All inspections: Mears Homecare Limited (London Bridge)

This announced inspection took place on 20 and 27 October 2015. Mears Homecare Limited (London Bridge) provides personal care to people living in their own homes in the London boroughs of Kensington and Chelsea and Hammersmith and Fulham. People’s care from the service was commissioned by local authority staff who had specified the amount and type of support and care people should receive.

Since our previous inspection of 26 and 27 March 2015, the provider and management of the service had changed. The service was rebranded from Care UK Limited (London Bridge) to Mears Homecare Limited (London Bridge) in June 2015. A contract with Care UK Limited (London Bridge) was terminated by one local authority after our 26 and 27 March 2015 inspection due to concerns on the reliability of support provided to people using the service. An older people’s extra care housing care scheme which we found to be providing unsafe and inappropriate care and support at the previous inspection was no longer part of the service. The number of people supported by the service had reduced to 750 from 1221 at the time of the last inspection.

At our inspection on 26 and 27 March 2015 of Care UK Limited (London Bridge) we found the service in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to care and welfare, staff support and quality monitoring. We had received an improvement plan after that inspection. At this inspection of 20 and 27 October 2015 of Mears Homecare Limited (London Bridge), we followed up on the improvement plan and found that action had been taken to address the breaches.

The provider notified us the registered manager had left the service in October 2015. A services contracts manager of Mears Homecare Limited (London Bridge) was appointed to manage the office. A regional operations manager who is also a registered manager of another service with the same provider will oversee the operations Mears Homecare Limited (London Bridge) until a registered manager is appointed. The service was being managed this way at the time of this 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 of 20 and 27 October 2015 we found five people had not always received the support and care they required through missed visits. People found it hard to contact office staff to discuss concerns about their support and care.

People felt they were not always treated with kindness and respect. Some people were not happy with the attitude of staff and lack of good communication with the office.

People were supported to receive their medicines safely as prescribed. Staff carried out medicines risk assessments and put in place plans to support people safely.

Staff understood how to protect people from the risks of abuse and neglect. The provider had dealt with safeguarding concerns appropriately. The provider had used safe staff recruitment procedures.

Staff understood the principles of the Mental Capacity Act (MCA) 2005 and supported people to make their own decisions. People were happy when they received care and support from regular members of staff.

Some people were supported with their meal preparation, eating and drinking as part of their care and support. Staff supported people in line with their choices and preferences.

People and their relatives knew how to make a complaint and who to report to. People had made complaints about the service and the manner they were supported. The manager had addressed the complaints in line with the service’s procedures.

People’s needs were assessed and individualised support plans put in place. Staff held regular reviews and updated people’s care plans to reflect their changing needs.

Staff had received sufficient training to undertake their role. Staff received support from an out of hours on-call manager. The provider had implemented a tracker system to monitor staff visits and the quality of care and support provided to people.

The provider sent timely notifications to CQC on safeguarding concerns and serious incidents. Accidents and incidents were monitored and dealt with effectively. Checks were carried out to monitor the support and care offered to people and used to develop the service. People were asked for their views about the support they received and their feedback used to improve the service.

This announced inspection took place on 26 and 27 March 2015. Care UK Homecare Limited (London Bridge) provides personal care to 1,221 people living in their own homes. The service supports people in several London boroughs. Some people live in extra care housing units and receive care and support from a team of Care UK Homecare Limited (London Bridge) staff who are based in the unit. Most people’s care from the service was commissioned by local authority staff who had specified the amount and type of support people should receive.

Care UK Homecare Limited (London Bridge) was last inspected in April 2014 during the initial testing of the Care Quality Commission new inspection methodology and the service did not receive a published rating. It met all the regulations checked at that time.

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.

Prior to this inspection, relatives and a local authority commissioner told us that Care UK Homecare Limited (London Bridge) had not safely met the needs of some people with complex needs living in one extra care housing unit. During the inspection we confirmed that in the past year a small number of people living in this unit had repeatedly received unsafe and inappropriate care and support.

We found the registered manager had not ensured that staff fully understood the risks posed by people’s health conditions and how these should be taken into account when delivering people’s care and support.

Staff training did not adequately explain how risks to people should be assessed and recorded, so the guidance available to staff did not always contain important information about people’s needs.

Staff had not always received regular supervision and support and we could not be certain that they had the knowledge and skills to meet people’s needs.

During the inspection, the registered manager told us she was making changes to improve the service to people living in this extra care housing unit. A local authority social worker told us previous plans to improve the service people received had not been implemented. Therefore, it was too early to say whether these latest improvement plans would ensure people would consistently receive safe care and support.

The scope of the registered manager role at Care UK Homecare Limited (London Bridge) was broad due to the large number of people using the service and the fact that the service operated across several London Boroughs. Local authority commissioners told us this had an impact on the registered manager’s availability to implement improvements to the service people received.

Improvements were required by Care UK Homecare Limited (London Bridge) in relation to safeguarding people from the risk of unsuitable support; ensuring staff were competent to provide appropriate care and the leadership and development of the service.

We found breaches in relation to care and welfare, staff support and training and quality monitoring. You can see what action we told the provider to take at the back of this report.

This inspection also checked the quality of the service the majority of people received from Care UK Homecare Limited (London Bridge). People told us they were happy with the quality of the service when the same staff regularly supported them. However, they said when these staff were unavailable they were not always informed who would provide their care and support. Three local authority commissioners told us people gave them variable feedback on the reliability of the service.

People said staff were pleasant and friendly and treated them with respect. People said they were involved in planning their care. They said staff had assessed their needs and devised plans of care which staff followed. People told us they received appropriate support with eating and drinking and to access healthcare. People were telephoned or visited by staff from the service at regular intervals and were asked for their views of the service. Some people told us the service had made changes in response to their views about their care and support but other people told us the service did not keep them informed about changes to the members of staff who delivered their care.

The registered manager responded to complaints people made. Staff said their managers were supportive and records showed staff received regular training updates. The competency of staff to administer people’s medicines was checked.

The registered manager had some systems in place to monitor the quality of the service. For example, the quality of daily record keeping was checked and there were computer based systems to monitor the delivery of support visits. However, systems to monitor the quality of care planning and risk assessments were not yet in place. The registered manager had not carried out checks on the regularity and quality of staff supervision.

Care UK Homecare Limited (London Bridge) provides support, including personal care, to approximately 700 people in their own homes. The service operates in several London boroughs and provides assistance to people privately as well as to those referred by their local authority. It also assists people living in extra care housing schemes.

People told us they were happy with the care and support they received and said they would recommend the service to others. The service had assessed people’s needs and agreed with them a care plan which set out when and how they were assisted. People said the service was reliable and they received their support visits as planned.

There was a registered manager in place who had made improvements to the service. People were contacted by telephone to ask their views of the service and whether any changes to their support were required. In addition, the service arranged face to face meetings with people to review their needs.

People told us they had skilled care staff with whom they had a positive relationship. They said that their care workers ‘cheered them up’ and were always kind and respected them. People told us Care UK responded well to any queries and complaints. Some people said they were not always advised of changes to their support arrangements. For example, one person said they were not told the name of the care worker who would visit them whilst their regular care worker was away.

People told us they trusted their care workers and they felt safe. We found that people were protected from abuse. Staff were trained to recognise and report any concerns about people’s welfare. Hazards in relation to people’s safety, for example when moving around their home, were assessed. Plans were then put in place to reduce the risk of falls and other accidents. This helped keep people safe.

People said they received their medicines safely. This was because the provider had good arrangements in place to assess and meet people’s needs in relation to support with their medicines. People only received assistance with their medicines from staff who had been trained to ensure their competency. The provider checked that care workers had completed people’s medication records correctly. This ensured that there was clear information to confirm that people had received all their medicines as prescribed.

People told us that their care workers ‘knew what they were doing’ and provided them with the support they needed. Staff told us that the provider supported them to develop their skills and knowledge and they received regular supervision. All staff received training in key areas such as care planning and dementia care. Their knowledge was tested after they received training. There were robust arrangements in place which ensured all staff received follow up training at the intervals specified by the provider.

People told us that they were asked what assistance they needed with food and drinks when the provider assessed their needs. Care workers were trained to recognise nutritional risks to older people. They told us they would report any concerns they had to ensure that people’s family and health professionals were involved in helping to ensure people’s nutritional requirements were met.

During this inspection we spoke with 35 people using the service. All of the people we spoke with told us they were involved in the planning of their care.

We reviewed information about 12 people's care, we found their care needs were planned for and they were assigned suitably skilled care staff who understood people's care needs and how to protect them from risk of harm.

The majority of people spoken with were enthusiastic about the service they received and were complimentary of the carer. A large number of people had the same carer for a period of time which they appreciated for continuity of care. A person said "Tasks over and above the carers remit are carried out without asking ' it is simply done to make life all-round easier."

Care staff we spoke with said the management team were supportive and the training was good. Staff supervision and training was kept up to date.

The provider used systems to regularly check that care was being provided safely and appropriately, this was effective in identifying any shortfalls in the service and provision was made to respond to these appropriately. People acknowledged there were some issues in the past but they told us these were resolved to everyone's satisfaction.

People using the service told us that they were satisfied with the care provided by staff from Care UK Homecare Limited (London Bridge). They said that staff were reliable, polite and respectful. One person said about their carer "It means so much when she comes in every day" and said that they had never had a complaint. Another person said that they had "A good rapport" with the carers. They said that if the regular carer was being changed they asked to be kept informed of this and they had always been told of any change.

Staff told us that they enjoyed their work and felt well supported by Care UK Homecare Limited, they said they had good training and felt able to talk to senior staff about any concerns. They said that their rota was well planned and they had time to travel between the people they were supporting.

We received information from professionals who commission services. The majority of the information we received was positive. One person had concerns about a high number of missed and late calls in their area and felt that the lack of a locally based manager had a negative impact on the service provided. Other people stated that there had previously been issues of concern but they felt that improvements had been made and felt confident in new management arrangements.

People told us that they are satisfied with the service they receive from staff at Care UK. They said that they were helpful and friendly. One person said they prefer the weekday carers as they are more familiar to them and with their needs.

Local authorities who purchase a service from Care UK told us that they are satisfied with the care people receive.

Staff said that they receive good support and training opportunities to assist them in their work.

Archived: Mears Homecare Limited (London Bridge)

All Inspections

20 and 27 October 2015

During a routine inspection

26 and 27 March 2015

During a routine inspection

01/04/2014

During a routine inspection

8, 10 January 2014

During a routine inspection

13, 22 November 2012

During a routine inspection

14 February 2012

During a routine inspection