London Care (Westminster)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm. People received a safe service, were protected from abuse or neglect and had their human rights promoted. Staff and managers understood the reporting procedure for any safeguarding concerns or allegations. Risks to people were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Accidents and incidents were monitored and analysed, so lessons could be learned, and recurrences could be avoided. The service established solid relationships with healthcare professionals to help maintain people’s safety. The service followed robust recruitment procedures and there were enough suitably trained staff employed to meet people’s needs and keep them safe. Risks and hazards in people’s home environments were identified and mitigated in collaboration with people using the service. Staff and people using the service were protected from acquiring infections as much as possible. Staff completed comprehensive training for infection control and the provider made sure staff always had enough PPE. Staff supported people to manage their medicines safely where required. Regular medicines audits were completed, staff were trained and their competency was checked at regular intervals.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who used the service and their representatives told us the service had a culture of safety and learning. People knew who to contact if they had any issues and they were comfortable raising concerns. People confirmed that lessons were learned if things went wrong and changes were made to improve the service and avoid recurrences. One person’s relative told us how lessons had been learned from experience, and how staff helped their loved one to stay as safe as possible at night, in case they chose to get out of bed during that time. This relative explained, “They [staff] make sure the bed is all the way down and the crash mat and pillow are in place on the floor with a blanket. [Name]’s comfort and safety are looked after.” This person also added that staff were good at anticipating their loved one’s needs. Another person’s relative gave an example of how they had raised an issue and it had been satisfactorily resolved. This person told us, “I look at the email from the team in 2020 when the care wasn’t great. A lady emailed me back and they explained everything to me. We made an agreement and now they send a weekly rota to me and an upcoming rota. They have moved to an electronic system now, so I can keep track on what is going on.”

The management team told us that people’s safety was a priority. They said safety was everyone’s responsibility and it was maintained by being open and transparent and making sure lessons were learned from experiences. Staff were supported and encouraged to raise any issues or concerns so they could be addressed and risks could be minimised, without restricting people’s choices. Staff confirmed the management team shared information with them, to help ensure lessons could be learned. One member of staff told us, “Yes, they share learnings with us”. Another member of staff told us the provider explained learning from incidents and accidents to help reduce further risk. They said, “Yes they do; depending on the situation. Like a client that has specific need, they send out a letter and information on it”.

The provider had effective systems and processes in place, which helped enable learning from previous incidents where people may have been at risk. We saw the provider’s systems and processes promoted people’s safety as a priority, whilst not limiting their choices. People were supported and empowered to make informed choices and take calculated risks as safely as possible. We saw that incidents and complaints were reported, recorded and investigated appropriately and changes were made where needed, to improve the care service.

The management team and staff understood the importance of working collaboratively with people using the service and healthcare professionals. Staff told us they listened to the people they supported and their representatives and took appropriate action when needed, to help ensure people’s ongoing safety and wellbeing. One member of staff told us, “If I see a client’s mobility getting worse, I let the office know and they arrange for a social worker to see the client and increase the care package if needed.”

Local authority commissioners confirmed that London Care (Westminster) worked collaboratively with them and other healthcare professionals.

The provider had effective systems and processes in place to make sure that solid relationships with healthcare professionals were established to help maintain people’s safety. We saw evidence in people’s care records, which demonstrated effective communication and ‘joined up working’ throughout people’s care journeys. We also saw that the provider's policies, procedures, and processes were in line with current, relevant legislation.

People using the service, and their representatives, told us they felt safe with the staff who supported them. People also said they felt confident that the service would listen to them if they raised any concerns, or experienced a situation which made them feel unsafe. One person’s relative told us, “Yes, I would say they [care staff] are conscientious. Over the past few years there has been a decline in [relative]’s movement and mental capacity, which makes them more vulnerable. London Care have worked carefully on [relative]’s care plan and they have identified and managed risk well.”

The management team and staff demonstrated a clear understanding of abuse and neglect and knew how to recognise signs that may indicate a person was at risk. Staff worked hard to make sure people were protected from harm and reported any concerns quickly and appropriately. Staff and the management team confirmed that any restrictions on people’s freedom were only used when they were in the best interests of the person. They also had a clear understanding of the processes to follow, via the Court of Protection, if people needed any restrictions for their safety. All the staff we spoke with confirmed they had completed safeguarding training and would report any concerns without hesitation. A member of staff explained how they were concerned for a person’s safety and wellbeing. This was because the person was living with the early stages of dementia and lived on their own, with no family or other representatives. The staff member told us the person would often unwittingly lock the door to their flat and leave the keys in, so care staff could not go in and check on their safety and wellbeing. This member of staff explained that they had informed the office, who raised the concerns with the local authority. As a result, the local authority had worked with the provider to implement a protection plan for the person. Other staff made comments such as, “I make sure it is a safe environment for the client and for me and make sure they are not abused by anyone or anything.” “Protecting service users from abuse. Reporting it if you see anything or have any concerns. Whistleblowing to prevent abuse. You can contact the CQC direct for any concerns.” And, “Safeguarding is protecting the service user’s health, wellbeing and rights, as well as enabling choice and respecting their dignity.”

The provider had effective systems and processes in place to help ensure people were protected from abuse and neglect. We saw the safeguarding policies and procedures followed current and relevant legislation. The systems we looked at showed how concerns about people’s safety were recorded and reported to the registered manager, who raised them with other appropriate bodies, such as the local authority’s safeguarding team and CQC. Where appropriate, people and those important to them were involved in this process and informed about what action would be taken to keep people safe.

People told us the staff helped them to recognise risks in their daily lives and take action to reduce these as much as possible. People we spoke with confirmed they knew about their care plans and risk assessments and had been involved in compiling these. One person told us that because they had a visual impairment, staff were very good at recognising and explaining potential hazards to them, both inside and outside of their home, and helping them to manage these risks as independently as possible.

Staff and the management team confirmed that risk assessments were completed with people who used the service. This helped them to understand and manage the various risks they encountered in their daily lives. They told us people’s care plans and risk assessments were regularly reviewed and updated as soon as any changes were needed. A member of staff told us about an experience they had with a person using the service. They explained, “I entered a service user's home and there were lots of boxes in the entrance piled up. I spoke to them and let them know the risk of having the boxes there. They were very happy and said I was the only person that ever spoke to them about safeguarding and keeping safe.”

We saw the provider had effective systems and processes in place to assess and minimise risks that were identified for people using the service. Risk assessments were person centred and covered areas such as people’s mobility, daily living and personal care requirements. We also saw risks had been assessed for equipment used to support people, as well as staff working in people’s own homes. We saw that people’s care plans contained up to date information and guidance for staff about the action they should take to manage identified risks and keep people safe. There were clear processes, which staff followed when they needed to report concerns, incidents and accidents. These processes helped enable the provider to have oversight of risks and ensure they were mitigated as much as possible. The management team told us they completed regular audits and confirmed that people’s care plans were updated as soon as there were any changes or new risks were identified.

People who used the service and their representatives told us that staff respected people’s own homes. They said they had completed needs assessments and risk assessments when they began using the service. These assessments also included health and safety for themselves, as well as staff, within their individual home environments.

Staff and the management team told us that risk assessments for people’s individual home environments were completed prior to the service being provided and regularly reviewed thereafter. They said that when any issues were identified, these were discussed with the person using the service and, where necessary, their representatives and other healthcare professionals. Staff and the management team confirmed that appropriate action would be agreed together, to help make sure people’s home environments were safe to live in, as well as being safe for care staff to work in.

The provider had effective systems and processes in place to make sure risks and hazards in people’s home environments were identified. Risk management plans were completed with people using the service, to help mitigate identified risks as much as possible.

People we spoke with who used the service, or their representatives, told us they were happy with the care staff and believed they were recruited properly, skilled and appropriately trained. People said they felt the service employed enough staff. They said that staff were usually on time and always completed all the tasks they were required to do. A person using the service told us, “They have never been that late; maybe 5-10 minutes, which is not noticeable.” One person’s relative told us, “They [care staff] generally arrive on time. They give the appropriate time allocated to [relative] and complete the tasks they are required to do. It is very helpful for my [relative] to have the same carers and a regular time, as otherwise it can be confusing and disruptive but I am pleased to say it is mostly consistent.” Another person’s relative said, “Over the years I have seen many carers come and go but I think possibly the recruiting standard may have improved, as currently they are all good. Including the coordinator for my [relative]’s area, who understands the personalities of their clients and carers and matches them accordingly.” Other comments from people’s relatives and representatives included, “Sometimes they stay a bit longer than they should. It can be tricky changing [relative], making their lunch and getting them back in their chair. It can take time.” “Sometimes they may stay longer depending on what mood [person] is in; it could be longer.” And, “They try not to change [care staff]. [Person] is not good with change, so it would be one of the regular carers and [person] knows them extremely well.”

Staff told us their work schedules were achievable and they felt there were enough staff employed at the service. Staff said they were very well supported and had excellent training opportunities. One member of staff told us, “London Care Westminster has allowed me to start my level 3 apprenticeship in health and social care. More so, they are exceptionally good at organising training for their employees so we can get more knowledge. This has impacted positively to my apprenticeship training and has also helped shape my views about vulnerable people in numerous ways.” Another member of staff said, “I am very happy with my rota and I do stay for the full length of my time with each visit. I do have regular clients that I visit. I build bonds with them and support in any way I can. I do feel very supported in my job, as my team are always there to help answer any question I may have and support me in my role.”

We reviewed the Electronic Call Monitoring (ECM) data given to us by the provider, regarding the reliability and punctuality of staff. The provider acknowledged that there were still some ‘glitches’ with the electronic system but explained how they regularly monitored the data and maintained oversight of this issue. The management team were able to provide us with satisfactory evidence and explanations for the anomalies, such as no travel time, staff appearing to be in 2 places at once and staff not staying for their contracted period of time. For example, they explained that some people lived adjacent to each other, in supported living or sheltered housing. The management team and staff also told us how most staff were deployed using a ‘patch’ postcode system, which reduced travel time between visits. This information, together with feedback from people using the service, their representatives and care staff, assured us that there were enough staff to meet people’s needs in accordance with their agreed care packages. We saw the provider had a thorough staff recruitment process and records demonstrated this was followed. Staff disciplinary and capability processes were fair and regularly reviewed. This helped ensure staff were not disadvantaged because of any protected equality characteristics they may have. Staff completed comprehensive training that was appropriate and relevant to their role. They were also supported to deliver safe care by receiving regular supervisions, appraisals and development support and by being encouraged to be actively involved in improving the service.

People using the service and their representatives told us the care staff were clean and hygienic and followed appropriate infection control procedures, which helped keep everybody safe. People using the service and their representatives confirmed that staff washed their hands and used appropriate personal protective equipment (PPE), such as gloves and aprons. The manager of a sheltered housing complex told us there was a carers’ office on-site and confirmed that care staff always went there first, washed their hands and collected PPE such as gloves, aprons, foot coverings and arm coverings.

The staff and management team fully understood the importance of following infection control procedures, keeping people’s homes and equipment clean and maintaining a good standard of personal hygiene. One member of staff told us, “There are always supplies of PPE, gloves, shoe covers, facemasks and hand sanitisers.” Another member of staff also confirmed they used PPE and always had enough of everything they needed. This person said, “Yes; and I always go to the office to get more.” Another member of staff told us, “Prevent infection from spreading by wearing PPE, such as gloves and facemasks and washing your hands. Protect yourself and the service user.”

The people who received support with their medicines told us they were happy with the way the service and care staff managed these. One person’s relative told us, “Yes, they support [relative] with medication. They are fantastic; they collect the medication every month from [pharmacy] in a Dossett box and make sure it is administered every day.”

Staff and the management team told us that some people required support to manage and administer their medicines. They confirmed that regular monitoring and audits were completed by way of checking people’s medication administration records (MAR), spot checks and feedback from clients and their representatives. All the staff we spoke with confirmed they had completed training for medicines management and administration and were confident with this area of responsibility. Staff also understood their responsibility for reporting problems or errors with people’s medicines. One member of staff told us, “I will call the GP if they are still open, if not 111, and discuss the situation; call the office and let them know and follow the instructions given to me. Then I will note in feedback and follow up.” Other staff members made comments such as, “I am very confident towards all clients with their medication.” And “Very confident and if l have any problems l will call the office.”

The service had effective systems and processes in place to ensure people’s medicines were managed and administered in a safe way. People received their medication safely and as prescribed. The service’s medicines management processes reflected current and relevant best practice and professional guidance. The systems used for auditing medicines were reliable and robust.