Archived: Westminster Homecare Limited (Colchester)

There was a registered manager in place who was present at 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.

The service had its last comprehensive inspection in November 2017 and we rated the service ‘requires improvement.’ We met with the registered manager and the providers representative and asked them to take action in response to our findings. They sent us an action plan setting out what they would do by when. At this inspection we found that improvements had been made and the provider had addressed the concerns that we identified.

Detailed care plans were in place which outlined people’s needs and preferences. Summaries were also available for staff in an assessible format so that they could see at a glance what support was required. The information provided was person centred and people’s care needs were regularly reviewed, and plans amended as required. Staff were provided with guidance about how risks to individuals wellbeing should be managed and steps that staff should take to reduce the likelihood of harm.

There were systems in place for the management of safeguarding concerns and staff were clear about the actions that they should take if they had a concern.

There were procedures in place to guide staff in the administration of medicines and regular audits to check that people were receiving their medicines as prescribed. During the course of the inspection we identified a small number of shortfalls regarding recording and we have made a recommendation about this.

People told us that they received care from a consistent team of staff who knew them well. There were clear systems in place for people and staff to seek advice and support out of hours. A missed call tracker had been introduced to enable the registered manager to have greater oversight of any missed calls and to identify the reasons and any patterns.

Staff had received training which provided them with the necessary knowledge and skills. Staff received regular supervisions and appraisals to reflect on their practice and explore how their skills could be developed.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to eat and drink in line with their care plan and their nutritional needs. People had good access to health care support when they needed it. The agency sought advice appropriately from health professionals when people’s needs changed.

People told us that they were supported by a regular team of staff with whom they had good relationships. They described staff as kind and caring. Staff understood the importance of privacy and dignity. Care plans set out what people could do to maintain their independence and how staff could support people to retain their skills.

There was a complaints policy in place and people’s concerns were investigated. People told us that they felt comfortable raising concerns.

Staff told us that they were well supported, and the management of the service was approachable and helpful. Staff performance was monitored to ensure that they were working to the required standards and checks were undertaken on how care was being provided.

There were systems in place to ascertain people’s views about the quality of care they received and regular satisfaction surveys were undertaken.

There were quality assurance systems in place to help ensure any areas for improvement were identified and action taken to improve the quality of the service provided.

Westminster Homecare Limited (Colchester) is a domiciliary care agency. It provides personal care to people living in their own home in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection they were supporting 102 people. There was a registered manager in post who was present at the previous 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.

At this inspection we found that some of the improvements that they had previously made to the management of medicines had been sustained. There were greater levels of oversight and checks undertaken on the records and the medicines being administered to people.

Governance and auditing had also improved across the service and overall people’s experience was better. However the management of the service had not yet ensured consistency of practice across the service. People and staff continued to have some concerns about the scheduling of visits and how changes to the schedules were communicated. The operational management team told us that they intended to undertake further analysis of travel times for staff to address these concerns.

Risks were identified but risk management plans were not always clear or specific to the individual. Care plans were large and difficult to follow which placed people at risk of receiving inconsistent care.

There were clear systems in place to manage safeguarding concerns. Staff were clear about the procedures in place and we saw that where there were concerns referrals were made appropriately to protect people.

Staff recruitment systems were robust and staff did not staff work until these were complete. Staff spoke positively about the induction and training they received when they started to work for the agency. Ongoing training was provided to all staff to ensure that they were up to date with best practice and changes to the law. Staff received regular supervision and spot checks were undertaken to ensure that staff were meeting people’s needs and working to the required standards.

People were supported to eat and drink sufficient amounts and were offered choice. Where concerns were identified in people’s wellbeing the agency made appropriate referrals to other professionals. People had good access to health care support.

People had good relationships with the care staff who supported them and told us that they were kind, caring and treated them with dignity. There were clear systems in place to respond to complaints. Investigations were undertaken and apologies given when necessary.

The manager was approachable and there were arrangements to respond to people who used the service and staff outside of office hours. Staff understood their responsibilities in supporting people to live a full and independent life; however staff morale varied with some staff positive but others reporting a lack of team work across the service. People’s views on the quality of the service were sought in a number of ways including telephone monitoring and questionnaires. Regular staff meetings were held and newsletters sent out to improve communication. There were no formal systems in place to work with other providers who were also providing support to individuals and we have recommended that these are developed.

You can see what action we told the provider to take at the back of the full version of the report.

Westminster Homecare is a domiciliary care agency, delivering services in the Colchester and Clacton area of Essex. At the time of our inspection the agency was supporting 121people.

The service has a registered manager. 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.

Following our last inspection in September 2016 we issued a warning notice because the service had failed to ensure the safe and proper management of medicines and these concerns had been ongoing for some time. The warning notice included a timescale by which compliance with the legal requirements must be made.

We carried out this focused inspection to check that the provider had made improvements. This report only covers our findings in relation to the warning notice and those requirements. You can read the report from our last comprehensive inspection on our website at www.cqc.org.uk

Actions had been taken to improve medicines management. Staff had been provided with clear instructions on when and what they should administer. Advice had been obtained from the pharmacy regarding the administration of specific medicines and there were systems in place to address changes and variable doses. There was a greater awareness of risks regarding medication and care plans outlined the arrangements to reduce the likelihood of harm.

Audits were undertaken by office staff to check that staff were recording correctly and medicines management was explored as part of spot checks undertaken by senior staff. We found that the audits could be further strengthened to safeguard people.

Other issues identified in the September 2016 Inspection under the domain Safe were not followed up at this inspection. We will review our rating for Safe at the next comprehensive inspection. To improve the rating to “Good” would require a track record of sustainability.

Westminster Homecare is a domiciliary care agency, delivering services in the Colchester and Clacton area of Essex. At the time of our inspection the agency was supporting 130 people.

The service has a registered manager. 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.

Following our last inspection in September 2015, we asked the provider to take action to make improvements as we found risks to people’s health, welfare and safety had not been identified and monitored and people’s medicines were not being managed safely. We also identified that complaints were not responded to and managed effectively. The provider provided us with an action plan in which they set out what steps that they were going to take to ensure improvement. We rated the service Requires Improvement

We carried out this inspection to check whether the actions that they told us they had taken had led to improvements. We found at this inspection that they had provided additional training for care staff on medicine management and increased the spot checks of staff. However, whilst there were improvements in some areas, we continued to find issues with the management of medicines which meant that people continued to be at risk. We found that complaints were logged and investigated but the concerns that people raised about scheduling of their care calls and the timings of their calls were not always taken seriously. This meant that people did not have their concern acknowledged or addressed.

There were adequate numbers of staff however people expressed concerns about consistency and communication. The regional manager told us that they were working on this and there were flexibility with the timings. However travel time was not always programmed into staff schedules and this meant that the times they supported people could vary.

Risks such as those associated with the environment were identified and there were plans in place which set out how they should be managed. Care plans were in place but they were not always sufficiently detailed which combined with a changing workforce meant that people were at risk of receiving inconsistent care.

The provider had policies in place with regard to the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) 2005. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. Care staff had a good understanding of the importance of obtaining consent and protecting people’s rights.

People were supported with meals and staff worked with health professionals to support people with their health care needs.

People’s independence was promoted by staff and people felt involved in their care. People had good relationships with the staff and were treated with dignity and respect.

Staff told us that they were supported and trained. There were effective systems in place to respond to staff and people who used the service outside office hours.

Staff were positive about the manager who was accessible and had started to implement change.

There were systems in place to monitor the quality of care which included spot checks and audits. However these were not always comprehensive or effective at identifying and addressing the issues such as those that we identified around medication, infection control, complaints and scheduling.

During the inspection we identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we told the provider to take at the back of the full version of the report