We carried out a review of the data available to us about 479 Green Lanes on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about 479 Green Lanes, you can give feedback on this service.
479 Green Lanes is a domiciliary care service providing the regulated activity of personal care to older people aged 65 and over, some of whom were living with dementia. At the time of the inspection the service was supporting 112 people.
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
People and relatives told us that they received good care and support from a regular and consistent team of care staff.
People told us that they felt safe with the care staff that supported. Care staff described how they would recognise any signs of abuse and the actions they would take to report their concerns.
Risks associated with people’s health and care needs were identified and assessed with guidance available to staff on how to minimise known risks to keep people safe. However, further improvements were required in ensuring staff were provided with detailed guidance in relation to people’s identified individualised risks.
Management oversight systems in place enabled the registered manager to identify issues and improve the quality of care people received. Significant improvements had been made since the last inspection in this regard. However, during the inspection we did identify minor issues relating to detailed risk assessments and ensuring care plans were updated consistently where change was identified.
People received their medicines safely and as prescribed. Policies and processes in place supported this.
Process in place allowed for only those staff assessed as safe to work with vulnerable adults were recruited. There were sufficient numbers of staff available to meet people’s needs. People told us that they received care at the agreed time and where staff were running late this was communicated effectively.
Care staff received the required training and support to carry out their role effectively.
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.
People’s nutrition and hydration needs were assessed and appropriate support provided where required. Where people required support and assistance to access health and social care professionals due to a specific identified need, care staff and the service helped people with this.
People and relatives told us that care staff were kind, caring and respectful and that they received care and support that upheld their privacy and dignity.
Care plans were detailed, person-centred and captured people’s needs and wishes about the care and support that they required.
People and relatives knew who to speak with if they had any concerns and were confident their concerns would be addressed and resolved.
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 17 January 2019). We found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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. Whilst there were no breaches in regulations, further improvements were required under well-led for the provider to further implement and embed the required improvements.
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.
At our last inspection we rated the service good. However, the key question ‘Is this service safe’ was rated as requires improvement as we had found some minor concerns with medicines management and administration processes and a lack of information in some care plans around people’s risks and care needs.
At this inspection we found the service had not maintained its’ overall rating of ‘Good’. We found a lack of individualised risk assessments, concerns with medicines management and administration, consent to care had not always been appropriately obtained and documented and a lack of management oversight processes.
479 Green Lanes is a domiciliary care agency who provide a wide range of personal care options to people living in their own houses and flats in the community. It provides a service to older people, some of who are living with dementia. At the time of this inspection the service was supporting approximately 183 people.
Not everyone using 479 Green Lanes 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.
A registered manager was in post at the time of this inspection. However, the registered manager was away on leave and was not able to support the inspection process. The deputy manager and other members of the management team were available. 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.
Risks associated with people’s care and support needs had not always been identified and assessed so care staff were not given information on how to manage or minimise the risk to keep people safe and free from harm.
Medicines management and administration processes were not clearly followed and documented, which meant that people may not have been receiving their medicines safely and as prescribed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this in practice. However, records kept as part of people’s care plans did not always support this practice. People’s level of capacity, decisions made in their best interests and consent to care had not been obtained or appropriately documented within people’s care plans.
Care plans were person-centred and gave information about people’s likes, dislikes and preferences. However, information contained in the current care plan format was not always clear and easy to find. Some statements documented about people were not respectful and did not promote people’s dignity.
People and their relatives knew who to speak with if they had any complaints or issues to raise. However, the service did not always record complaints that had been directly raised with the service by people or their relatives.
Quality assurance systems in place did not identify any of the issues we found as part of this inspection process. Care plans, medicines administration records and daily records were not checked or audited to ensure that people were receiving care and support that was safe, effective and responsive to their needs.
People and their relatives told us that they felt safe and assured with the care and support that they received from care staff. Care staff knew about the different types of abuse and were clear on the actions they would take to protect people from abuse.
Safe recruitment processes were followed to ensure only those care staff assessed as suitable to work with vulnerable adults were employed.
Care staff received appropriate training and support to effectively carry out their role. This included induction, refresher training, supervision and an annual appraisal.
People were supported with their nutrition and hydration needs where this was part of the person’s package of care.
The service supported people with their health care needs where required. Where people required additional care, appropriate referrals had been made to the relevant healthcare professionals.
People and their relatives told us that care staff were caring and engaged with them whilst supporting them with their needs.
Most people and their relatives knew the deputy manager and other office staff more than they knew the registered manager.
At this inspection we have made two recommendations around best practice when applying the principles of the MCA 2005 and managing complaints. We also found the provider to be in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
479 Green Lanes provides personal care and support to people living in their own homes or within supported living schemes. There were 207 people using the service at the time of the inspection. The service supports people living with dementia, learning disabilities, mental health conditions and physical disabilities.
There service had a registered manager in post. 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.
At our last inspection in October 2015, we found that the service did not complete risk assessments where particular personalised risks had been identified. Where people had been noted to have complex needs and health issues, there was no guidance available to staff on how to support people with their care and support needs relating to the identified health condition. This resulted in a breach of Regulation 12 of the Health and Social Care Act 2008.
During this inspection we found that appropriate actions had been taken and improvements had been made. Care plans included appropriate risk assessments personalised to each individual person. In addition to this care plans also contained specific guidance about people’s complex needs and health conditions where appropriate.
Care plans that we looked at contained detailed information about the person that required support which included their likes and dislikes and how they wished to be supported. Environmental risk assessments had been completed which highlighted potential risks and how these could be mitigated.
Care plans had been signed either by the person using the service or their relative. People and relatives told us and records confirmed that they were involved in the planning of their care and also confirmed that the service regularly reviewed their care package with them.
The provider had appropriate policies and processes in place in relation to the Mental Capacity Act 2005 (MCA). Records confirmed that staff had received training on the MCA and when we spoke with staff they demonstrated a good awareness and understanding of the principles of the MCA and how these were to be applied when supporting people.
The service had recruitment processes in place which ensured that only suitable staff were employed.
People told us that where staff supported them with their medicines, this was carried out appropriately. We looked at seven Medicine Administration Records (MAR) and found that there were no gaps in recording. MAR charts are the formal record of administration of medicine within the care setting. However, where medicines were administered from a blister pack or dossette box, the individual name of the medicine, dose and frequency prescribed was not detailed on the MAR chart. We did note that the service had recorded people’s required medicines on the person’s care plan but this did not always match the prescribed medicines at the time of our inspection as the medicine information had been obtained during the initial assessment.
Staff told us and we saw evidence that care staff received medicine training on a yearly basis. However, the service did not complete a formal medicines competency assessment to confirm their learning. The administration of medicines was observed during spot checks, where field supervisors carried out observations when care staff were on a care shift. However, the spot checks did not provide any detail about what areas of medicine administration had been observed and checked to confirm competency.
People told us that they felt safe in the presence of the care staff that supported them. Staff demonstrated a good understanding of safeguarding and what this meant in order to ensure people were protected from abuse. Staff knew who to report abuse to which included managers as well as external agencies such as the police, local authority and the Care Quality Commission (CQC).
Overall, people and relatives told us that they were happy with the care that they or their relative received. They received regular and consistent staff who were caring and ensured that their privacy and dignity was maintained at all times. Staff also confirmed that they supported regular people and were allocated to work with people in the same area which was normally local to where they lived.
People and relatives told us that they felt staff were adequately trained and skilled to provide good and effective care. Staff also confirmed that they had received an induction prior to starting work as well as on-going training as part of their personal development. Staff told us and records confirmed that they received regular supervision and had also received an annual appraisal which looked at their overall development and training needs.
People and relatives told us that they knew who to speak with if they had any concerns or issues with the service that they or their relative received. A record was kept by the service of all complaints received. This included details of the complaint and the investigation that had been conducted. Most complaints received had been through the local authority complaints system and therefore the response the service provided with the outcome of their investigation was directly sent to the relevant local authority. The service did not provide any form of response, including an apology where appropriate, directly to the complainant.
A number of quality assurance systems were in place which included staff spot checks, telephone monitoring and annual feedback surveys that people and relatives completed. We saw that the registered manager regularly checked the systems in place for their effectiveness and where actions were noted these were followed up.
479 Green Lanes is a home care agency based in North London which provides domiciliary care services predominately in Enfield and Haringey. This was an announced inspection and the service was given 48 hours’ notice. This was to ensure that someone would be available at the office to provide us with the necessary information.
The service was last inspected on 12 June 2014 and was found to be fully compliant in all areas that we looked at.
At the time of the inspection there were 187 people using the service. The service provides domiciliary care services to younger and older people with dementia, learning disabilities or autistic spectrum disorder, mental health conditions and physical disabilities. The service operates from offices based in Enfield.
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.
People and relatives told us that they were satisfied with the care and support that they received. Staff were caring and carried out their duties with dignity and respect at all times.
Each person using the service had a care plan. An assessment had been completed prior to the service starting. The care plans we looked at gave basic information about the person’s needs and requirements. Most care plans were regularly reviewed and updated and included moving and handling risk assessments. However, the care plans did not include personalised risk assessments where particular risks had been identified. There was also lack of information and/or guidance about some people’s health conditions.
Care plans were basic and did not include much detail about the individual, their life history and were not person-centred. Care plans had been signed by people using the service or a relative and people and relatives told us that they had been involved in the care planning process. However assessment paperwork did not evidence that the service had tried to ascertain if a person had capacity or not and where someone lacked capacity what steps had been taken to ensure they were supported appropriately and that other people had been involved in any decision making process.
The registered manager did not undertake any internal quality assurance audits to ensure that the service was providing a good quality and effective service. Tracking systems were evidenced to inform management of when reviews or supervisions were due but there was no evidence of any care plan or staff file audits to check content and quality of these and to highlight any issues. Spot checks and telephone checks were carried out to ensure that people were receiving a service that had been scheduled however, where missed calls were noted, no recording or analysis of these had carried out to look at any emerging patterns or to learn from these occurrences and to prevent these from re-occurring.
Staff recruitment processes were robust. We looked at ten staff files which showed that prior to employment of care staff all appropriate checks had been completed. Staff files showed two written references, identity and visa checks and criminal records checks.
We looked at training records for staff. We saw that in all cases essential training, covering a variety of topics, had been undertaken including induction training. The service had introduced the Care Certificate to all new staff employed. Staff members received regular supervisions and appraisals. This showed that appropriate systems were in place to support staff to do their job.
The service did have an electronic rota management system in place but this was not being used effectively. Manual systems were in place to set rotas and staff members were not provided with a weekly rota. We were informed by the service that the staff were aware of their rota and did not need to be given confirmation of this.
There was a clear management structure in place which staff understood. Staff were aware of their role, responsibility and accountability in relation to the provision of services. People told us they knew who and how to contact the service if they had a concern or complaint. The registered manager sought regular feedback from people and staff through spot checks, telephone monitoring and questionnaires.
At this inspection we identified a breach of Regulation 12. This breach was in relation to risk assessments. You can see what action we told the provider to take at the back of the full version of this report.
During this inspection we spoke with eight people who used the service and two relatives of people who used the service. We also spoke with the Registered Manager, one member of office staff and four care staff.
As part of this inspection we also looked at a compliance action that we had made during our inspection of the service on 30 January 2014. During the inspection in January 2014, we were concerned that the provider did not have systems in place to assess and monitor the quality of service that people received. During our inspection on 12 June 2014, we found that the provider had taken steps to ensure that they had systems to assess and monitor the quality of service that people received.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
Eight people who used the service told us that they felt safe when being cared for by care staff in their own home. They also told us that staff treated them with respect and dignity. One person told us, "I trust staff and I feel safe with them' and another said, 'Carers are very good. They are polite and respectful. I have no complaints'.
Relatives of people told us that they were confident that people living in the home were safe and had no concerns in respect of this.
The agency had a safeguarding policy which included guidelines on how staff should respond and act if they suspected abuse was taking place. We noted that the policy did not contain the contact details for the local authority and the Care Quality Commission (CQC) and raised this with the provider.
We looked at the training records for care staff and noted that the records indicated that the majority of staff had received safeguarding training.
People were cared for, or supported by, suitably qualified, skilled and experienced staff. We saw that the necessary employment checks had been carried out prior to staff starting work.
Is the service effective?
People we spoke with said that they were satisfied with the care provided by the agency and felt that people's needs had been met. One person said, 'The carers are excellent. I couldn't wish for more. They are caring and capable'.
Relatives were positive about care staff and said that they were helpful and listened to them. One relative told us, "I am happy with the care provided'.
We looked at six care files and saw that people's care needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. Risk assessments had been carried out where necessary. Care plans included information about people's preferred routines and healthcare needs. However, we saw that care plans lacked information about people's interests, likes and dislikes.
Is the service caring?
People we spoke with were positive about the agency and care staff. They told us that they had been treated with respect and dignity by care staff. People told us that they felt comfortable around care staff. One person said, 'My carer is excellent' and another said, 'Carers are very nice. You can't beat them'.
Staff we spoke with said that they were aware that all people should be treated with respect and dignity and were able to give us examples to demonstrate how they ensured this.
Is the service responsive?
People who used the service and relatives we spoke with told us that if they had any concerns or complaints, they would feel comfortable raising them with the agency.
We saw that the agency had a complaints policy and procedure and kept a record of complaints received.
During our inspection on 30 January 2014, we were not provided with evidence that all care staff had received regular and individual spot checks to ensure that they were competent. Our inspection on 12 June 2014 found that the majority of staff had received spot checks and this was confirmed by staff we spoke with.
Our inspection on 30 January 2014 found that there was no system in place to monitor when care staff arrived for their appointment and we discussed the safety of people who had special healthcare needs and the risks involved if care staff did not turn up on time. Since our inspection, the agency had implemented an automatic alert system and we saw evidence of this. We however noted that the system was not operating at the time of our inspection on 12 June 2014. The Registered Manager confirmed that the system was due to start operating on 23 June 2014. .
Is the service well-led?
During our inspection in January 2014, we were concerned that there were not adequate arrangements in place for monitoring and reviewing the quality of the service provided to people. During our inspection on 12 June 2014, we found that the provider had adequate arrangements in place for monitoring and reviewing the quality of service. We saw that the provider had a quality assurance policy and procedure and we saw evidence that questionnaires were sent to people who used the service and their relatives. However, we did not see evidence that telephone quality monitoring was carried out regularly.
Staff told us that staff meetings took place quarterly and they felt comfortable raising concerns and queries with the management.
The agency had a safeguarding policy and procedure. Staff had received training on how to respond to allegations or incidents of abuse. Agreed action plans following a safeguarding meeting had been responded to. However, the safeguarding policy and procedure provided had not been updated.
Care staff had received essential training, supervision and support to ensure they were able to do their jobs well. This was confirmed by staff we spoke with. New staff had been provided with a period of induction.
There were arrangements for quality assurance and the results of a recent satisfaction survey indicated that the majority of people who used the service were satisfied with the quality of services provided. We however noted that improvements were needed to ensure that all essential checks and reviews were carried out.
The needs of people who used the service had been assessed and the required care had been provided. People and relatives who spoke with us said they felt safe with care staff and no concerns were expressed. The agency had an appropriate safeguarding policy and procedure. Staff had received training on how to respond to allegations or incidents of abuse.
Care staff had been provided with supervision and support to ensure they were able to do their jobs well. People who used the service and their relatives spoke positively about staff and said they found their care staff to be reliable.
There were arrangements for quality assurance. Spot checks and reviews had been carried out.by senior staff. The results of a recent satisfaction survey indicated that the majority of people who used the service and their representatives were satisfied with the quality of services provided.