St Georges Home Care Ltd

St Georges Home Care Ltd is a domiciliary care service that provides care and support to people living with dementia, physical disabilities and mental health conditions. At the time of our visit 32 people living in north London were using the service.

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

During this inspection we found the service had made improvements around the management of risks and quality assurance.

Whilst the service had improved the way they scheduled and monitored care visits, and staff had the right skills and qualifications, we identified some shortcomings around recruitment checks. We made a recommendation around safe recruitment practices.

Risks associated with people’s health and care were identified and assessed as and when needed, and staff were provided with clear guidance on how to minimise these risks. People told us they felt safe with the care and support they received. People received their medicines as prescribed. The service followed strict infection prevention and control measures to keep people safe.

People received care that was tailored to their individual needs and staff knew them well. Care plans were person-centred and documented how people wanted to receive their care. The service managed complaints effectively and relatives told us they felt confident in raising any concerns but were pleased with the care and support their loved ones received. Staff communicated with people in ways they understood.

People, relatives and staff spoke positively of the management and the support they received. There was an open and inclusive culture at the service. Systems were in place to assess and monitor the quality of the service provided. The service sought feedback from people, relatives, staff and professionals which they used to drive improvements. The team worked in partnership with healthcare services and other professionals to improve and maintain people's quality of life.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 October 2020) and there were 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 improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider sought training and guidance on effective scheduling of care visits as well as communication with people and relatives. At this inspection we found improvements had been made around these issues.

Why we inspected

We carried out an announced focused inspection of this service on 23 September 2020. Breaches of legal requirements around safe care and treatment and good governance were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

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. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Georges Home Care Ltd on our website at www.cqc.org.uk.

Follow up

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

St Georges Home Care Ltd is a domiciliary care service that provides care and support for people living with dementia, physical disabilities and mental health conditions. At the time of our visit the service was providing care to 62 people. 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

During this inspection, we found shortfalls in how the service was delivered. The three main matters that the service needed to improve were related to poor communication with people using the service and relatives; poor oversight of care visits and timing and lack of development of risk assessments.

During this visit, we found that shortfalls around risk assessment that were highlighted during our last inspection had not been addressed. We found new issues related to care plan reviewing and scheduling as well as monitoring of care visits, and regulatory requirements.

Not all quality monitoring systems were effective as they had not addressed issues identified by us during our inspection.

People and relatives gave mixed feedback about the service. Some said they were happy with the care they received, others had less positive experience.

Staff were recruited safely and staff understood how to protect people from avoidable harm and abuse. There were appropriate infection control and prevention processes in place and staff were provided with enough personal protective equipment (PPE). Medicines were managed safely. Accidents and incidents were recorded, monitored and action was taken to ensure these were not repeated.

Staff were provided with information about their roles and care responsibilities as well as updates related to the service delivery. Overall staff felt supported by their managers and they were happy working for the service.

The service gathered feedback from people about the care they received.

External professionals spoke positively about the managers, staff and the support provided by the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update): The last rating for this service was good (published 6 September 2019). The safe domain was rated as requires improvement as there was one recommendation about the risk assessment process. At this inspection we found improvements had not been made and the provider was in breach of regulations.

Why we inspected: We received concerns in relation to staffing, the quality of care and the use of personal protective equipment (PPE). As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. We have identified breaches in relation to safe care and treatment and good governance. We made two recommendations on scheduling and monitoring care visits and customer care. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Georges Home Care Ltd on our website at www.cqc.org.uk.

Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

St Georges Home Care Ltd is a domiciliary care service that provides care and support for people living with dementia, physical disabilities and mental health conditions. Until April 2019 the service was known as Memories Home Care. At the time of our visit the service was providing care to 12 people. 11 people 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

Between February and April 2019, St Georges Home Care Ltd. had undergone the change in the ownership and management of the service. The change was managed thoughtfully and with consideration of possible disruption this could cause to the staff and people who used the service.

Aspects of the service delivery needed further improvement. These related to risk assessment and management, management of medicines and person centred care planning. This was to ensure people were always protected from harm and that staff had sufficient information about people. The provider was in the process of addressing this. Overall people and their relatives told us they were satisfied with the service they received. We made two recommendations about effective risk assessment and management and person centred are planning.

Staff were recruited safely and the service helped to protect people from abuse from others. People said they felt safe with staff who supported them. Staff knew what action to take if they thought somebody was at risk of harm. Other safety measures were followed to ensure the risk to people’s health and wellbeing was minimised. This included suitable numbers of staff being deployed to support people, infection control measures and effective management of accidents and incidents.

People’s health and care needs had been assessed before the service started. Staff received appropriate training and ongoing support and supervision to help them to provide safe and effective care to people. People were supported to have a nutritious diet that met their needs and personal preferences. Staff ensured people had access to healthcare professionals when their care and health needs changed. People's rights under the Mental Capacity Act 2005 (MCA) were protected. People were supported to make decisions about their care and their consent was sought by staff before providing care.

People and relatives thought staff were caring and kind. One relative told us, “My [relative’s] carers show a great deal of caring and kindness towards him.” People thought staff respected their dignity when providing personal care. Staff spoke about people with respect and they said providing safe and considerate care to people was important to them. The staff team was racially and culturally diverse and the service provided care to people from various backgrounds and walks of life.

Care plans were personalised and included information about people health care and communication needs. However, more information was needed about people’s life stories and what was important to them. The provider was in the process of implementing a new online care management and monitoring system. The system would enable to further improve personalised care planning. The registered manager assured us more information about people’s backgrounds would be included in the new care plans. People could raise complaints about the service provided and most people we spoke with said they were happy with how complaints were dealt with.

People and relatives spoke positively about the service. Most of them described it as providing good care. The management team carried out weekly monitoring of staff and care packages to ensure care was provided as people wanted it. The registered manager knew their responsibility related to the management of the regulated activity. They ensured the requirements were followed.

People using the service, their relatives, staff employed by the service and external professionals were encouraged to give feedback about the service provided. The registered manager was in the process of gathering all information to analyse the feedback and to formulate a plan on improvement actions needed.

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 21 January 2017).

Why we inspected: This was a planned inspection based on the previous rating.

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.

We carried out an announced inspection on 19 December 2016. This was the first inspection of this service.

Memories Home Care is a domiciliary care service that provides care and support for people living with dementia, physical disabilities and mental health conditions.

A registered manager was in place at the time of the inspection. 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 service provided person centred care and support to people and took into account peoples preferences.

Staff could explain how they would recognise and report abuse and had received the appropriate training in safeguarding adults.

There were systems in place to ensure that medicines had been stored, administered and reviewed appropriately. Staff had been trained in the administration of medicines and their competency assessed annually.

Person centred risk assessments had been undertaken. Plans were put in place to minimise any risks identified for people and staff to ensure they were safe from harm.

Staffing arrangements were adequate to meet the needs of people using the service.

There were appropriate procedures in place for the safe recruitment of staff and to ensure all relevant checks had been carried out.

Staff was up to date with their mandatory training which included basic life support health and safety, information governance, fire safety, moving and handling and infection control.

Staff received regular one to one supervision and the content of supervision sessions recorded was relevant to individuals’ roles.

The registered manager and the staff had a good understanding of the principles of the Mental Capacity Act (MCA).

Staff were very clear that treating people with dignity and respect was a fundamental expectation of the service. They had a good understanding of equality and diversity and understood the need to treat people as individuals.

Care plans were personal and provided detailed information for staff to follow.

A complaints policy and procedure was in place, and structures were in place to address complaints effectively.

The culture at the service was positive and open and the registered manager was approachable.

Regular spot checks on staff performance were undertaken to measure competency and if required, appropriate steps would be taken to address any shortfalls.

Quality assurance questionnaires were also undertaken twice yearly with people using the service and their relatives in order to measure satisfaction and ensure a high quality service was being delivered.