Archived: London Care Holloway

London Care (Holloway) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to people living with dementia, learning disabilities or autistic spectrum disorder as well as physical disability and sensory impairment. There were approximately 186 people using the service at the time of the inspection. All of them were receiving personal care. This is help with tasks related to personal hygiene and eating. The provision of personal care is regulated by the Care Quality Commission.

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

Since the last inspection the service has made improvements in several areas of the service provision. This included improved risk assessment and management, increased continuity of care to people by the same staff and dealing with complaints. The provider has also introduced a new online care planning system which helped staff to provide responsive, individualised and considerate care.

Some aspects of the service provision needed further improvement, and these were related to the management of medicines, communication around care visit schedules and the customer service. However, overall people and their relatives told us they were satisfied with the service they received.

People felt safe when cared for by staff. Staff were recruited safely and the provider’s safeguarding polices and procedure helped to protect people from abuse. Risk to people’s health and wellbeing had been assessed and managed. Staff were provided with information on how to protect people from harm. This included various risk control measures relating to people’s environment, specific health conditions and infection control. The managers also regularly monitored, analysed and learnt from accidents and incidents that occurred within the service. There were enough staff deployed to support people. The managers were working towards ensuring that staff attendance had been monitored and punctuality improved.

People’s needs were assessed and people’s care plans included information gathered during the assessment meeting. The provider’s new online care planning system enabled information about people’s care to be updated in a real time and with no delay. Therefore, staff could have access to up to date information about people’s care needs and how to best support them. Staff were sufficiently trained. A range of managerial staff checks, such as spot checks and one to one supervision, helped to ensure staff provided care that was safe, effective and kind. 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. Staff supported people to have their needs met. This included providing a nutritious and sufficient diet, having access to external health professionals when needed and other needs around people’s individual health conditions, religious, cultural and personal requirements.

Overall people thought staff were kind and compassionate. All people and relatives spoke positively about their regular care staff. People felt cared for and supported as required. Some people and relatives said it was more difficult to create friendly relationships with staff who supported them when their usual care staff was not able to visit. People were supported to sustain their independence as staff encouraged people to do things for themselves as much as possible. People said staff were considerate, respected their privacy and ensured their dignity was protected when receiving care.

Most people and relatives said the service had dealt with their complaints promptly and to people’s satisfaction.

The managers knew their roles and responsibilities related to the managing of the regulated activity. There were quality monitoring systems in place to help to monitor and improve the service delivery. The managers were ambitious and driven to ensure identified gaps in the service provision were addressed. The general feedback from people, relatives and staff was positive. Improvements since the last inspection were observed by people and relatives and we found that overall satisfaction with the service provision had improved.

We have made two recommendations about the management of medicines and aspects of customer service.

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 12 July 2018) and there was a breach of Regulation 12. 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 Regulation 12.

Why we inspected: This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Care Holloway 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 (Holloway) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to people living with dementia, learning disabilities or autistic spectrum disorder as well as physical disability and sensory impairment. There were approximately 390 people using the service at the time of the inspection. All of them were receiving personal care.

The service had a registered manager in the post at the time of the inspection. 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 and associated Regulations about how the service is run. We found that the registered manager had sufficient experience and training to be able to manage the regulated activity effectively.

At our previous inspection on 17, 18 and 19 January 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the agency did not manage people’s medicines safely and did not respond to complaints effectively. Issues around lateness, missed visits and poor communication had not been addressed appropriately and immediate improvements had not been implemented. At this inspection we found that some improvements had been made. More improvements were required to ensure the service fully met the requirements of Regulations and effectively addressed issues around the service delivery.

At this inspection we found improvements in how the agency dealt with people’s complaints. However, further progress was needed as not all people using the service had confidence that the agency would deal with complaints raised by them effectively and to people’s satisfaction.

At this inspection improvements were observed in how the agency managed people’s medicines. Further improvements were needed to ensure that staff competencies in medicines management had been assessed and that staff had access to up to date information about medicines prescribed to people.

At this inspection we found the agency had not assessed risks to health and wellbeing that were associated with the diagnosis of diabetes. Therefore, we were not confident that staff were provided with sufficient guidelines on how to support people with this diagnosis safely.

We saw that risks associated with other conditions had been assessed as staff were provided with guidelines on how to support people. Staff understood their role in reporting of any accidents and incidents. These were recorded and monitored by the management team. We found that the agency had not informed the Commission about two incidents. They should have done it as required by the Regulations and we are currently looking into this matter.

There were sufficient staff deployed to support people and care visits had taken place. However, people told us care staff allocation had not always been consistent and people did not always know which staff member would visit them. This had impacted people as they felt uncomfortable receiving support from different care staff.

People felt safe with staff who supported them. Staff had received safeguarding training and they knew what to do if they thought people were at risk of harm. The agency worked alongside the local authority to ensure any safeguarding concerns had been investigated and actions were taken to protect people. Appropriate recruitment procedures ensured that people were protected from unsuitable staff.

People had their needs and preferences assessed before they started receiving support from the agency. This information was then used to inform plans of care for each individual person using the service. Staff thought care plans were useful as they helped them to understand people’s needs and provide care and support that was required. The agency was working towards implementing a new electronic care planning system. This was to allow instant care plan updates when people’s needs had changed and to reduce the time care staff spent on completing daily care records so they could spend more time on providing care to people they supported.

Staff received support in the form of one to one supervision and a yearly appraisal of their skills. Staff were also provided with regular training to ensure appropriate level of skills required to support people effectively.

When required staff supported people to have enough food and drink. However, more information was required in people’s care plans and risk assessments on how to support individuals with diagnosis of diabetes.

Staff supported people to have access to social care and health professionals when people’s needs had changed or their health suddenly deteriorated.

The agency worked within the principles of the Mental Capacity Act (MCA) and staff asked people’s permission before providing care to them.

People were supported by kind and caring staff who respected them. Staff communicated with people in the way people preferred. If needed the agency provided information in various formats and had them translated into other languages so people could understand. People’s dignity and privacy was respected and people could choose if they wanted to be supported by a male of female worker.

The agency had promoted equality and diversity amongst staff and people using the services as much as they could. Staff received training in equality and diversity. When possible people and care staff were matched to help people feel comfort and familiarity when receiving support.

There were systems in place to record, monitor and analyse all aspects of the service delivery. We found that the registered manager had used these processes to monitor the service delivery, and take action on improvements that had been identified as a result.

Staff thought the agency was well led and they felt supported by the management team. Various team meetings gave the office and care staff opportunity to share experience and discuss various aspects of the service delivery.

The provider carried out annual quality questionnaires about the service that they received and any areas for improvement. In the survey that was carried out in 2017, 68% of people who responded said they were satisfied or very satisfied with the service provided. We saw that the outcomes of the survey had been analysed and actions were taken to address any issues identified.

We found one breach of the Health and Social Care Act Regulations. We made three recommendations related to assessing of staff competencies in administration of medicines, effective communication with people who used the service and management of complaints.

The service was last inspected on 8 January 2016 and was meeting all the standards that we looked at. However, since the last inspection the service had moved offices and re-registered at a new address. The new location therefore required an inspection for it to be rated under the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

London Care (Holloway) provides personal care and support to people living in their own homes or within supported living schemes. There were 397 people using the service at the time of the inspection.

The service had a registered manager in post at the time of the inspection. 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 that we spoke with were generally happy with the care that they received. They also told us that staff were caring and ensured that their privacy and dignity was maintained at all times. However, concerns and complaints raised by people and their relatives were consistently around staff arriving late to their call, missed visits and the poor communication from the office informing them of any changes. Although the service had a number of monitoring systems in place, rotas that we looked at did not evidence that care staff were allocated sufficient travel time between each call. The registered manager highlighted to us that they had recognised these issues and that an action plan was in place to address them.

In addition people and relatives also told us that generally from Monday to Friday they received regular and consistent staff to support them. However, at weekends this was not always the case and communication was poor on the part of the service when informing people and relatives of any changes or lateness that may occur.

Complaints received by the service were dealt with according to the provider’s complaints policy. Full details of the complaint, an investigation report with details of actions taken and responses to the most complainants were recorded. An overview of all complaints was available which allowed the registered manager to monitor for any trends or patterns. However, where some records confirmed that the person or their relative had been spoken or written to and feedback had been provided this was not seen for all complaints that had been received. In addition people and relatives feedback was that although they felt able to complain to the service they never received any feedback on the outcome of the complaint.

The registered manager had systems in place to monitor and check the quality of care being provided. This included spot checks, random weekly checks of care plans and staff files, electronic monitoring systems, overviews of staff training and when it was due, missed and late visits, complaints and safeguarding investigations. However, where significant concerns and issues had been raised around lateness and missed visits, or ensuring people and relatives received appropriate feedback upon raising a complaint, this had not been addressed.

Medicines were not always managed safely. Medicine Administration Records (MAR) that we looked at were incomplete as care staff were not always signing the MAR to confirm that medicines had been administered where required. Therefore, we were unable to confirm that people were taking and receiving their medicine as prescribed. The registered manager explained that safe medicines management was a concern that they had already identified and systems were to be put in place to oversee and manage this.

Each person receiving care had a care plan in place which outlined the person’s needs and requirements and how they wished to be supported. Health, safety and environmental risk assessments had been completed which highlighted potential risks and how those risks could be mitigated. As part of the pre-service assessment, personal and individual risks were also identified and in some care plans specific guidance was provided to staff on how to reduce, mitigate or support the person with those risks. However, not all care plans contained this level of detail. Where some individualised risks had been identified, information had not been recorded on how to support the person with the identified risk.

People and relatives told us that they and the person that required care felt safe in the presence of the care staff that supported them. Care staff demonstrated a good understanding of safeguarding and what this meant in order to ensure people were protected from abuse. They knew who to report abuse to and were confident that management would take immediate action. Staff knew what the term ‘whistle-blowing’ meant and were aware of the external agencies they could contact if they needed to report any concerns.

Care plans had been signed either by the person using the service or their relative. The service had policies and procedures in relation to the MCA (Mental Capacity Act 2005). The registered manager, senior staff members and care staff had a good understanding of the MCA and that they should always presume that people have the capacity to make decisions. The service did not complete any capacity assessments as it was always assumed that people had capacity when referred to the service. However, where a person lacked capacity or changes were noted in a person’s mental capacity, this was appropriately referred to the relevant agencies for an assessment or review of the care package to take place.

Staff told us and records confirmed that they received training prior to starting work as well as on-going training as part of their personal development. This included face to face sessions as well as on-line training courses.

The service had safe recruitment process in place which ensured that only suitable staff were employed.

We received mixed views from people and their relatives about whether they knew who the manager was and about the management of the service overall. Some people and relatives told us that they knew who the registered manager was and felt confident in reporting any concerns or issues that they had. However, some people told us that they did not know the manager but classified the care co-ordinators and field care supervisors as the manager and with whom they communicated with most. Concerns were also raised about the poor communication from the office especially where people had raised complaints and concerns but had not received any feedback about the actions taken and the outcome of their complaint.

The service carried out quarterly quality monitoring which included telephone interviews as well as planned quality assurance visits to people receiving care and support. In addition, people and relatives were also asked to complete annual quality questionnaires to obtain their feedback on the service that they received and if there were any improvements to be made. People and relatives confirmed that they had completed these questionnaires and we saw a summary that was compiled by the provider outlining the main issues and concerns that people had raised so that these could be addressed locally.

We identified a breach of Regulation 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to managing people’s medicines safely, effectively managing complaints and addressing the issues around missed visits and lateness. You can see what action we told the provider to take at the back of the full version of the report.