Archived: London East

Updated 21 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 8 January 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. The inspection team consisted of two inspectors.

Before we visited the service we checked the information we held about the service and the service provider. This included any notifications and safeguarding alerts. A notification is information about important events which the service is required to send us by law. The inspection was informed by feedback from professionals which included the local borough contracts and commissioning team that had placed people at the home, the local borough safeguarding team, and local clinical commissioning groups. We reviewed the information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During our inspection we spoke with the manager, one team leader, one client coordinator, and three care workers. We looked at five care files, staff duty rosters, six staff files which included supervision records and recruitment records, a range of audits, minutes for various meetings, two medicines records, accidents and incidents, training information, policies and procedures, and complaint information. After the inspection we spoke with four people who used the service and five relatives.

Updated 21 February 2018

This inspection took place on 8 January 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

London East is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing a service to 20 people.

The service did have a registered manager however the person had been promoted elsewhere within the company. The service had a different member of staff acting in the role of manager with day to day responsibility for running the service. The manager had started the process to apply for the role of 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 the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Responsive, Effective and Well-led to at least good. The service was last inspected in November 2016 when we identified breaches of regulations regarding notifications of other incidents, need for consent, staffing, safe care and treatment and good governance. We asked the provider to take action to make improvements. Although the provider had addressed specific concerns around notifications of other incidents, need for consent and staffing, the breaches of regulations continued on this inspection in relation to safe care and treatment and good governance. We also found on this inspection a breach of regulation for person centred care.

We found care plans lacked detail regarding the specific nature of the support people needed and people’s preferences were not always clearly captured.

Risks people faced had been identified, but the measures in place to mitigate them were not clear. Medicines records for people who received medicines on a ‘when required’ basis (PRN) were unclear. PRN medicines are to be taken as needed instead of on a regular dosing schedule. The governance and audit arrangements of PRN medicines had failed to identify or address the range of concerns found during the inspection.

Staff received regular supervision and records showed staff were able to give feedback and suggestions about how the service should be run. However it was not always clear senior staff provided support and guidance following feedback received in supervision. We have made a recommendation about supervision.

The service was recording complaints however outcomes and learning points identified had not been recorded. We have made a recommendation about the management of complaints.

Staff undertook training to help support them to provide effective care. Staff had a good understanding of the Mental Capacity Act 2005 (MCA). MCA is legislation protecting people who are unable to make decisions for themselves.

People and their relatives told us they were supported with choosing what they wanted to eat and drink with the support of staff.

People’s cultural and religious needs were respected during care planning and delivery. Discussions with staff members demonstrated they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

People who used the service and their relatives were positive about the staff and told us they were caring. People and their relatives were involved in the planning of their care.

Staff, people and their relatives felt the manager and the office staff were approachable and accessible.

We identified breaches of three regulations. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for the service is Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.