London Care - Brighton

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We identified 1 breach of legal regulation for dignity and respect. People were not always treated with kindness, compassion and dignity. They told us some staff were rude and task orientated instead of focusing on the person and how they wanted to be supported. People had raised concerns with the provider about the conduct of some staff. However, no additional training or support was given to staff to ensure better experiences for people. Most people told us they were independent. However, staff could not always explain how they promoted people’s independence. Some care plans did not contain information on how people wanted to be independent and what they could do themselves. People told us they did not have a regular group of care staff who could get to know them well. Some staff could not give examples of how they knew a person well or how they would respond if a person’s needs had changed. Care plans did not always fully reflect people’s physical, mental, emotional and social needs. Although most staff spoke positively about leaders, not all staff knew about the providers whistleblowing policy and how to raise concerns when things had gone wrong. The provider told us they hold care awards for staff to recognise and celebrate their achievements.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives were not always positive in their feedback about staff. They told us they had reported concerns about staff being rude and task orientated. Feedback from people about staff treating them with dignity and respect was mixed. Comments included, “Some are nice, can be kind and caring”, “I think so, some carers are very polite”, “Some do but not all”, “No I don’t think they understand dignity and respect” and “I’m not sure they respect my privacy as I am not always covered up.”

Some staff described ways they demonstrated kindness and compassion to people. One staff said, “Most important to go in and be pleasant, have a chat, be nice and offer even if they don’t accept. For example, to prepare food, clean certain things, try to make it a good experience.” However, some staff told us about care tasks they completed and could not explain how they treated people with kindness and compassion. Leaders did not always recognise poor conduct of staff or take appropriate actions. For example, during a routine supervision, 1 staff spoke about a person they supported in a disrespectful manner. However, the supervisee did not address this lack of respect towards the vulnerable person, nor offer retraining for the staff member.

Professionals feedback included concerns had been raised about lack of dignity, respect and privacy but that the provider was working to address them. The provider had systems in place to ensure people were treated with dignity and respect however these were not always effective. People had raised concerns with leaders about the conduct of some staff. Although leaders addressed the theme of conduct and behaviour of staff in a team meeting, concerns had not been followed up with individual staff, nor additional training or support given to ensure better experiences for people.

People and relatives told us they were not always treated as individuals, that staff were focused on completing their tasks and leaving for the next care call. Some comments we received were, “I have to tell them what is needed to be done, and how to do it. But they just ignore me and stand or sit in the lounge on their phones. Staff obviously have not been trained nor do they have any initiative. They don’t communicate at all”, “They don’t even put on [persons] tv or even speak to them when sitting in the lounge with them. They are rude and are on their phones all the time” and “My [person] is very apprehensive about having them in the home as they just come in, no greeting, no eye contact and no conversation. Never offer them a drink or any other support. It’s not really acceptable to be treated in this way.”

Feedback from staff was mixed. Some staff told us about different ways they could support people, such as “Everyone has different needs. I have not had to deal with anything religious. I treat service users with respect and dignity. I have not had to deal with anyone and their religious beliefs, I just treat them the same. I am Christian and if I go to a Muslim, I will respect them and take off my shoes when going into their home” and “I would ask them questions. If I want to know anything about them, I need to communicate with them. They have it written in their care plans. You read it on the work phone.” However, some staff could not explain or give examples of how they treated people as individuals, nor understood how equality and diversity was relevant to their role. Not all care plans had personalised information about people such as their beliefs or cultures.

The provider had an equality and diversity policy, and staff had received training in this. However, there were gaps in staff knowledge and the support they provided. People had raised concerns with leaders about staff conduct but this had not been dealt with appropriately. People’s needs and personal preferences were not always at the centre of their care and decision making about how best to support people to achieve the best outcomes. For example, one person told us they had to adapt to what the service could provide, “When carers change my pads it tends to be a male and female carer. I was not happy with that to start with, but I have got used to it now.”

People told us they were mostly independent and made their own choices. Some comments included, “I am as independent as I can be”, “I presume so, but [person] is still independent to a point”, “I’m never restricted” and “Carers ask if I want any other help, but I am as independent as is possible.”

Some staff gave us examples of how they supported people with choice and control. For example, “Always offer choice every step for example when picking out clothes”, “Food, some may want to eat a certain thing. We offer choice and encourage them to pick what they like best” and “Every client has choice to choose what they want to do. I ask them what they want.” Three staff told us how they supported people to be independent. One staff told us, “A client says they do things themselves, so we encourage them. We don’t force them. Sometimes they don't want to do it, so I do it for them. Like making a sandwich”. However, some staff could not explain or give examples of how they encouraged people to be independent.

Care plans did not always fully reflect people’s physical, mental, emotional and social needs. Care plans did not always contain information about how people would like to be independent and what they could do themselves. Interests and hobbies were not always documented. The provider had an action plan to review care plans. However, this would take time to embed.

People and relatives told us staff did not always identify or respond to their immediate needs. People were concerned about receiving lots of different carers instead of having a small team that could get to know them well. Feedback included, “The confusion is that we don’t have consistent regular carers. In fact, there can be at least 15 different carers visiting my [person] a week whom we do not know”, “Well there has been changes of 3 managers within the last 3 months and no I do not get regular carers. I’m not surprised with this agency and lack of leadership” and “In the 6 weeks of having carers visiting, I have had lots of different carers, who I do not know or have ever met before.” Care calls were often late or cut short, and some calls were missed. A professional told us, “I have just had a service user’s relative call me in distress as their loved one’s carers had not turned up and they are bed bound requiring pad changes throughout the day. [Relative] had tried calling the number the provider gave him, but it kept going to voicemail.”

Feedback from staff about how they would respond to people’s changing needs was mixed. One staff said, “It may be physical changes. We may see they are declining in health or in pain. We have to be very observant, talk to them and ask if they are ok. We make a note for feedback and communicate with the manager. We let them know if someone is not well.” However, some staff could not tell us about the people they supported and could not demonstrate they knew them well enough to identify changes to their needs. Most staff told us they did not always have consistent schedules to support the same people, or enough travel time as they were reliant on buses for transport. They told us if they were running late, they would try to complete tasks quickly in order to get to the next call on time.

Feedback from staff about whether they felt supported and valued by leaders was mixed. Some positive comments included, “They are very good if there is an emergency and can't work, they are very good about it and make sure everything is ok. If had a problem I would talk to the manager, and they would be kind” and “I had a situation recently where I got sent to a new client. They were saying things I was uncomfortable about. I called the office, and they took the client off my rota.” However, one staff told us, “On one occasion, my work phone wasn’t syncing correctly, and didn’t show any shifts on [day]. Therefore, I made arrangements on that day, not knowing there was an issue with the phone. I went to the office to double check; the manager was quite aggressive and even used an offensive word that bothered me a lot”. Staff told us they had been raising concerns about not having enough travel time and not being paid for travel time. The branch manager told staff during a team meeting they were reviewing the rota and area zones to improve punctuality by reducing travel time. Staff told us the office provides them with PPE.

Staff felt they were not always able to report concerns about discrimination to leaders. One staff told us if they faced discrimination, they would only report it if it happened more than once. Another staff member said, “If people are rude, just keep smiling and sometimes, they apologise and start laughing.” One supervision record advised a staff member “To defuse any confrontation with [name] if possible and report back to the office”. The provider told us they were working with staff to encourage them to raise their concerns. However, this would take time to embed. The provider told us they hold care awards for staff to recognise and celebrate their achievements.