London Care - Brighton

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We identified 1 breach of legal regulation for governance, about complaints. Complaints were not always handled as per the provider’s policy. People told us staff did not always interact positively with them. Not all people and relatives knew how to raise concerns. Where concerns had been raised, people saw little improvement. Leaders had not always documented concerns or evidenced that appropriate actions were taken. This meant they were not able to monitor quality and safety concerns. People’s care and treatment was not always delivered in a way that met their needs. Care plans did not always contain important information about people such as communication needs or specific health conditions, and who to contact for medical support. Staff did not always monitor or respond to people’s changing needs. People were not always involved in the planning of their care. Most people and relatives told us they had not had reviews of the person’s needs or seen their care plan. People did not always have positive experiences or outcomes. People, relatives and professionals told us communication from the office required improvement.

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 care was not always person-centred. People told us staff did not always understand what was important to them or able to provide care in a way they liked. People had complained to the provider about the conduct of some staff but told us little improvement had been made. People told us they were not introduced to new staff, or asked if new carers could shadow their care call. One relative said, “They (staff) were even bringing people in who was doing the training. They didn’t ask me beforehand. Even in the hospitals, they ask you if it’s ok if another junior doctor shadows.”

Staff told us they had time to read care plans. However, some care plans did not provide them with all the information they needed. Staff feedback about person-centred care was mixed. Some positive comments were, “Structuring care around what a person needs and what they can and can't do. Encourage personal choice and freedom” and “Maybe focus on the needs of the individual, treating people with respect and involve them in whatever you are doing.” However, not all staff understood what it was or able to give examples of how they promoted this.

People’s care and treatment was not always delivered in a way that met their needs. Care was not always coordinated and responsive. People told us that they or their relatives organised specialist support such as chiropody and district nurses. They told us they were not confident staff would be competent to arrange specialist support in a timely manner. People told us they had not had reviews of their care. One person told us, “No, I have never had any meeting to develop a care plan, never seen a care plan and never had a review of the care plan.” We reviewed 8 care plans. Seven of these were either inaccurate, not completed, lacked detail about specific health conditions or which health professionals to contact when concerned.

Not all staff understood the importance of working closely with a range of other agencies. Comments included, “No, sometimes we see a district nurse comes to check a client” and “Not done this.” Staff did not always know people well or were aware when additional support was needed. One staff told us, “[Person] didn't want their medication, they have the right to refuse. You just check they have taken it. They were really down. I left the house and the manager phoned me. She had checked my rota because I was running late. I told her why I was late and what happened. The manager got a doctor out who came and helped the person.”

Staff did not always work closely with other professionals and agencies to ensure a joined-up approach to people’s care. Feedback from social care professionals included delays with communication, training concerns where staff lacked understanding of care requirements, including medication and some general needs, for example use of equipment.

We saw evidence the provider had recorded communication with social workers, relatives and GP’s. This was completed by staff who worked in the office. However, care staff were not confident or knowledgeable on how to recognise concerns, or how to report them. One staff said, “There was one time I went to service user house and [person] had cut themselves with a sharp object. I had to call office and then call ambulance to come to them and give me permission to leave.” Care plans did not always contain information on key professional contacts including diabetes nurses or district nurses.

People, relatives and professionals told us communication from the office required improvement. People told us they were not informed if calls would be late. One person said, “Today the carer was very late for her visit. No one informed me of this lateness. If carers are late which is daily, I never get informed from the carer or the office” and “Yes there has been missed calls but I’m never notified of them or any reason why.” Some people had communication needs such as hard of hearing or poor eyesight. Care plans did not always include how to provide information or communication in accordance with those needs. People told us they did not have copies of their care plans and did not know what information it contained.

Staff did not always understand what people’s communication needs were and how best to support them. Although some gave examples of how they supported people with hearing difficulties or dementia, some staff did not recognise basic communication needs and how to support people. One staff said, “No-one has communication needs.”

People’s communication needs and preferences were not always clearly recorded in care plans. The branch manager told us they had one person who required written information in large print. However, the person’s care plan did not reflect this or the impact it had on them, nor if the person required additional support such as reading food packaging cooking instructions or letters they received in the post.

Not all people knew how to share their concerns with the Provider. Where people had raised concerns, these were not always responded to, or they felt they were not taken seriously. Comments included, “I have spoken to my [relative] so she can contact the manager to raise concerns at the level of care I was receiving, and carers were not doing anything they should be doing for me. Nothing has changed so far” and “Yes, we have raised many concerns about timings of carers, lateness, no shows of staff. Not checking [persons] drinks. The level of standards of the carers and medications being placed in different wrong boxes. Very little responses received and few changes to care support and timings.” Some people told us they had not been asked for their feedback from the provider to help shape the service or to make improvements.

Staff did not always understand their role when people raised concerns. One staff said, “They have to tell the manager first not me.” Concerns and complaints were not always documented in line with the providers complaints policy. The registered manager told us they were reliant on the branch manager to handle complaints. They told us they could check their computerised system, and it would bring up all complaints. We saw 2 complaints had been recorded. However, people told us about the complaints they had raised, and these were not recorded on the providers system. The branch manager later told us, “I didn't know but there is a section on our rostering that we can put our notes onto and what we've done. We'll make notes now of conversations we've had and what we've done to address it. Prior to that it was all on email, so I need to go through about 5 months’ worth of emails to add to the system.” The registered manager told us they do people surveys using their system and it was called ‘Voice of the Customer’. They told us a staff member meets with the person or relative and goes through a survey.

The provider had not ensured all people had access to their complaints policy or procedure. Concerns were not always dealt with in line with the providers complaints policy. Data had not been uploaded to the provider’s computerised system to enable leaders to monitor trends, demonstrate learning or make service improvements. The provider was not aware of the concerns found on inspection. Systems the provider had in place to gather feedback were not always effective. Not all people had been asked for their feedback. Where some people had the opportunity to give feedback and shared their concerns, it was not always evident how this was used to drive improvements.

People told us they did not always receive the support they needed. Care plans did not always detail reasonable adjustments required to ensure people’s specific health conditions and communication needs were met. People told us most appointments and referrals were made by themselves or family members.

Staff did not always speak about people with dignity and respect. Leaders did not always address conduct of individual staff to promote good outcomes for people. Feedback from external agencies and professionals about staff working with them to promote people’s access to services was not always positive. One professional told us there were provider concerns in relation to ‘care plan inaccuracies’ and poor communication with people, relatives and other professionals. Staff told us they did not routinely support people with medical appointments. Leaders told us support with appointments could be arranged when requested.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it. Care plans lacked information about how to raise concerns with external healthcare teams to ensure people received the right support. For example, people who had catheter care, their care plans did not include detailed information on what to monitor for, what to do if there were concerns and who to contact for medical support.

People did not always have positive experiences or outcomes. People told us they were not always treated with dignity and respect. Not all people had information on how to raise their concerns. Some people told us there had been little improvement when they had raised concerns. One professional told us there were communication issues with the provider in relation to ‘responding positively to concerns’.

Staff did not always understand equality and diversity or protected characteristics. No competencies were undertaken to check staff understood how to apply this to their role. For example, the branch manager told us, “One person, English is their second language. We tried to match our carers from around that country but the [relative] only wants British people.” The branch manager did not recognise that the person and proposed staff were from two different countries and cultures. The wishes of the person and relative had not been taken into consideration before care started.

The provider had systems to gather feedback from people and staff. However, not all concerns were documented in line with provider’s policies. It was not always evident how lessons were learnt to prevent reoccurrences or make improvements.

The service was not supporting anyone at the end of their lives at the time of assessment. Where completed, care plans reflected if people had advanced decisions about their care, a DNACPR or RESPECT form in place and where it was located in their homes. However, not all care plans contained detailed information about people’s wishes or plans for the future.

Staff told us they did not have training in end of life care. They were not able to tell us the important aspects of support for people at this time of their lives. One staff said, “Have worked with a service user who passed away. Do what we would normally do. I don’t know if they were end of life.” They were not aware if the person had a specific care plan for their end of life wishes. We reviewed training records which demonstrated staff had completed online training. However, no competencies had been carried out to check staff knowledge and skills to deliver this support.

The registered manager told us there was an end of life section in their care planning system. They said if people did not want to talk about it during an assessment, they would enter a date on their system for it to be reviewed with people. However, people told us they had not reviews of their care plans. It was not evident the provider had reviewed end of life care with people to support them to plan for the future.