Link Community Care (Tottenham)

Link Community Care is a domiciliary care service providing personal care in people’s own homes. At the time of our inspection there were 58 people using the service. The service was supporting older people and adults with physical disabilities.

People’s experience of using this service and what we found

We found the management of the service did not have effective and tested systems to respond to safeguarding concerns and when people had accidents and incidents such as falls. There was also a practice of staff being removed from individuals’ rotas when people complained rather than investigate and take actions such as revisit staff training. This meant other people could be at risk and lessons were not being learnt.

The registered manager and provider were not effectively assessing the quality of care to spot problems and act to fix them. Audits did not effectively look into people’s actual care experience. The management and provider did not have a culture to effectively investigate concerns.

When issues were raised to the office these issues were not processed and dealt with appropriately. There were missed opportunities to advocate for people, assess the quality of staff practice, and learn lessons.

New staff, who did not speak English well, they needed more support to understand their role and the people they were supporting. People were sympathetic to this issue, but the management although aware of this issue, had not effectively revised how they were supporting this element of their work force. Some people told us this undermined their care experience.

We had a mixed response with how people found their care. Some spoke well of the regular staff who supported them. The staff knew what these people’s needs were and how they wanted to be supported. These people had got to know the staff and felt comfortable in their company. One person said, “My main carer is excellent, [carer] treats me with respect.” Another person said, “We [person and carer] have a good natter.”

Others found staff did not understand their needs and what their care plan was asking of them. One person told us, “They [management] need to support those carers who have recently arrived from overseas.”

Most people said they saw staff at regular times which they were happy with. Some people told us they had experienced late and missed care visits. The providers electronic system which logged when staff visited people, did not support this view, but some people were very clear about this.

People were generally 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; but there were issues with policies, systems, and management knowledge in relation to people’s consent to care and being involved in decisions relating to their care.

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 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to protecting people from potential harm and abuse. We found issues with how management promoted people’s safety and how well the service was managed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This was the first inspection of the service since registration in August 2016.

This service 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 and younger disabled adults.

Not everyone using Link Community Care 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.

There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was present during the inspection.

Procedures relating to safeguarding people from harm were in place. Staff we spoke with understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005.

The service operated safe staff recruitment procedures and ensured that all staff were suitable for the role before beginning any care work.

Medicines were managed safely and the service was expanding on the number of people that they thought may benefit from staff prompting people to remind them to take medicines.

Risk assessments provided staff with guidance on how to mitigate people’s individual personal risks. Risks had been clearly identified and risk reduction measures were identified and acted upon.

Staff were provided with a suitable induction as well as on-going regular training and supervision to support them in their role.

People were involved in planning their care and had regular reviews to gain their opinion on how things were. Staff knew people well and people and relatives felt that they were treated with dignity and respect. Care plans were person centred and included information on how people wanted their care to be delivered as well as their likes and dislikes.

People and relatives were provided with information on how to make a complaint and their views were obtained and acted upon. People were treated with dignity and respect and trusted the staff that supported them.

People who used the service, relatives and stakeholders had a range of opportunities to provide their views about the quality of the service and the provider monitored the performance of the service.

Further information is in the detailed findings below.