North London Adult Care Ltd

North London Asian Care is a registered charity that provides personal care to people living in their own homes. It provides care and support to adults of all ages, but most of the people using the service at the time of our inspection were older people. The service specialises in providing a service for people from an Asian background but also supports people from all ethnic groups. People receiving a service included those with dementia, mental health issues and physical disabilities. There were 55 people receiving personal care at the time of the inspection.

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.

The risk assessment and care plans for a person with diabetes did not provide enough information for care workers to ensure safe care.

People using the service and their relatives were happy with the service. They received their care from care workers who got to know their needs well.

Staff completed training relevant to their role. Mandatory training had been completed. Some staff did not have training in certain topics which would enable to ensure consistent effective care. Staff arrived on time and stayed for the agreed amount of time. People had no complaints about timekeeping.

People received good support with their medicines. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff to provide the support people needed, at times of their choice. People received compassionate care. Care workers enjoyed their work and felt supported by the service. The service was able to provide most people with care workers who understood their culture, religion and spoke the same language as them. People and their relatives were happy with this service. Staff turnover was low, which supported people to receive consistent care from staff who knew them well.

The management team worked well together and everyone was aware of their responsibilities.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 April 2021). There was a breach of legal requirements found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a comprehensive inspection of this service on 16 February 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for North London Asian Care on our website at www.cqc.org.uk.

Recommendations

We made 2 recommendations. One was to improve the care plans and staff training for people with diabetes, which the registered manager started to do immediately. The other recommendation was to ensure good recruitment practice was followed consistently.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

North London Asian Care is a registered charity that provides personal care to people living in their own homes. It provides care and support to adults of all ages, but most of the people using the service at the time of our inspection were older people. The service specialises in providing a service for people from an Asian background but also supports people from all ethnic groups. At the time of the inspection there were 77 people using the service.

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

People were generally happy with the service. They had good relationships with their care workers and said the care workers knew their needs well.

Risks identified with people’s health, care and support needs had been assessed and risk assessments had improved since the last inspection. People received their medicines safely and as prescribed. Policies and systems in place supported this.

People and relatives told us that they were supported by regular care staff who generally arrived on time.

Care staff had access to the required personal protective equipment (PPE) to prevent and control the spread of infection.

People’s care plans had improved to reflect their needs better, the service had started providing individual supervision to staff, new systems had been implemented to monitor staff arriving at people’s homes on time and to monitor whether staff had supported people to take their medicines each day.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

People were supported with their nutrition and hydration where this was an assessed need. The guidance on the type of food people liked to eat and whether they needed support to eat lacked detail in some cases.

The service supported people with their health by raising any health concerns with health professionals and family members when needed.

Care workers spoke positively about the registered manager and management team. They told us they felt supported and could call for advice and guidance at any time.

There were procedures in place to respond to complaints.

There had been some improvements in the management of the service since the last inspection. The registered manager had implemented some new systems and audits to monitor the quality . The registered manager and the provider were aware that further improvements were needed and they were meeting regularly to monitor improvements.

People and their relatives gave positive feedback about care workers but some negative feedback about the management team and the way they engaged with them. .

The service had a recruitment policy which included all the required checks on new staff but the policy had not been consistently applied and some required checks had not been carried out. The registered manager carried out the missing checks when we raised this concern.

We have made two recommendations. We recommended the service consider giving people a copy of their care plan in a way they can understand, for example in a language they are able to read and we have recommended that the service seek advice and training on good practice in customer relations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 28 April 2020). The service remains rated requires improvement.

There were breaches of regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 ( Regulated Activities) Regulations 2014 at the last inspection. The concerns were about lack of person-centred care plans, medicines management, risk assessments, staffing and overall management of the service. The service was rated requires improvement in all areas.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of those regulations.

Why we inspected

This was a planned inspection based on the previous rating and continued concerns about the service.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach of regulation in relation to staff recruitment as the service was not consistently following best practice in recruitment new staff. This was a breach of regulation 19 (Fit and proper persons) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 meet with the provider and return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

North London Asian Care is a non-profit making registered charity that provides personal care to people living in their own homes. It provides care and support to adults of all ages, but most of the people using the service at the time of our inspection were older people. The service specialises in providing a service for people from an Asian background but also supports people from all ethnic groups. At the time of the inspection there were 103 people using the service.

People’s experience of using this service and what we found

People’s care plans were not person centred and were task focused.

There was mixed feedback about the competence of staff. Staff did not receive regular supervision. We have made two recommendations about person centred care planning and assessing staff competence and performance.

We received some feedback about instances of poor staff communication and timekeeping concerns. Medicines records did not accurately and consistently reflect the support people needed particularly in relation to topical creams.

Risk assessments lacked guidance in relation to managing and mitigating risks to ensure people are safe.

There were systems in place to assess and monitor the quality of the service provided. However, were not sufficiently robust to identify that improvements were needed in relation to risk assessments, medicines, staff timekeeping and communication, staff competence and regular supervision and care plans not being person centred.

People told us they felt safe using the service. Staff followed appropriate infection control practices. Accident and incidents were recorded and acted upon. Any lessons learnt were used as opportunities to improve the quality of service.

Assessments were carried out prior to people joining the service to ensure their needs could be met. People were supported to maintain good health and access to a range of healthcare services when needed. People were supported with their food and drink.

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.

There were procedures in place to respond to complaints. The provider had investigated and responded promptly to any concerns received.

The provider worked in partnership with healthcare services and professionals to plan and deliver an effective service.

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 1 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified four breaches in relation to safe care and treatment, deployment of staff, person centred care 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in February 2016 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

North London Asian Care is a non-profit making registered charity that provides personal care to people living in their own homes. It provides care and support to adults of all ages, but most of the people using the service at the time of our inspection were older people. The service specialises in providing a service for people from an Asian background but also supports people from all ethnic groups. At the time of the inspection there were 115 people using the service.

There was a registered manager in post at the time of our 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 and associated Regulations about how the service is run.

People told us they felt safe with the staff who supported them in their home and they were treated with kindness. Staff understood their responsibilities in keeping people safe from bullying, harassment, avoidable harm and potential abuse.

Potential risks to people’s safety had been identified and ways to mitigate these risks had been discussed with the person and recorded so staff knew how to support the person safely.

People told us that staff came at the time they were supposed to or they would phone to say they were running late.

Recruitment systems were robust to ensure that only the right staff were recruited to keep people safe.

Staff we spoke with had a good knowledge of the medicines that people they visited were taking. People told us they were satisfied with the way their medicines were managed.

People who used the service and their relatives were positive about the staff and told us they had confidence in their abilities and staff told us that they were provided with a good level of training in the areas they needed in order to support people effectively.

Staff offered choices to people as they were supporting them and people told us they felt involved in making decisions about their care.

People told us they were happy with the support they received with eating and drinking and staff were aware of people’s dietary requirements and preferences.

People confirmed that they were involved as much as they wanted to be in the planning of their care and support. Care plans included the views of people using the service and their relatives. Relatives told us they were kept up to date about any changes by staff at the office.

People and their relatives told us the management and staff were flexible and quick to respond to any changes in their needs. Care plans reflected how people were supported to receive care and treatment in accordance with their current needs and preferences.

People told us they had no complaints about the service but said they felt able to raise any concerns without worry.

The service had a number of quality monitoring systems including yearly surveys for people using the service and their relatives. People we spoke with confirmed that they were asked about the quality of the service and had made comments about this. They felt the management listened to them and took their views into account in order to improve service delivery.

After the inspection the provider contacted us and informed us that a new manager had been appointed at the agency and had applied to be registered with the Care Quality Commission.

This focussed inspection took place on 22 January 2016 and was announced. We gave the provider one days’ notice that we would be visiting their head office. We gave the provider notice as we wanted to make sure the registered manager was available on the day of our inspection. This inspection was carried out by a single inspector. This report only covers our findings in relation to the registered manager within the well-led section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for North London Asian Care on our website at www.cqc.org.uk

North London Asian Care is a non-profit making registered charity that provides personal care to people living at home. It provides care and support to adults of all ages, but most of the people using the service at the time of our inspection were older people. The service specialises in providing a service for people from an Asian background but does also support people from other ethnic groups.

We met with the registered manager and saw that their registration certificate was on display in the agency head office. 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 and associated Regulations about how the service is run. The service is required by law to have a registered manager. Because the service now had a registered manager in post we were able to change and revise the rating for the ‘Well-Led’ section from ‘requires improvement’ to ‘good’.

People's needs were mostly assessed. Some care and treatment was planned and delivered in line with the person's individual care plan. However this did not include regular reviews to ensure people’s needs were met. One relative told us “They have not assessed recently and only come once a year and do it.”

Appropriate care planning was mostly taking place. Records showed that prior to people receiving care in most cases an assessment had been made of people's needs. This included the involvement of other professionals.

The provider was not taking appropriate steps to ensure that there were sufficient numbers of suitably qualified, skilled and experienced persons employed to safeguard the health, safety and welfare of people. There was not enough supervision or management capacity to carry out the co-ordinator tasks.

The provider was not regularly assessing and monitoring the quality of the service and identifying and managing risks. We did not see evidence of audits or periodic reviews of the service to identify those risks. One person told us “The agency, has not taken any performance review or any consultation.”

Relatives told us they felt staff understood the needs of the people. Relatives of people who use the service confirmed that regular checks were carried out to make sure that people received the quality of care they expected. They told us that if they preferred they could talk to someone in their community language when providing feedback about the service.