Archived: London Care (Wallington)

London Care (Wallington) is one of several services owned by London Care Limited. London Care (Wallington) is a large domiciliary care agency which provides personal care and support to people in their own homes. The majority of people using the service were funded by their local authority but some people were paying for their own care. At the time of our inspection there were approximately 100 people using the service. People who use the agency had a wide range of needs include those associated with dementia, mental health and learning and/or physical disabilities.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run. The registered manager on our records had moved to another of the provider’s services and a new manager had been appointed for this service. They had submitted their registered manager application to CQC.

We found the provider in breach of their legal requirement with regard good governance. The provider did not have a complete picture about the support people experienced, to be reassured that this was being provided to a good quality standard. This was because the arrangements in place to regularly seek people’s views about the quality of care and support they received had not been consistently followed.

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

Other opportunities were available to people to participate and become involved in consultations and discussions about wider service improvements or changes. There were internal mechanisms in place to check service standards such as internal audits by senior managers. Senior staff were clear where current shortfalls and gaps were in the service and were taking action to address these. These reflected issues we identified during this inspection around frequency of reviews of people’s care and support needs, staff supervision, and current arrangements to gain people's views about the quality of support they received. All staff were aware of their responsibilities for ensuring people experienced good quality care. There was accountability and responsibility for achieving this at all levels. However it was too early to judge at the time of this inspection how the improvements being made had improved outcomes for all people using the service.

Some people’s care and support needs had not been reviewed within agreed timescales so that information about these was up to date and current. Action was being taken at the time of this inspection to ensure overdue reviews would be prioritised. Where people’s needs had been reviewed, and changes were required to their care and support package, support plans had been updated to reflect this. People told us their views were taken into account when staff assessed their care and support needs. People’s support plans were reflective of their specific needs and preferences for how they wished to be supported. People said staff had a good understanding of their needs and how these should be met.

Records showed not all staff had received recent supervision so that they were appropriately supported in their roles to care for people. Senior staff had taken action to ensure supervision meetings were scheduled to take place in the coming weeks to bring these up to date. Despite this, staff said they were very well supported by senior staff and felt able to discuss with them any issues or concerns they had. Staff received relevant training to meet people’s needs. Senior staff monitored training to ensure staff’s skills and knowledge were kept up to date. Staff said they were asked for their views and suggestions about how the service could be improved and encouraged to report any poor working practices they observed.

The majority of people we spoke with were satisfied with the care and support they received. People said they were comfortable raising any issues or concerns they had directly with staff and knew how to make a complaint if needed. They provider used learning from these and from visits by the local authority contracts team to continuously improve the service.

People told us staff looked after them in a way which was kind, caring and respectful. People’s right to privacy and dignity was respected and maintained by staff, particularly when receiving personal care. People were encouraged to do as much as they could and wanted to do for themselves to retain control and independence.

People told us they felt safe with the care and support provided by the service. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse and not harmed by discriminatory behaviour or practices. Risks to people’s health, safety and wellbeing had been assessed by senior staff. Staff were given guidance and instructions on how to minimise any identified risks to keep people safe from harm or injury.

The provider ensured people were supported by staff that were suitable and fit to work for the service. The provider had robust recruitment procedures and carried out employment and criminal records checks on all staff. The majority of people told us they had no concerns about staff turning up late or missing a scheduled visit. This indicated there were sufficient numbers of staff available to support people. Staffing levels were monitored by senior staff to ensure people’s needs could be met at all times.

Where the service was responsible for this, people were encouraged to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. They received their medicines as prescribed. Staff monitored people’s general health and wellbeing. Where they had any issues or concerns about this they took appropriate action so that medical care and attention could be sought promptly from the relevant healthcare professionals.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff received training in the MCA so they were aware of their roles and responsibilities in relation to the act. Records showed people’s capacity to make decisions about aspects of their care was considered when planning their support. Where people lacked capacity to make specific decisions there was involvement of their relatives or representatives and relevant care professionals to make these decisions in people’s best interests.