Westminster Homecare Limited – Norfolk and Suffolk

Westminster Homecare Limited (Norwich) is a domiciliary care service providing personal care to people living in their own homes. 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. At the time of our inspection there were 68 people receiving the regulated activity of personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not provide care or support to autistic people or anybody with a learning disability. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support: Model of Care and setting that maximises people’s choice, control, and independence

Systems were in place to collate people's feedback on the service they received. Some people felt communication needed to improve around changes to their care calls and the provision of a rota for their calls. We have recommended the provider review this area. The provider had implemented a system to ensure calls were monitored live. This system supported calls being on time and ensured no missed calls occurred.

Right Care: Care is person-centred and promotes people’s dignity, privacy, and human rights

People were supported to stay safe. Safeguarding concerns were identified and acted on. People received their medicines as prescribed. Infection control risks were responded to appropriately and staff were provided with personal protective equipment.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive, and empowered lives.

Some people felt newer staff did not always understand how to support them. We have recommended the provider review this area further. The management team had good oversight of quality and risks within the service. Effective governance systems were in place. The management team were keen to develop and improve the service. They engaged effectively with external resources to help support this.

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 requires improvement (published 11 June 2021).

Why we inspected

We received information that indicated improvements had been made in relation to safe and well-led. As a result, we undertook a focused inspection to review the key questions in these areas only.

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 based on the findings of this inspection.

Recommendations

We have made two recommendations regarding the communication of call times and reviewing the competency of new staff.

Follow up

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

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

Westminster Homecare is a domiciliary care service. They provide personal care and support to people living in their own homes. 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. At the time of our inspection the service was providing a regulated activity to 88 people.

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

There were some gaps in the registered manager’s awareness of the organisation and quality of service some people were receiving. Staff did not always display professional, safe and caring conduct when visiting people.

There was not always a positive working culture which included staff and people fully in the running of the service. Staff worked well as a team, but there was some separation between the care staff and office staff in terms of teamwork.

People using the service and their relatives felt that the management team were approachable and felt comfortable to contact them if they had a problem.

There were mixed feelings about whether people and their relatives felt involved in the service and their care, and staff were not always informed about changes in a timely manner.

There were enough safely recruited staff to cover care visits. People who had a consistent group of staff for their visits were more positive than those who received care from many different staff members.

There were systems in place which supported staff to keep people safe from harm.

Care plans contained information relating to risks to people, and guidance for staff to mitigate these. Some further information and guidance around specific risks associated with health conditions would be beneficial.

Where it was included in their care, staff supported people to take their medicines safely. Risks relating to medicines had been fully assessed and recorded in the care plan.

Systems were in place to prevent and manage the spread of infection, including COVID -19.

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 Requires Improvement (published 7 August 2019). At this inspection enough improvement had not been made and the rating remains the same.

Why we inspected

This was a planned focussed inspection on Safe and Well-led, based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westminster Homecare Limited on our website at www.cqc.org.uk

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Westminster Homecare Limited (Norwich) is a domiciliary care service providing personal care to 100 people 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

At this inspection, we found that there continued to be a lack of effective managerial oversight of the service. The quality assurance checks in place did not enable the registered manager and senior staff to respond quickly to resolve problems regarding late care visits. Although care visits to support people were not being missed, people using the service and relatives informed us that at times the staff were late attending the care visits and they were not always informed of the situation. This caused distress in some cases, as people could not be confident that the staff would attend to provide their care.

Staff were recruited through a robust recruiting procedure. However, we found there were not always enough staff employed to attend to people’s arranged care visits at the times stated. This resulted in staff sometimes running late and we were also informed that insufficient travelling time was allocated to staff between call visits.

Each person had a care plan containing a risk assessment. Staff were aware of people’s needs and how to support them. This included recorded information in the care plans regarding peoples prescribed medicine’s and staff had received training in the administration of medicines.

The staff were provided with supervision and on-going support including training. Staff recorded when necessary how they had supported people to have enough to eat and drink of their choice. People’s care plans recorded information about support provided by other professionals and when appointments had been made for them by the staff with their permission.

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.

People told us that their personal care and support was provided in a way which maintained their privacy and dignity. People spoke positively about the way staff treated them and reported that they received appropriate care. Staff demonstrated a good knowledge and understanding of the people they cared for and supported, such as people with a diagnosis of diabetes or dementia.

The registered manager and senior staff carried out an assessment of people’s needs before they commenced using the service. The information recorded identified how the support was to be provided in line with the person’s preferences and choices. The service had a complaints process and we saw that complaints were recorded and responded to in line with the recorded procedure. Some relatives were complimentary about the support provided by members of staff, while also expressing concerns about the inconsistency of knowing which staff were coming to care for their relative.

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 requires improvement (published 23 October 2018) and there were two breaches of regulations. 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 some improvements had been made and the provider was no longer in breach of regulations.

The last rating for this service was requires improvement (published 23 October 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. We will describe what we will do about the repeated requires improvement rating in the follow up section below.

Why we inspected

The inspection was prompted in part due to concerns received about medicines administration, staff training and late call visits. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Westminster Homecare Limited (Norwich) is a domiciliary care agency that provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our visit 145 people were using the service.

Not everyone using Westminster Homecare Limited (Norwich) receives a 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.

There was a registered manager at this agency who was supported by an office staff and other senior staff. 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.

At our previous inspection we rated this service as Requires Improvement. The rating remains Requires Improvement at this inspection. 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, Effective and Well-led to at least good.

The provider’s monitoring process did not effectively identify issues or take action to resolve these, in particular in relation to medicine recording errors. Medicine administration records were not always completed correctly and this put people at risk that they had not received their medicines as prescribed.

Staff knew how to respond to possible harm and how to reduce most risks to people. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Staff used personal protective equipment to reduce the risk of cross infection to people.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). 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. People received support with meals, if this was needed.

There was enough information for staff to contact health care professionals if needed and staff followed the advice professionals gave them.

Staff were caring, kind and treated people with respect, although the agency did not always respect people’s right to be cared for by staff of the gender of their choice. People were listened to but were not always asked about their care. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and care records were in place and contained enough information to guide staff in how to do this.

A complaints system was in place and there was information available so people knew who to speak with if they had concerns. Staff had adequate guidance and support to care for people at the end of their lives, if this became necessary.

People’s views were sought but no action was put into place to improve issues that were raised.

Staff were supported by and supportive of the registered manager and office staff.

We found a breach of Regulation 12 and of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regard to medicines management and to the governance of the agency. You can see what action we told the provider to take at the end of this report?

Further information is in the detailed findings below

There was a registered manager in post. 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.

At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We identified a breach of Regulation 12 because risks were not always adequately assessed and actions were not always taken to mitigate the risks to people. Concerns for people’s safety were not sufficiently analysed to help identify patterns of concern. The service had not always ensured they had current and up to date information regarding staff they employed. Medicines were not always safely managed or always given as the prescriber intended.

We found the service was also in breach of Regulation 17. This was because the provider’s quality assurance systems had failed to identify the improvements needed. Recording regarding people’s care needs and how the service had taken action in response to concerns was poor. People’s care records did not always contain sufficient guidance and information for staff.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA. Not all staff understood what the MCA was and how this impacted on their practice. We found the provider was in breach of Regulation 11 as the service was not consistently working within the requirements of the act. This was because mental capacity assessments were not carried out to determine if people were able to make decisions, and if not, a best interests process was not always followed.

Staff spoke positively regarding their training, however we found training was not always provided that was specific to staff role or people’s specific needs and health conditions. New staff were provided with a comprehensive induction and the service carried out checks to ensure they were confident and able to carry out their role.

The service liaised with health care professionals to support people’s health care needs, where required. However, it was not always clear if this was always done appropriately or when required.

The majority of people received support from regular and consistent staff. This helped staff to provide support in accordance with people’s needs and preferences. However, we found some examples where this was not always the case and people did not always receive support that met their individual needs or preferences.

People told us they knew how to complain and raise concerns. Some of the people we spoke with told us they did not always receive an apology or a clear response to the issues they raised. Formal complaints were investigated and responded to, however where issues were raised in a less formal manner they were not always responded to.

There was mixed feedback from staff regarding the support and leadership of the service. Some staff felt adequately supported by the service managers and administrative staff whilst others did not feel management were always approachable. We also received conflicting feedback from staff regarding morale in the service.

People were supported by caring staff who treated them respectfully and with dignity. Staff supported people to be as independent as possible and consulted them regarding the support provided.

People we spoke with told us that the carers met their needs. One person commented 'They are very efficient; I generally get to see the same carers which means I have been able to build good relationships.' Another person stated 'I have a decent team of carers that come and see me, they know my routines and how I like things done.'

We spoke with five members of staff about their knowledge of infection control practices. Each person spoken with had a good understanding of the requirements. These included the need to wear personal protective equipment such as gloves and aprons. Staff were also aware of the requirement to maintain good hand hygiene.

Appropriate checks were undertaken before staff began their employment at this service. This meant that only suitably vetted people were employed to work with vulnerable adults.

The provider had an effective system to regularly assess and monitor the quality of service that people received.