London Care - Brighton

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s needs were not always robustly assessed, and some care plans lacked detailed information around the person’s needs and wishes. People’s care and treatment needs were not always routinely monitored which meant some people did not have good outcomes. Some staff lacked knowledge of mental capacity, and how it applied to their roles. People told us they were not always asked for their consent before staff completed tasks. The provider worked with external agencies. However, communication was not always effective to ensure care was co-ordinated.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were not always assessed before they began using the service. Feedback from people was mixed. Comments included, “Yes someone came to the home, but didn’t ask my wife what she required or what my wife was capable of and her abilities”, “They did visit but the information was not put on the system, so carers did not know” and “I don’t think I was asked what I needed 6 weeks ago. I have not seen anyone visit me to ask such questions, nor have I had a letter to inform me of the service I would be getting. One night a carer turned up at my house without me knowing and told me she was my carer. This occurred on 3 days. Then I was notified that I had a service.” People's care documentation was not always reflective of their current support needs.

The registered manager told us they had an assessment process for people before they receive a package of care from the service. They said, “When we receive a referral from the local authority, we read through the social worker care plan, and initially decide on whether we can meet the customer needs. We then reply to state that we initially accept and share a potential assessment date and potential start date. We then book in the assessment with the customer and start our assessment with the customer.” The provider told us how they use their computerised system to put information directly onto a care plan. They told us they did not have a pre-assessment tool or form, nor could they provide evidence of a person’s assessment meeting prior to them starting a care package. Care plans contained information for staff about lone working and how to reduce risk of danger to themselves.

The provider told us about their pre-assessment process. However, care plans were not always completed. One person’s care plan which was updated in April 2024 was blank apart from some care task guidance for staff. Where some care plans and risk assessments were updated during this assessment, not all people were involved to ensure the information accurately reflected their needs.

People told us staff were not skilled to provide support with food and drink. Some of the comments from people and relatives included, “The carers I have had do not know the food I like. They can’t make toast. They buttered bread and put it in the toaster which could have caught on fire. Don’t know how to make a sandwich, don’t even understand what a sandwich is. Can’t make a cup of tea”, “I have microwave meals which most of my carers have no idea how to use. They can get me breakfast. I have shown a couple of carers how to use the toaster to make toast” and “I make the meals and place the salads in the fridge and rice in the rice cooker so my wife can have both a cooked and cold meal. But 5 out of 7 days the food is left untouched. The carers do not give my wife any meals. I leave water available for my wife to drink and carers are supposed to encourage her to drink but most of the time the water has not been touched.”

The branch manager told us, “In the assessment it will be clear if they need extra support with meals or drinks. A lot of our clients are more than capable to request what they want. There are a few clients that we have where we say please document what I've eaten and drunk, and their portion sizes. This is because they have dementia and sometimes, they don't think about being hungry or thirsty, even if you leave drinks about for them.” The registered manager told us how they can add detailed information in care plans about people’s specific needs. However, care plans did not always contain detailed information on how to support people with specific health conditions. For example, one person living with diabetes, their care plan did not contain any guidance for staff on what foods to encourage them to eat or avoid. Some care plans lacked detailed information about people’s likes, dislikes, allergies and personal preferences for when and how they enjoyed their meals.

The provider had a nutrition policy. Staff received training for nutrition and hydration. However, staff did not always have the skills to provide basic support with meals and drinks. During the assessment, the provider held a quiz with staff to develop their knowledge of basic food items and to support people with meals. However, staff had not received additional training or coaching to develop their knowledge and skills to provide effective and safe care. The registered manager told us how they are kept up to date with best practice tools and guidance, “Policies are review by London Care, this includes The National Institute for Health and Care Excellence(NICE) guidance. I get a lot of support from London Care with updates, training, communication from the provider, regional manager meeting.” They told us how their staff team are kept updated via systems on their work phones.

People told us they did not require staff support with medical appointments. People told us they did not have copies of their care plan and did not know what information it contained.

The registered manager told us how they worked with professionals involved in people’s care. We reviewed general records for people which confirmed some communication with GPs, nurses and social workers had occurred. This was carried out by leaders and not care staff. Some care staff told us they had seen nurses during care calls. However, they did not know why the professionals were there or how the service worked in a joined-up approach to ensure continuity of people’s care. The registered manager told us how they maintained relationships with hospital teams to ensure appropriate notice was given to the provider before a person was discharged back home. They told us how communication with the local authority commissioning team was improving.

Feedback from 4 professionals about communication from the service was not always positive. We received comments such as “We are working with the provider to address concerns. They have been engaged in this process” and “I have had issues with getting a response.”

The registered manager told us they have the ability to create hospital passports for people when required. They said people also had a paper copy of care plans in their homes which could go with them to hospital. However, people told us they did not have a copy of their care plans in their home. The registered manager told us about information sharing with other professionals involved in people’s support. Most information was passed through telephone calls or e-mails with records of each under general notes. The registered manager told us they had not been to any provider meetings in Brighton. The branch manager told us, “The next time they have a registered manager one in Brighton I am hoping to attend. I just haven't had time in the last 6 months.” The provider did not always demonstrate how they worked in partnership to share best practice and learning.

People told us most staff did not know them or their specific health needs well. One relative said, “I think there is a lack of communication with people who receive this service and their family, there seems to be no structure and meeting of people’s needs. There certainly doesn’t seem to be very much care. [Person] has a UTI because carers have not encouraged [them] to drink during the day and they are now on anti-biotics.’

Feedback from staff about how they supported people to live healthier lives was mixed. One staff said, “Eating healthy food, daily movement, engaging them in things they like. A service user needs a walk round the garden, and we help her. Encourage them to do what they like to and want to do.” However, not all staff could explain how they supported people with specific health conditions to live healthier lives. One professional told us there was a theme of care plan inaccuracies for people and that staff lacked knowledge and skills. They told us the provider was working to address these concerns. Other professionals told us how they had concerns about poor medicine support for a person where errors occurred and how missed calls for a person requiring continence support resulted in them laying in wet continence aids. This meant people did not always have good outcomes.

The provider did not always have effective processes in place for identifying risks to people’s health and well-being and providing guidance for staff on how to support people to prevent deterioration. For example, some people lived with diabetes. Guidance was not always included in care plans for staff on how to support people with their dietary needs, how to monitor their blood sugar levels, which professional to call in an emergency and what levels of support was provided by family members. Another care plan stated a person had a stroke but there was no information on what the impact was for their eating or drinking, or what staff should do if they had concerns. These measures should be in place to support people in living healthier lives.

Feedback from people about being involved in reviews of their care was mixed. People told us they did not have copies of their care plans in their homes. We received comments such as, “I really can’t remember, but I am sure I haven’t had a care plan, nor seen one and definitely not had a review either of my needs during this year having the service”, “I have had no care plan or reviews” and “If the meeting we had was to develop a care plan we have never seen it and have had no reviews.”

The provider told us they had systems and processes in place to regularly review people and the care they required. However, they recognised some care plans lacked important information and where people’s needs had changed, this was not always reflected. The provider had an action plan to ensure reviews would take place, but this would take time to embed.

There was not always a robust process in place to ensure care plans were completed before people received care or updated when people’s needs had changed. Care plans did not always include people’s likes, dislikes and preferences. Some care plan audits had not identified the shortfalls we found during our inspection.

People and their relatives told us staff did not always seek their consent before commencing care. Comments included “I am not sure as I am not in the room” and “Some carers do.” Care plans did not always reflect if people with dementia or cognitive issues had full or fluctuating capacity to make decisions and how best to support them.

Some staff told us they did not have training in mental capacity and others could not explain how it applied to their role. One staff said, “I know about that in relation in regard to medication but not other things.” Three staff told us mental capacity was about specific levels of support people needed with medicines. Comments from other staff included, “I have not heard of that” and “No, I don't know what it is.”

The provider had a mental capacity policy. Training records showed staff had received online training in mental capacity. However, the provider could not demonstrate any competencies were completed with staff to check their knowledge and develop areas they were not confident in. Leaders told us all their customers had capacity and there was no-one with best interest decisions. However, two care plans were signed by a relative instead of the person. Another care plan mentioned potentially restrictive practice but there was no best interest decisions made. The provider had picked up this concern during our assessment. They had an action plan to review and update people’s care documentation.