London Care (Rochester)

Updated 13 August 2019

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

This inspection was carried out by two inspectors, three assistant inspectors, a directorate support co-ordinator and two Experts by Experience. 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 this was a large service and we needed to get details of the people using the service and arrange telephone interviews with people and staff.

Inspection activity started on 12 June 2019 and ended on 19 June 2019. We visited the office location on 13 June 2019.

What we did before the inspection

We reviewed information we held about the service including feedback received and statutory notifications. Statutory notifications are reports of events that providers have a legal duty to notify us of. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 19 people who used the service and 9 relatives. We also spoke with the registered manager, the regional manager, the regional director, two co-ordinators, and eight care staff.

We looked at care plans for 24 people, including information about risks and medicines. We checked 10 staff files and records of staff training and supervision. We reviewed the providers records of quality assurance including audits, surveys and spot checks. We looked at records of accidents and incidents and complaints, as well as meeting minutes and some policies.

After the inspection

We received information from the registered manager by email, including evidence relating to staff training and incidents. We also received an action plan of initial actions taken in response to our feedback.

Updated 13 August 2019

About the service: London Care (Rochester) is a domiciliary care agency providing personal care to people in the community in their own houses and flats. They provide support to people with physical disabilities, older people and people living with dementia and mental health conditions. At the time of this inspection, they were providing personal care to 353 people.

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

People told us they felt safe but we found records relating to risk were inconsistent and there were not always plans in place to keep people safe. People said calls were usually fulfilled on time but they told us that sometimes they were supported by inconsistent staff and the provider did not have a robust system to monitor call attendance and punctuality. Records relating to medicines were not always accurate and where inconsistencies were identified the actions taken to address them were not robust.

Assessments did not always gather enough detail and important information about people’s healthcare was not always documented. Care plans did not always contain detailed information about people’s preferences for care and we found instances where information about people’s culture was missing. Records relating to complaints and incidents sometimes lacked accuracy and the systems to check and audit care files were not robust.

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 supported this practice. However, there were gaps in documentation relating to people’s legal representatives where they could not consent and this was addressed by the service after the inspection.

People said staff were caring and promoted their independence. People said they liked the food prepared for them by staff. There was limited evidence of people’s involvement in care but staff were able to demonstrate ways they offered people choice and respected people’s dignity. Staff had received training and support for their roles and had regular meetings.

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 (Report published on 14 October 2016)

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to medicines, risks and personalised care planning. We also found shortfalls in the way the quality of care people received was monitored.

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.