We carried out a review of the data available to us about London Care (Raynes Park) on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about London Care (Raynes Park), you can give feedback on this service.
London Care Raynes Park is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community, in six London Boroughs. At the time of the inspection the service was providing personal care for 151 people. The range of people the provider is registered to give support to includes care for older people, people with dementia, learning disabilities or autistic spectrum disorder, mental health, and physical disabilities.
The Care Quality Commission (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 consider any wider social care provided.
People’s experience of using this service and what we found
People received a safe service and staff had a safe environment to work in. The provider had enough, appropriately recruited staff available to meet people’s needs. This meant people were supported to enjoy their lives in a safe way. The provider assessed and recorded risks to people and staff, and they monitored and updated them, as required. The provider reported, investigated and recorded accidents, incidents and safeguarding concerns, appropriately. Medicines were safely administered, by trained staff and people prompted to take their medicines, if required. Infection control procedures were followed.
The provider had an open, honest and positive culture with an identifiable management structure and leadership. There was a clearly defined vision and values that staff understood and followed. The provider identified areas of responsibility and accountability, that staff were enabled and prepared to take responsibility for. They were comfortable reporting any concerns they may have, in a timely fashion. The provider regularly contacted people and their relatives when reviewing the quality of the service provided and made changes to improve the care and support people received. This was in a way that best suited people. The provider established working partnerships that promoted people’s participation and reduced social isolation. Registration requirements were met.
People were supported to have maximum choice and control of their lives staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service support this practice.
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 (published 20 January 2021).
Why we inspected
This inspection was prompted by a review of the information we held about this service taking a focused inspection approach to review the key questions of Safe and Well-led.
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 remains Good. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Care Raynes Park on our website at www.cqc.org.uk.
London Care Raynes Park is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community, in six London Boroughs. At the time of the inspection the service was providing personal care for 185 people. The Care Quality Commission (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 consider any wider social care provided.
People’s experience of using this service and what we found
At the last inspection there weren’t suitable numbers of staff available to meet people’s needs and audits did not always identify issues in relation to late visits and action taken was not always clear. At this inspection suitable numbers of staff were available to meet the needs of people and audits identified issues in relation to late visits and action taken was clear.
The service provided was safe for people to use and staff to work in. People were enabled to live safely and enjoy their lives, by the support they received and risks to them being assessed and monitored. The agency reported, investigated and recorded accidents and incidents and safeguarding concerns. Medicines were safely administered, by trained staff. The agency met shielding and social distancing rules, used Personal Protective Equipment (PPE) effectively and safely and the infection prevention and control policy was up to date.
The agency’s culture was open, honest and positive with transparent management and leadership. The organisation had a clearly defined vision and values that staff understood and followed. Areas of responsibility and accountability were identified, with staff willing to take responsibility and report any concerns they may have, in a timely fashion. The agency reviewed service quality and made changes to improve the care and support people received. This was in a way that best suited people. The agency played a role in the community through well-established working partnerships that promoted people’s participation and reduced social isolation. Registration requirements were met.
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 6 April 2019).
Why we inspected
This inspection was prompted in part due to previous concerns received that there weren’t suitable numbers of staff available to meet people’s needs, audits did not always identify issues in relation to late visits and action taken was not always clear. A decision was made for us to inspect and examine the risks associated with these issues.
CQC has introduced focused/targeted inspections to follow up on previous breaches and to check specific concerns.
We undertook a focused inspection approach to review the key questions of Safe and Well-led where we had specific concerns about staffing numbers and audit management.
As no concerns were identified in relation to the key questions is the service Effective, Caring and Responsive, we decided not to inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
London Care Raynes Park is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults in six London Boroughs. At the time of the inspection the service was providing personal care to 300 people. The Care Quality Commission (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 consider any wider social care provided.
People’s experience of using this service:
¿ The service did not always deploy sufficient numbers of staff to meet people’s needs and keep them safe. On-going monitoring of missed and late visits, did not always identify issues and it was unclear what action was taken to address late calls.
¿ Audits carried out by the service did not always identify issues in relation to late visits. Action taken was not always clear.
¿ The service had made improvements to the safe management of medicines. Medicines were administered as intended.
¿ People were protected against the risk of identified harm and abuse as risk management plans in place gave staff clear guidance on mitigating risks. Staff received on-going safeguarding training and were aware of the provider’s policy on identifying, responding to and escalating suspected abuse.
¿ Infection control guidelines in place, gave staff clear guidance on managing cross contamination. Sufficient quantities of Personal Protective Equipment (PPE) were available to staff.
¿ Staff continued to receive on-going training to enhance their skills and experiences, which they put into practice. Staff received regular supervisions, to reflect on their working practices.
¿ Managers and staff were knowledgeable about and adhered to the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s consent to care and treatment was sought and respected.
¿ Where agreed in people’s care packages, people were supported to access food and drink that met their dietary needs and preferences.
¿ People received support from staff that were caring and compassionate to their needs. Where required staff members supported people to access healthcare professional services to monitor and maintain their health and wellbeing.
¿ People were treated with dignity and respect. Staff were aware of the importance of respecting people’s privacy when delivering personal care.
¿ People’s dependency levels were monitored regularly to ensure support provided met their needs. Staff were aware of the importance of encouraging people to do things for themselves where safe to do so to enhance their independence.
¿ People and their relatives were encouraged to share their views in the development of the service.
¿ Care plans were person-centred and detailed people’s health, social and medical needs. Care plans were regularly reviewed to reflect people’s changing needs and changes were swiftly shared with staff members.
¿ People were aware of how to raise a concern and complaints. Complaints were recorded, action taken documented and responded to in a timely manner.
¿ At the time of the inspection, the service was not providing palliative care to people. However, the provider had procedures in place should end of life care support be required.
¿ The registered manager was aware of their roles and responsibilities in relation to notifying the CQC of notifiable incidents.
¿ The service had a clear management structure in place. People confirmed the registered manager had made improvements since the last inspection and was approachable, supportive and available.
¿ The registered manager sought people’s views through spot checks and quality assurance call monitoring. Records confirmed people were generally satisfied with the care and support they received.
¿The registered manager actively sought partnership working through other healthcare professionals and stakeholders to drive improvements.
Rating at last inspection: The service was previously inspected on 25 July 2018 and was given an overall rating of Requires Improvement because we rated the key questions, is the service safe, effective, responsive and well-led? as Requires Improvement. The service was rated Good in the key question, is the service caring?
Why we inspected: This was a planned inspection in line with our inspection programme.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect the service sooner.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults and younger adults with disabilities.
Not everyone using London Care (Raynes Park) receives 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. The service supported around 350 people at the time of our inspection.
At our last comprehensive inspection on 4 and 5 August 2016 we found four breaches of legal requirements in relation to staffing, safe care, person-centred care and good governance. The provider wrote to us with their action plan on 27 September 2016 and told us they would resolve these issues by 30 November 2016 although some actions would be ongoing.
We conducted a focused inspection on 10 March 2017 to check the provider’s actions to improve the key questions ‘Safe’, ‘Responsive’ and Well-led’ to at least good. At the focused inspection, we found that although the provider had made some improvements, they were still in breach of the regulations in relation to safe care, person-centred care and good governance.
At this inspection of 25 July 2018 we found that the provider continued to be in breach of the regulations in relation to safe care. Medicines were still not managed safely in that medicines administration was not always accurately recorded and people’s care files did not reflect any risks associated with the medicines they were prescribed. You can see the action we have told the provider to take with regard to this breaches at the back of the full version of this report.
We have also made recommendations. The first is in relation to the personalisation of people’s care plans, these required review to ensure the tasks people were able to undertake independently were reflected. The second is in relation to communication of the management structure so that people and their relatives are clear on who the manager is.
Some areas of the service required improvements. Staff training, supervision and appraisal required updating to ensure staff were compliant with the provider’s requirements. Complaints had not been responded to in a timely manner, however the new manager had taken ownership of these issues.
Management at the service had recently changed and they were able to show us a robust action plan that had identified these areas that required development. We were satisfied with the improvement plan that the provider had in place.
At the time of inspection the manager had applied for their registration with the CQC. 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.
People and their relatives told us they felt that the care delivered by the service was provided by staff that knew how to keep them safe. There were robust safeguarding procedures in place to ensure that staff were able to report any concerns, and that these were appropriately investigated. Recruitment processes ensured that staff were vetted to ensure they were safe to work with people. Staff took necessary measures to prevent the spread of infection when supporting people.
People were supported with meals of their choosing, prepared to their liking. When support from other healthcare professionals was required the service supported this. People’s capacity was recorded in line with guidance, to ensure people were enabled to make decisions.
People felt well cared for and that staff were considerate of their needs. Where people had any cultural or religious beliefs these were supported. People’s privacy and dignity was respected when being supported by staff.
Relatives and people were involved in the planning of care to ensure that it met people’s needs, including regular reviews. The provider was in the process of reviewing the care of all individuals using the service. The provider had measures in place to support people using the service who required support with end of life care.
The manager was new to the service, and was focusing on governance systems to improve the quality of the service. Staff spoke positively of the support they received from the new management team. The service sought feedback from people through telephone monitoring and surveys.
London Care (Raynes Park) provides personal care and support to people living in their own homes. This includes both younger and older adults and people who may be living with dementia. At the time of our inspection there were approximately 450 people using the service. 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.
The purpose of this inspection was to check the improvements the provider said they would make in meeting legal requirements. At this inspection, we found that although the provider had made some improvements, particularly in regards to staffing, they were still in breach of the regulations in relation to safe care and treatment, person-centred care and good governance.
Medicines were still not managed safely. Medicines records contained unexplained gaps, misspellings and other errors so we could not always be sure people received their medicines as prescribed. Some records showed people did not receive medicines at the correct times and some medicines such as topical ointments were missing from medicines records. There was insufficient information about the medicines people took, what they were prescribed for and the support people needed to manage long-term health conditions safely.
People’s risk assessments were not sufficiently personalised and in some cases were completed incorrectly. Some people did not have any assessments of specific risks associated with their care or their health. We did not always find evidence that staff were following risk management plans designed to keep people safe from the risks of skin deterioration.
We also found that care plans still did not contain an appropriate level of detail for staff to provide person-centred care. They did not always take into account the specific support people needed, for example around personal care, continence care or diabetes management. Care plans sometimes contained contradictory information or did not contain any details about people’s preferences as to how staff carried out care tasks. However, the care plans did contain information about people’s preferences in relation to food, their life history and family relationships and some information about communication needs.
Although the provider carried out a range of audits and checks and had taken some action to address the shortfalls we found, the measures they took to do this were not effective. Despite carrying out extra audits and checks, additional staff training and supervision and assigning lead roles to senior staff, the provider had not made sufficient improvements to meet the required standards within an appropriate timescale. However, we did note that the quality of some records, particularly daily records staff kept of the care they provided to people, had improved since our last inspection.
We are taking further action against the provider for a repeated failure to meet the regulations in relation to safe care and treatment, person-centred care and good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to the back of reports after any representations and appeals have been concluded.
There were enough staff to keep people safe. The provider monitored staffing levels on an ongoing basis and took steps to recruit new staff when numbers became low. The provider regularly checked to ensure people were receiving all of their planned visits and that staff arrived at their homes punctually. People had also indicated that they were pleased with the quality of service thy received in general.
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.
Medicines were not always managed safely, because appropriate information about people’s medicines was not included in people’s files and in several cases records either showed people were not receiving medicines as prescribed or were not clear enough to show that they did. There were gaps in records and insufficient information about medicines to be taken only when required. There were procedures in place to ensure people did not run out of medicines and these were stored appropriately where applicable. Staff supported people to take medicines independently as much as possible and there were risk assessments to cover this.
People had risk assessments and care plans in place but these were not personalised enough for the provider to be sure they were assessing, managing and mitigating risks arising from individual needs such as people’s health conditions and that they were meeting people’s individual needs. People’s risk of malnutrition was not always appropriately assessed. People’s care was not always planned in a way that was personalised and met their individual needs. Information was missing from people’s care plans about their preferences and how staff should carry out care tasks, and tasks that staff performed did not always correspond with the care plans, meaning there was a risk that people were not consistently receiving the care and support they needed.
There were not enough staff on duty to keep people safe and meet their needs at weekends and in the extra care scheme. However, the provider had taken appropriate steps to make sure that staff they employed were suitable to care for people. People felt safe using the service and the provider had appropriate procedures, staff training and monitoring to protect people from abuse and discrimination.
The provider used various checks, audits and a quality team to make sure the service was of good quality and continually improving. The provider’s quality checks had identified the problems that we found, but when we visited the issues had not yet been resolved although work was taking place to address them. Poor record keeping meant that we could not be sure people were receiving the care they needed. Audits showed record keeping was improving but at the time of our visit this did not meet the standards required by the regulations that providers must comply with.
There were systems in place to record, monitor and learn from accidents and incidents. Staff were trained to respond to emergencies.
People were happy with the way staff supported them with their meals. Staff were aware of the importance of respecting people’s preferences and cultural needs around food. Staff helped people to stay healthy and to access healthcare services when they needed it.
The provider met the requirements of the Mental Capacity Act (2005). They followed appropriate procedures to ensure that decisions about the care of people who were unable to consent to them were made in their best interests. Staff obtained people’s consent before carrying out care tasks. Some staff did not understand that they should not deprive people of their liberty without the correct legal safeguards in place but the provider was addressing this through staff training.
Staff were happy with the support and training they received. They had a comprehensive induction before starting work and they had supervision, appraisals and opportunities to attend staff meetings. The registered manager used a number of methods to help ensure staff received updated knowledge about best practice in care and the opportunity to discuss it.
People were happy with the care and support staff provided. They were treated with respect and dignity and staff worked with people to promote their independence. Staff provided people with the information they needed to make decisions about their care. This included providing staff who spoke the same language as people, where possible. Staff respected people’s religious, cultural and other diverse needs.
Consistent staffing meant that people had the opportunity to develop positive relationships with the staff who cared for them.
People were able to raise concerns and complaints when they needed to. The registered manager made sure they responded to these quickly and resolved them to people’s satisfaction. People were aware of the complaints procedure.
People and staff had opportunities to feed back and to be involved in decisions about how the service was run. The registered manager acted on their feedback and valued their opinions. People and staff felt that the service had a positive culture that enabled them to speak freely about their concerns and opinions. Staff were aware of the provider’s values and considered these as part of their work.
We found breaches of regulations during this inspection relating to safe care and treatment, person-centred care, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.