This comprehensive inspection took place on 12 December 2018 and was announced. We gave the provider 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure someone would be available when we inspected.
The service was last inspected on 12 May 2016 when we rated the service good in all key questions and overall.
Westminster Homecare Limited (West London) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults including those with physical frailty or memory loss due to the progression of age whilst others were living with the experience of dementia or had mental health needs. At the time of our inspection, there were 172 people using the service. Most people using the service were receiving funding from their local authority, either Hounslow or Ealing, and a few people were funding their own care.
There was a registered manager in post at the time of our 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.
There was a policy and procedures for the management of people’s medicines and staff had received training in this. However, one person who used the service had not received their medicines as prescribed.
There were systems in place to monitor and assess the quality and effectiveness of the service, and the provider ensured that areas for improvement were identified and addressed. However, a medicines audit had failed to identify the issues we found during our inspection.
Compared to the number of calls completed, the number of missed calls was small, but in each case, these were investigated and recorded. The registered manager showed us evidence that a new system had recently been put in place to improve this and prevent further missed visits.
Feedback from people and their relatives was not always positive. Some people said they did not always feel listened to by office staff when they raised concerns. Others told us they were happy and had built a good rapport with the care workers.
There was a complaints procedure in place which the provider followed. All recorded complaints had been addressed appropriately and in line with the provider’s procedures.
The risks to people's wellbeing and safety had been assessed, and there were detailed plans in place for all the risks identified.
Incidents and accidents were recorded and appropriate action was taken. The provider ensured that lessons were learned when things went wrong and put action plans in place.
People and staff were protected from the risk of infection and cross contamination. Staff were issued with appropriate equipment and received training in infection control.
There were procedures for safeguarding adults and the care workers were aware of these. Care workers knew how to respond to any medical emergencies or significant changes in a person's wellbeing.
The registered manager raised safeguarding concerns to the local authority and worked with them to investigate these and take appropriate action.
People's needs were assessed by the provider prior to receiving a service and care and support plans were developed from the assessments. People had taken part in the planning of their care and received regular visits from the care coordinators or the field supervisor.
Most people we spoke with and their relatives said that they were happy with the level of care they were receiving from the service and found the care workers kind and respectful.
The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act (MCA) 2005 and we saw evidence that staff received training in this.
Records showed that, where able, people had consented to their care and support and had their capacity assessed prior to receiving a service from the agency.
The provider employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff absence. Recruitment checks were in place to obtain information about new staff before they were allowed to support people unsupervised.
People's health and nutritional needs had been assessed, recorded and were being monitored.
Care workers received an induction and shadowing period before delivering care and support to people. They received the training and support they needed to care for people.
Staff told us that the registered manager was approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. The registered manager felt supported by senior management.