This inspection took place on 24 and 25 September 2018 and was announced.At an inspection of this service on 4, 5 and 6 April 2017 we found that some aspects of the management of medicines were not safe and so there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the quality assurance systems regarding medicines auditing and the management of staff rotas and late visits were not well managed and so there was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to the serious nature of the breaches we took enforcement action against the registered provider. Two warning notices were issued, for breaches of Regulations 12 and 17. Warning notices give the provider a specific time frame in which to improve in the areas identified at the inspection.
On 1 and 7 September 2017 we undertook a focused inspection to check whether the service had met the breach of legal requirements in relation to Regulations 12 and 17, concerning safe management of medicines, quality assurance of medicines and staff rotas, which had resulted in
enforcement action. We found that the service had failed to meet the requirements of the enforcement action we had taken and continued to be in breach of Regulations 12 and 17.
Following that inspection, we wrote to the provider using our powers under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, to ask the provider to send specific information on actions they intend to take to address the concerns that we had raised and by when to improve the key questions of ‘Safe’ and ‘Well-led’ to at least good. An action plan was submitted which detailed the steps they planned to take to make the required improvements.
The local authority for Enfield had placed an embargo on Westminster Homecare (Enfield / Waltham Forrest) following the inspection in April 2017 to prevent the service taking on any new people. The provider also implemented a voluntary restriction on referrals from the London Borough of Waltham Forest until the necessary improvements had been implemented. The provider lifted the voluntary suspension for new referrals from Waltham Forest in January 2018. The London borough of Enfield lifted the embargo place on the service in August 2018 after significant improvements had been noted.
Westminster Homecare (Enfield / Waltham Forest) is a domiciliary care agency. It provides They provide a wide range of personal care options to people living in their own houses and flats in the community. It provides a service to older people, some of who are living with dementia. At the time of this inspection the service was supporting approximately 173 people.
Not everyone using Westminster Homecare (Enfield / Waltham Forest) receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
A registered manager was in post 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.
During this inspection we found that the provider had made significant improvements and had addressed the breaches previously identified and was now meeting the regulatory standards.
However, we continued to receive feedback from people and their relatives that timekeeping remained an on-going concern and that people and their relatives did not believe that the service communicated with them effectively especially when care staff were running late or when changes had been made to the care staff they were scheduled to receive. We have made a recommendation around further improving systems and processes when allocating sufficient travel time so that people receive their care call on time.
People received their medicines safely and as prescribed. The provider had implemented robust systems and processes to ensure that medicines management and administration was safe and closely monitored. However, some concerns were noted around the recognition of certain high-risk medicines and their side effects and the documentation around as and when required medication.
The registered manager and provider had introduced a variety of processes which enabled the service to regularly and comprehensively monitor the quality of care provision. Issues and concerns identified were clearly recorded and where improvement and learning were required this had been implemented.
Risks associated with people’s health and care needs were identified through the care planning process. Guidance and information was available for care staff to follow so that people’s known risks could be reduced or mitigated to keep people safe.
Care staff were able to describe the different types of abuse people could experience and clearly explained the steps they would take if abuse was suspected.
Safe recruitment processes were followed to ensure only those care staff assessed as safe to work with vulnerable adults were employed.
Care staff received appropriate training and support to effectively carry out their role. This included induction, refresher training, supervision and an annual appraisal.
People were supported with their nutrition and hydration needs where this was an identified and assessed need as part of the person’s package of care.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
The service supported people with their health care and medical needs where required. Where people required additional care and support, appropriate referrals had been made to the relevant healthcare professionals.
Care plans were person centred and detailed and clearly set out the person’s support needs which enabled care staff to deliver care.
People and their relatives told us that care staff were caring and engaged with them whilst supporting them with their needs.
People and their relatives knew who to speak with if they had any complaints or issues to raise. However, most people and relatives told us that they did not feel their complaints were always adequately addressed.
Most people and their relatives knew their allocated care coordinator more than they knew who the registered manager was. The care co-ordinator was the person who was always in contact with them about their care and support package.