Background to this inspection
Updated
22 February 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector. An Expert by Experience carried out telephone interviews with people receiving care. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 6 January 2020 and 7 January 2020 with telephone interviews and ended on 10 January 2020. We visited the office location on 8 January, 9 January and 10 January 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We obtained feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We spoke with 18 people who used the service and one relative about their experience of the care provided. During the inspection we spoke with the registered manager, managing director, director of operations and assistant director of operations, deputy manager and care coordinators. We received feedback from 14 care workers. We reviewed a range of records which included the care plans for 18 people and multiple medication records. We looked at the records for five care workers in relation to recruitment and supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence we found. We looked as the training records and care worker rotas.
Updated
22 February 2020
About the service
Care Outlook – Hillingdon is a domiciliary care service providing personal care and support for people in their own homes. The majority of people receiving support had their care funded by the local authority. At the time of the inspection the service provided support for approximately 305 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Medicines were not always managed in a safe way to ensure they were administered appropriately and as prescribed.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People’s care plans did not always provide accurate information relating to the care and support they needed, so staff had all the information they needed to care for people.
The provider had a range of audits in place, but the audits in relation to care plans and the administration of medicines did not always provide appropriate information to identify where actions for improvement were required.
People told us they felt safe when receiving care. The provider had processes in place for the recording and investigation of complaints and incidents and accidents. Risk management plans were in place providing care workers with guidance on how to minimise risks for people using the service.
The provider had a recruitment process and there were enough care workers allocated to provide support based upon the care needs of people. Care workers received the training and supervision they required to equip them with the skills to provide care in a safe and effective way.
People told us they felt the care workers provided support in a kind and caring manner while encouraging them to maintain their independence whenever possible.
People had an assessment of their care and support needs completed before they started to receive care from the service. People were supported to access healthcare professionals when required.
The provider worked with other professionals and organisations to help ensure people had access to equipment and support in a timely manner as well as supporting people to take part in activities to reduce the risk of social isolation.
People using the service and care workers felt the service was well run.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 11 July 2017).
Why we inspected
This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive, Effective and Well Led sections of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
Enforcement
We have identified breaches in relation to person centred care, need for consent, safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.