Background to this inspection
Updated
9 November 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 18 and 19 July 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to respond to our queries.
The inspection team consisted of two inspectors and one expert by experience, who carried out phone calls after the visit to the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
On the day of the inspection we visited the agency’s office and spoke with the registered manager, the deputy manager plus eight care staff. We visited five people who used the service and their families. We spoke on the phone to eleven people and nine family members. We met the staff supporting people at three of the visits. We contacted an additional four members of care staff by telephone. We emailed every member of care staff for their views on the service and received eight responses. In addition, three members of staff chose to email us anonymously. We spoke to four health and social care professionals to gather their views on the service.
We reviewed all the information we had available about the service including notifications sent to us by the manager. Notifications are information about important events which the provider is required to send us by law. We also looked at information sent to us from others, including family members and the local authority. Prior to the inspection we sent out a questionnaire asking people and their families to give their opinion of the service. We received 29 responses from people and four from family members. We used this information to plan what areas we were going to focus on during our inspection.
We looked at nine people’s care records and five staff records. We examined information relating to the management of the service such as health and safety records, personnel and recruitment records, quality monitoring audits and information about complaints.
Updated
9 November 2016
Westminster Homecare Limited (Chelmsford) provides support to people in their own homes. It does not provide nursing care. At the time of our inspection the service was supporting approximately 200 people.
At our previous inspection in September 2014, we found care plans did not always outline people’s needs and did not give clear guidance to staff on how to support people. At this inspection we found the registered manager had addressed the concerns we had raised and updated the care plans for people using the service.
The inspection took place on 18 and 19 July 2016 and was announced.
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.
We found a number of breaches 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.
New people did not have their needs and risks assessed in a timely manner before they started receiving care. Staff did not therefore have the necessary information available to minimise any potential risks and meet people’s needs safely.
Staff were recruited safely, however there were not sufficient staff to manage risk and meet people’s needs as outlined in their care plans. People were not assured that the timings of support would meet their personal circumstances and preferences.
Although, staff were trained to administer medicines, they did not consistently follow the organisation’s procedure when recording the support provided with medicines. It was therefore not always possible to be sure people had received the correct medicines. Changes in visit times meant some people’s medicines were not administered in a timely manner.
There were procedures in place to safeguard people from abuse and unnecessary harm, and staff were able to describe how they would use these to keep people safe. Care plans outlined the risks staff needed to be aware of when they worked with people.
Staff received comprehensive training and induction, however checks to ensure new staff had the necessary skills prior to starting support were not sufficiently robust. Some staff did not have the skills to effectively support people with dementia.
Care plans outlined how to support people who were not able to make a decision about the support they received. Staff were aware of the need to offer choice and seek permission before providing care. Staff supported people to ensure their dietary needs were met however; they did not always follow guidance in care plans where people with dementia needed additional support to have enough to eat and drink. People were supported to access health professionals when required.
Where people were cared for by staff they knew, care workers were respectful, kind and compassionate. However, changeable rotas and staffing meant people felt they were at times supported by care workers who did not have the necessary time or knowledge about their needs.
Where care plans were in place for people these were detailed and personalised. People and their families, as appropriate were involved in the review of their support. Communication between staff was not always effective so people did not always receive continuity of care. People received a personalised response to formal complaints, however were dissatisfied with how informal complaints and concerns were dealt with.
There were measures in place to monitor the quality of the service, whilst overall these systems worked well; there were gaps, where the manager was not able to demonstrate they could monitor the support people were receiving.
Morale was low amongst staff who felt they were being asked to carry out an unrealistic number of care visits. The manager had not ensured the staff and office communicated and worked well together.
The manager had started to pro-actively deal with the concerns we had found during our visit. They were committed to driving improvements in the service.