Archived: Westminster Homecare Limited (Chelmsford) Also known as Westminster Homecare Chelmsford

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.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found.

Is the service safe?

When we arrived at the service headquarters, the registered manager greeted us and noted our identification. We were asked to sign the visitor’s book and were given a tour of the building where we met members of staff and were shown the fire exits.

The registered manager explained to us how the service recruited staff. Checks were made upon people’s backgrounds to check that it was safe for the service to employ them to work with vulnerable people.

We saw the staff rota, which showed the allocation of staff. It was explained to us how staff were assigned to provide care to people with respect to their needs and allocated care hours. Should the staff feel the hours were not sufficient to meet the person’s needs, this change in need would be raised with the local authority or those responsible who placed the contract of care with the service to resolve.

Is the service effective?

Prior to the person receiving care from the service a needs assessment was carried out to determine if the service could meet their needs. There were systems in place to audit care plans. The service had a process in place called ‘spot check’. The reason for the spot check was for the senior member of staff to check on the quality of care. This would include checking that the staff were on time, staff had recorded information appropriately and followed the care plan. The staff members were not given prior knowledge of the spot checks.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. However, we found that some care plans were lacking in the detail required to minimise risks to people’s health and wellbeing. This meant that we could not be sure that the appropriate care was being provided effectively because the care plans were incomplete.

Is the service caring?

We saw that the staff interacted with people in a respectful and professional manner. One person told us: “The staff are kind.” Another person stated “Terrific people, cannot find any fault.” The registered manager informed us that the service or staff member would contact the person who used the service if they were ever running late. Three people confirmed to us that staff were very good at time keeping and that they were informed if they were going to be late. This invariably was due to traffic problems on the day.

Is the service responsive?

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included increasing the support as arranged with the local authority and working with other health care professionals, including doctors and district nurses. The service had an effective complaints procedure in place.

Is the service well-led?

The service had an out of hours on-call system in operation throughout the 24 hour period to support staff and people who used the service should the need arise. The registered manager was knowledgeable and had undertaken training with regard to the safeguarding of vulnerable adults. We saw that the service provided induction and on-going training for staff to support them in their roles.