Background to this inspection
Updated
14 January 2021
The inspection
As part of a pilot into virtual inspections of domiciliary and extra-care housing services, the Care Quality Commission conducted an inspection of this provider on 10-12 November 2020. The inspection was carried out with the consent of the provider and was part of a pilot to gather information to inform CQC whether it might be possible to conduct inspections in a different way in the future. We completed this inspection using virtual methods and online tools such as electronic file sharing, video calls and phone calls to gather the information we rely on to form a judgement on the care and support provided. At no time did we visit the provider’s or location’s office as we usually would when conducting an inspection.
Inspection team
The inspection was carried out by two inspectors, Expert by Experience and CQC support services. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service also provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection to ensure we could speak with a representative group of people using the service and that the provider was able to share the evidence with us remotely. This was because it is a large service and we needed to ensure the provider and the registered manager would be able to support the inspection.
Inspection activity started on 10 November 2020 and ended on 12 November 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from Healthwatch, the local authority and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed information shared by the provider. We used all of this information to plan our inspection.
During the inspection
We spoke with 47 people using the service and their relatives about their experience of the care provided. We spoke with seven staff members including the registered manager, operations director, senior and care staff. We contacted people, their relatives and staff via telephone.
We reviewed a range of records. This included eight people’s care records and multiple medicines records. We looked at two staff files in relation to recruitment and overall staff training records. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at additional management records. We spoke with further five staff members.
Updated
14 January 2021
This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the provider.
About the service
Westminster Homecare Limited (Bexley) is a homecare agency providing personal care to people living in their own homes and specialist housing in the Dartford and Bexley area. At the time of the inspection the agency supported 247 individuals with their personal care. The agency provided care mainly to older people living with dementia and some people with physical support needs or learning difficulties.
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
People’s care records were sometimes disjointed, and details on people’s needs and risks were included in different pieces of care documentation. Staff knew people and the provider’s recording systems well, hence there was no impact on the quality or safety of the service people received. However, the recording systems could make it difficult, especially for new staff to retrieve the essential information quickly which could affect the consistency of the care provided. The provider took action to review those records and to consolidate them.
People felt safe receiving care and support from Westminster Homecare Limited (Bexley) and were protected from avoidable harm. Staff were aware of safeguarding and individual risks to people and able to support them safely. This included safe administration of medicines where people required support. People were protected from infections. The provider ensured staff adhered to the Covid-19 national guidance.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff enabled and supported people to be as independent as possible and respected their individual choices.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The agency supported some people living with learning difficulties in their own homes and everyone had individual person-centred care plans and care package in place. The service worked in partnership with people, their representatives and local social services which enabled people to live in the community as independently as possible. People’s care plans were person-centred and promoted their independence, dignity and human rights.
People told us staff were kind, attentive to their needs and took effort to get to know them. When people shared concerns, the provider took prompt action to address and resolve those to improve people’s experience of care. Staff knew people well and encouraged them to be involved in their day to day care.
People were involved in planning of their care and regular reviews. They told us care was tailored to their individual needs and preferences and most felt the support they received was person-centred. Their care records confirmed this. People knew how to raise complaints if needed and most people felt listened to by the provider who acted to respond to their comments and improve the service when needed.
People, their relatives and staff were mostly complimentary about the management and leadership of the service. Staff felt valued and supported. The management team completed regular checks of quality and safety of the service and where shortfalls or lessons learned where identified, remedial action was taken. The service worked in partnership with the local authority and other local professionals’ networks as part of the response to the Covid-19 pandemic.
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 on 25 July 2018).
Why we inspected
This was a planned pilot virtual inspection. The report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the provider.
The pilot inspection considered the key questions of safe and well-led and provide a rating for those key questions. Only parts of the effective, caring and responsive key questions were considered, and therefore the ratings for these key questions are those awarded at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westminster Homecare Limited (Bexley) on our website at www.cqc.org.uk.
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.