London Care (Westminster)

London Care Westminster is a domiciliary care agency which provides personal care to people living in their own homes. At the time of our inspection there were approximately 220 people using the service. 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

People told us they were happy with the care and support they received, although on occasions staff arrived "a little late". This feedback reflected our findings which showed staff were frequently not provided with the travel time between visits that they needed.

People's needs were assessed and planned for. However, we found some people were placed at risk by the provider when they did not receive care from two staff members together, as the provider was not following the person's agreed care plan.

People told us they felt safe and comfortable with their care workers. People were supported by safely recruited staff who received appropriate training to carry out their duties.

People felt assured that staff understood how to meet their personal care needs and support them to take their medicines, if this was part of their care plan. People commented on how staff worked in a hygienic way and took suitable action to protect them from the risk of infection.

People and their representatives were asked for their views about the quality of their care and support and they had developed positive relationships with their care workers and the office based staff team.

People were communicated with and consulted in a variety of ways including surveys, telephone monitoring calls and 'spot check' visits from supervisors and managers.

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 6 July 2021).

Why we inspected

The inspection was prompted in part due to concerns received about people's safety and the management

of the service. We received information of concern in relation to whether people received scheduled visits from care staff in line with their agreed care plans, and whether some members of the care staff team had completed their annual mandatory refresher training to enable them to provide safe care and support. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

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

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 good to requires improvement. 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 London Care Westminster on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and good governance at this inspection.

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.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

London Care Westminster is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection there were 184 people using the service.

People’s experience of using this service

People told us they were treated with kindness and respect by their care workers. Comments from people included “I am confident that Mum is being well looked after” and “It's a really well managed organisation.”

There were improved systems for ensuring that people’s medicines were managed safely and that this was checked by the registered manager. People reported that they received their medicines safely and without problems. Staff understood their duties to report suspected abuse and the service acted promptly to safeguard people when abuse was suspected.

People told us they benefitted from consistent care workers who arrived punctually. Staff movements were well planned and monitored effectively using an electronic system. Staff were safely recruited to their roles. Risks to people’s wellbeing were assessed appropriately and action was taken to mitigate risk, including understanding risks from people’s health conditions and ensuring that moving and handling tasks were carried out safely.

The service ensured that staff had access to personal protective equipment (PPE) and used this appropriately to protect people from the risk of COVID-19. Staff adapted to changing circumstances and guidance on infection control. There was a suitable contingency plan to ensure the service could continue to operate and the service monitored the impact of the pandemic on people. People were kept informed through regular communication from the service.

The registered manager ensured the service detected and investigated when things had gone wrong and ensured that lessons were learned as a result, and complaints were investigated openly and honestly.

People’s care was planned and delivered to meet people’s needs. The service worked with local organisations including the local authority to advocate for people and report any concerns about people’s wellbeing.

The service promoted an open, person-centered culture which was respectful and positive about people’s differences, and celebrated staff’s achievements. There were suitable systems to ensure that people received a good standard of care and that managers could detect problems early. Staff reported feeling well supported by their managers and able to access advice or support when they needed to.

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 requires improvement (published 26 July 2019).

Why we inspected

We carried out an announced comprehensive inspection of this service on 24 April 2019 and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve both the management of medicines and systems to assess and monitor the quality of the service.

We undertook this focused inspection at the provider’s request 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 of Safe, Responsive 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 London Care Westminster 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.

London Care (Westminster) is a domiciliary care agency which provides personal care and support to people living in their own homes. It provides a service to older and younger adults, including people living with dementia and people with chronic health care needs and/or a disability. Not everyone using London Care (Westminster) receives 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 consider any wider social care provided. At the time of our inspection the service was providing personal care to 160 people.

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

Although people were supported by staff who had received medicine training, we found care staff did not have comprehensive written information in care files to confirm which medicines they needed to support people to take. This applied where people could independently take their own medicines but needed reminding by staff. We found one medicine record for a person who was being assisted by staff that was difficult to decipher and other medicine records had gaps where staff should have completed an entry. People commented they felt safe with care staff and enjoyed their visits from individuals they had got to know well. People had previously experienced issues in relation to staff reliability but most people and relatives we spoke with stated the service delivery had improved. People were supported by safely recruited staff.

We noted the provider was carrying out audits and had made changes to scheduling practices to promote improvements and better outcomes for people who used the service. However, we found quality monitoring processes had not been sufficiently rigorous enough to ensure people had consistently received a smoothly delivered service. Although some people described the service as having been chaotic at times, people told us they had observed signs of improvement. The provider was working well towards achieving improvement objectives established with the local authority quality assurance team. The provider was open with us about problems the service had encountered last year and earlier this year, due to certain unforeseen circumstances which impacted on the stability of the management and office team. Although some people described the service as having been chaotic at times, people told us they had observed signs of improvement.

People's needs were assessed and their preferences were sought to ensure they received appropriate care. Risk assessments were in place to identify and reduce risks to people's safety and wellbeing. Staff with appropriate training supported people to meet their healthcare needs, and their nutritional needs where this formed part of their care plans. 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. The provider recorded where people had legally appointed attorneys to act on their behalf but the provider did not always evidence the original documentation had been checked.

Some people and relatives felt frustrated by their prior attempts to contact the office by telephone if they had queries or concerns, although people confirmed it was now easier to do so. Complaints were being properly investigated and used for future learning where applicable by the current management team. People stated they were pleased with the kind and caring approach of care staff and they felt respected. Personal care and other support was delivered in a manner which promoted people's dignity. Some people did not feel consulted about how their care was delivered and stated they were not contacted by office staff to plan and review their care. Care plans contained information about people's cultural and religious needs and whether they needed support to meet these needs.

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 registered with us on 14 May 2018 and this is the first inspection. The service was previously registered at a different address but did not have an inspection while at the previous premises.

Why we inspected

This was a planned first comprehensive inspection. We have found evidence the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this full report. You can see what actions we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches of regulation in relation to the safe management of medicines and the effectiveness of the provider's own quality monitoring 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.