care'.

At the time of our inspection the service did not have 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A service manager responsible for the day to day running of the service had been in post since 5 March 2018 and was therefore relatively new to the service.

At our previous inspection of Vincentian Care Plus on 11 and 14 August 2017, we identified continued breaches of regulations in regards to person-centred care, safe care and treatment and good governance and the service was rated inadequate overall. You can read the report from our last inspection, by selecting the 'all reports' link for Vincentian Care Plus on our website at www.cqc.org.uk.

Following the last inspection we issued two warning notices in relation to good governance and safe care and treatment. We asked the registered provider to send us an action plan setting out how they intended to improve the quality of the service and meet legal requirements. We received the provider’s plan of action on 18 October 2017 stating that improvements would be made by December 2017.

At this inspection we found the registered provider had made some improvements in relation to late and missed visits. However, we identified continued breaches of the regulations in relation to safe care and treatment and good governance. We found a further breach of the regulations in regards to safeguarding, staff training and failure to adequately display CQC ratings. 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.

People and their relatives continued to express frustration with the way the service was managed.

People and their relatives didn’t always feel that staff were equipped with the training, skills and experience required to support people with specific healthcare needs.

Risks in relation to people’s safety were not always being addressed through the implementation of a robust risk assessment process.

People told us they felt safe when being supported by regular members of care staff. However, people were less complimentary about the service received from staff they were not familiar with.

People's medicines were not always being managed safely. Medicine records were not always completed correctly. Explanations for recording omissions were not adequately addressed through the provider’s auditing processes.

The provider was not always ensuring people being supported with shopping tasks were protected against financial abuse.

Quality assurance procedures were ineffective. We identified multiple shortfalls in the way the provider implemented and operated auditing systems.

Where possible, people were involved in decisions about their care and how their needs would be met. Where appropriate, relatives and healthcare professionals contributed to the care planning process.

Staff had completed training in aspects of mental health legislation. Staff supported people to make their own decisions and sought consent before delivering care and support.

People were supported to eat and drink where this formed part of an agreed package of care.

The provider had safeguarding policies and procedures in place. Staff told us they would speak to a manager if they had concerns about a person’s health, safety or welfare.

The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss.

Staff supported people to attend healthcare appointments as required and liaised with people’s relatives, GPs and other healthcare professionals to ensure people’s needs were met appropriately.

Staff were following correct infection control procedures.

Recruitment practices ensured the right staff were recruited to support people to stay safe. There were enough staff deployed to meet people’s assessed needs.

People and their relatives felt able to raise concerns and were provided with information about the provider’s complaints procedures.

We rated the service inadequate at our previous inspection in August 2017. At this inspection we rated the service ‘requires improvement’ overall. The service remains in ‘special measures’. This is because the service is still rated 'inadequate' in the Well Led domain.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We are considering what further action we are going to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 11 and 14 August 2017 and was announced. We told the registered manager 48 hours before the inspection that we would be visiting. This was to ensure the registered manager would be available to take part in the inspection.

At the previous comprehensive inspection on 14 and 15 July 2016 we identified breaches of regulations in regards to person centred care, safe care and treatment, good governance, staffing and notifications. We made one recommendation in relation to medicines management. We rated Vincentian Care Plus as requires improvement overall. We asked the registered provider to send us a plan to tell us what they would do to meet legal requirements. The plan detailed what actions the registered manager and staff would take to meet legal requirements. You can read the report from our last inspection, by selecting the 'all reports' link for Vincentian Care Plus on our website at www.cqc.org.uk.

At this inspection we followed up on the breaches of regulations to see if the registered provider had made improvements to the service. We found that the registered provider had taken some action to meet the regulations. The improvements we found were in relation to staffing and notifications.

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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found people were at risk because the service did not have effective systems in place to manage missed and late visits. During and after the inspection we requested a log of missed and late visits but at the time of writing this report this was not received as requested. There was a system for people using the service and staff to contact a manager outside of regular office hours. However, people using the service and staff said that their call was not always answered when they contacted the out of hours telephone number.

People were at risk of not receiving their medicines safely because there were not effective systems in place to monitor and audit medicine administration. The registered manager did not have systems in place to ensure that people had their medicines as prescribed in a safe way.

The service did not have effective systems in place to ensure that care records were accurate and up to date. We found that people’s care records contained gaps in them and were not always updated. People had an assessment of their needs before using the service. Care reviews of people’s health care needs were completed on a regular basis. However we found following a review, people’s care plans were not updated to reflect changes in need or level of service. This meant that people’s care records did not always reflect their current needs.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. The registered manager and staff did not understand the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Records showed that a person’s medicine was hidden within their home and appropriate steps had not been taken to assess their capacity to make this decision and to ensure that the decision was made in their best interests.

People had the opportunity to provide feedback about the service. People provided mixed views about the service and the quality of the care they received. The registered manager had not taken action to manage the concerns raised by people.

People said that their regular care worker was caring and understood their needs. They commented that they were treated with dignity and their privacy respected when they were receiving care and support.

Risks to people’s health and wellbeing were assessed. There was a plan in place for the identified risks and guidance for staff to manage them. Staff understood the registered provider’s safeguarding procedures and knew what action to take if a person using the service was at risk of abuse or harm.

People were supported by health care services. When people’s care and support needs changed staff sought appropriate advice from health and social care professionals.

People gave their consent to the care and support provided. A relative gave consent on behalf of their relative if they were unable where they had the legal authority to do this.

There were effective systems in place for people to make a complaint. The registered manager dealt with complaints about the service. We saw records that showed the registered manager had acted on complaints and responded appropriately.

People had meals that supported their requirements and personal choices and preferences. Staff completed shopping and meal preparation for people as required.

Staff had support from the registered manager. Staff completed an induction, supervision, training and appraisals on a regular basis. Staff had the opportunity to discuss their personal and professional development needs. These were recorded and the registered manager supported staff to achieve self-identified goals.

The registered provider ensured there were enough staff deployed. This ensured people received their care and support from a member of the care team as required and in line with the care assessment. The registered provider followed robust recruitment processes. This ensured suitable staff were employed to provide care and support to people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We identified continued breaches of regulations in regards to person centred care, safe care and treatment, and good governance. We are considering what further action we are going to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Vincentian Care Plus is a domiciliary care agency providing care and support to people living in their own homes. There were 157 people using the service at the time of our inspection. At the last inspection which took place on 1 July 2014, the service was meeting all of the regulations we checked.

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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

In September 2015, the provider was awarded a local authority contract to provide domiciliary care for people living in the London borough of South Westminster. After an initial period of transition and a number of issues relating to missed visits, and electronic logging in/out systems, the service continues to grow, currently providing over 2000 hours of care and support on a weekly basis.

The Director of care and the registered manager were aware that updated systems and new ways of working need to be established and embedded into practice to ensure the continuous delivery of safe and appropriate support to people using the service. The registered manager told us, “It has been a bit turbulent, there have been lots of changes and changes of staff, this has impacted on the things we do.” Staff recruitment is ongoing.

The service received the majority of its referrals from health and social care professionals working in the local community. This information was used to inform and develop care plans in consultation with people, their family members (where appropriate) and senior staff members.

Where possible, initial assessments were completed before a package of care was organised. Care plans recorded people’s health care needs and included contact details, information relating to personal care, medicines, communication and nutritional needs. However, we noted that reviews of people’s health care needs were not carried out with sufficient frequency to ensure people were kept safe and their health and well-being promoted.

Risk assessments were either not in place or had not been fully completed in all of the care records we looked at. Where risk assessments had been completed appropriately these covered a range of issues including people’s home environments, moving and positioning, equipment and mobility. For example; these included details about how people mobilised and whether they required walking aids, the support of another person or were independent. However, not all risk assessments had been reviewed and/or updated in line with the provider’s policies and procedures.

Where appropriate, specialist advice and support had been sought in relation to meeting people's needs and this advice was included in care plans. We saw advice from re-enablement teams, district nurses and community mental health teams was included in people’s care records. However, staff were not always aware of or following this advice.

Where staff were responsible for prompting people’s medicines, staff had completed training in medicines administration. However, we found that effective systems were not in place to ensure the administration of medicines was always recorded in a safe and consistent manner and regularly monitored for potential errors or omissions. The director of care emailed us following our visit to demonstrate that staff had been notified of changes to the way medicines administration or prompting should be recorded in people’s daily logs.

Staff had a good understanding of safeguarding procedures and knew what steps they would take if someone was at risk of abuse or harm. Despite this, the provider was not always notifying the Care Quality Commission (CQC) of serious safeguarding incidents which should have been reported to us in line with the provider’s registration requirements.

CQC monitors the use of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of the principles of the MCA and how this might affect the care they provided to people. Staff we spoke with understood what the MCA is designed to do and were able to describe how they supported people to make decisions.

People were asked (where possible) to provide their consent to the support being provided. Where people were not able to consent, we found that care records had been signed by a manager or a family member.

Most people felt able to make a complaint if they needed to and knew how to do so. Staff were aware of their responsibilities regarding reporting any complaints, accidents and/or incidents and systems were in place to record these.

There were protocols in place to respond to any medical emergencies or significant changes in a person’s health and well-being. When required, staff supported people to attend health appointments.

Staff were aware of people’s specific dietary needs and preferences and people received the level of support they required to have enough to eat and drink. Some staff told us they had completed training in food preparation and hygiene.

The provider sought feedback from people using the service. However, this was not done on a regular basis and some people had not been asked about the care they received for over 12 months.

Staff supervision and appraisal was not always taking place in line with the provider’s policies and procedures and neither were staff meetings organised regularly enough to provide staff with a forum to discuss service improvements, learning and development opportunities; share good practice approaches and/or discuss any concerns they may have.

The provider had policies and procedures in place for the recruitment of new staff. Most of the people we spoke with expressed positive views about the care staff. People told us they felt safe and were supported by staff who treated them with dignity and respect.

We identified breaches of regulations in regards to safe care and treatment, person centred care, good governance and notifications and made one recommendation in relation to medicines management. You can see the action we have told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. We found people were supported appropriately and sensitively. People told us they felt safe. We found sufficient staff were available to deliver people's care needs and they received the training needed to provide appropriate care and support.

Is the service well led?

People we spoke with, staff and most relatives were very positive about the management of the service. Staff told us they felt supported by the manager. One staff member told us, 'It is a vocation for them (the managers). They are available 24/7 and really care about what they do.'

Is the service effective?

People's health and care needs were assessed with them. We saw evidence to show people were always involved in writing and agreeing their care plans. Specialist dietary and healthcare needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support needed.

Is the service responsive?

We saw there was an effective complaints procedure in place. On person told us, 'The managers are wonderful. I can phone them anytime and they always listen to me and sort things out. I can't fault them.'

Is the service caring?

We found people were supported by kind and considerate staff. We spoke with staff who told us about how they provided care and support. People we spoke with were very positive about the caring nature of staff members supporting them. One person told us, 'My carer is an angel. She always goes the extra mile and I don't know what I'd do without her.' A relative told us, 'The carer is really good with (my relative). She always protects (their) dignity when providing personal care.'

We saw the provider offered a befriending service to people who required extra support.

Each person's care package and their needs were regularly reviewed and updated in line with the agency's own guidelines. People and/or relatives we spoke with confirmed carers carried out different tasks in line with what they had asked for.

Vincentian Care Plus had clear protocols in place to protect a person's safety and welfare when co-operating with more than one stakeholder who was involved in a person's care or when they moved between services.

People we spoke with and/or their relatives said they knew how to raise a complaint if they needed to.