Archived: London Care (Barnet)

At our last inspection of the service on 15 August 2013 we had found that care workers were not receiving the amount of supervision stipulated in the provider's policy and the registered person had not taken proper steps to ensure people were protected against the risks of receiving inappropriate or unsafe care by means of the effective operation of systems designed to identify and manage risks to people and monitor the quality of service provided.

At our inspection on 19 November 2013 we found that a significant number of visits to people who used the service had been missed or late. Some missed visits had resulted in people not receiving their prescribed medicines on time. In addition the system in place for receiving, handling and responding to complaints made by people who use the service or their representatives was not effective. Not all complaints had been fully investigated or resolved where possible to the satisfaction of the complainant. A backlog of complaints had accumulated and there was no plan in place to address the backlog.

At this inspection, carried out over two days in January and February 2014 we found that although improvements had been made in some areas, other areas continued to cause concern.

The backlog of complaints had been dealt with and new complaints were responded to promptly and people were informed as to how they could escalate their complaint if they were unhappy with the outcome.

However, we found that many care workers were not receiving the level of supervision, appraisal and training that was specified in the provider's policy. We also found that systems to regularly assess and monitor the quality of services provided were not followed by staff and as a result risks relating to people's health, welfare and safety may not have been identified, assessed and managed. Quality monitoring visits and telephone calls were not carried out with the expected frequency. The expectation for quality monitoring visits and calls was four per year. Less than 30% of people we sampled had received more than two visits or calls regarding the quality of the service they were receiving in the last year and less than half of the people we checked had had a monitoring visit or call in the last three months.

After the last inspection we had served a warning notice on the provider in December 2013 as they had failed to notify the Care Quality Commission of a minimum of nine allegations of abuse. At the current inspection we found that the provider had failed to notify the Care Quality Commission, without delay, of a further four allegations of abuse in relation to people who used the service. The provider had failed to comply with the warning notice.

We also looked at the complaints process and found that the system in place for receiving, handling and responding to complaints made by people who use the service or their representatives was not effective. Not all complaints were fully investigated or resolved where possible to the satisfaction of the complainant. People we spoke with were all dissatisfied with the way their complaints had been dealt with by the service. A backlog of complaints had accumulated and there was no plan in place to address the backlog.

The registered person had also failed to notify the Care Quality Commission, without delay, of several allegations of abuse in relation to people who used the service.

However, several people and relatives told us that they had experienced a number of problems with care staff arriving late or not at all. A person who had recently started using the service described the service as 'haphazard' and said that on one occasion the carer had arrived three hours early for a midday visit. A relative told us their mother had experienced frequent missed visits or carers arriving very late. As a result the person using the service had not received their medicines on time. The relative told us 'the carer came at midday to give her morning medicine, so when are they going to give the midday tablet; this means she misses a dose.'

Although care staff received appropriate training we found that they were not receiving regular supervision in line with the provider's supervision policy. Systems in place to assess and monitor the quality of service were also not effective as the risks to people from missed and late visits had not been identified and addressed effectively. Several people and relatives told us it was difficult to contact the office to raise concerns about missed or late visits.