Red Sea Community Programme

The service sent us an action plan shortly after our inspection informing us that they had made the relevant adjustments and improved their risk assessment procedure, by providing greater detail about how to safely manage risk in relation to carrying out the regulated activity of personal care.

During our inspection on 26 November 2018, we found that the provider had improved and reviewed risk assessments. We saw that risk assessments had greater detail about how to manage the risks. However, risks assessments were found to be generic and did not clearly relate to the individual. People who used the service and relatives raised no concerns regarding care practices when providing personal care. Care workers demonstrated good understanding of how to minimise risk to people who used the service when providing personal care. We further found during this inspection that the service had improved their quality assurance monitoring processes and found them now to be effective.

Red Sea Community Programme (RSCP) is a small domically care agency located in Harlesden, North West London. During the day of our inspection the service provided personal care to 24 people, most of the people were from Somali background, living in their own home. The service employed 21 care workers.

Not everyone using RSCP receives a regulated activity; 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 take into account any wider social care provided.

A manager was registered 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.’

Staff were recruited safely and there were enough staff to ensure all care visits were made, with staff staying the required length of time and completing required tasks. Staff received appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and received formal supervision where they could discuss their ongoing development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. People and relatives told us that they were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed at each care visit. People felt safe and appropriate referrals were made to the safeguarding team when necessary.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People's healthcare needs were being met and people received assistance with their medicines if required. If people received support with their nutrition, this is recorded in people’s care records.

People who used the service knew how to raise a complaint and care workers were aware of the appropriate action to be taken. The complaints procedure was displayed. Records showed complaints received had been dealt with.

Everyone spoke highly of the registered manager and nominated individual and said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they acted to make improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

The registered manager informed us that they were a community resource and provided an advisory and interpreting service for people from Somalia and the Middle East. The service had translated important documents for Somali service users. In addition, they sometimes spoke on behalf of people in meetings with the statutory bodies such as the local authority, health authority and the Police.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

The last comprehensive inspection we carried out in November 2016 found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. During this inspection, we found that the service had taken action to comply with the requirement. The service had a system of checks to ensure people received the care they needed. Audits had been carried out since the last inspection. In addition, the service had also been subject to inspections by the local authority’s commissioning and quality monitoring department. Following these audits, the service had taken action to improve areas identified. We however, noted that further improvements were needed to ensure that checks and audits covered all important areas such as risk assessments and care documentation. This would ensure the service could better identify and promptly rectify deficiencies. We have made a recommendation in respect of this.

We received positive feedback from people and relatives of people who used the service. They spoke highly of care workers and informed us that they were satisfied with the care and services provided. They informed us that people had been treated with respect and they were safe when cared for by the service. There was a safeguarding adults policy and care workers were aware of the procedure to follow if they suspected people were being abused.

The service had a policy and procedure for the administration of medicines. The nominated individual told us that care workers did not administer medicines but only prompted people to take their medicines.

Risk assessments were seen in the care records of people. However, they were not sufficiently comprehensive as they did not inform care workers of what specific risks or problems may be experienced by people concerned and how to keep people safe. For example, there was no mention of risks of hypoglycaemia or hyperglycaemia for someone with diabetes. In the case of epilepsy, there was no guidance regarding ensuring people were kept safe when having a seizure. One person who needed to be hoisted did not have a risk assessment. The risk assessment for hoisting was provided after the inspection. We have made a requirement in respect of this. The nominated individual stated that they would ensure that other risk assessments were more comprehensive.

The service had a recruitment procedure. Essential checks had been undertaken prior to them starting work. We however, noted that two care workers had issues related to their criminal records checks. Risk assessments related to these issues had not been documented in their records. We also noted that five previous employers’ references of five care workers appeared similar and the service had not re-checked to verify they were accurate. The nominated individual stated that the five care workers had worked at the same place. We have made a recommendation in respect of this.

The service had a training programme to ensure care workers were competent and able to care effectively for people. Certificates were seen in the records of care workers. They had the necessary support, supervision and appraisals from management staff. Teamwork and communication within the service was good. New care workers had been started on a comprehensive induction called The Care Certificate.

Care workers were caring in their approach and able to form positive relationships with people. There were arrangements for encouraging people and their representatives to express their views and make suggestions regarding the care provided and the management of the service. Individual assessments and care plans had been prepared for people. However, the care documentation was not structured and information was not always easily accessible. The nominated individual informed us after the inspection that they had started to structure the care records. Reviews of care had been carried out to ensure that people received appropriate care.

The service had a complaints procedure and people and their representatives knew who to contact if they had concerns. Two complaints recorded had been promptly responded to. People and their representatives expressed confidence in the management of the service.

Overall, we noted that the service had made some improvements since our last inspection in November 2016. However, further improvements are needed to ensure the safety of people and that deficiencies are promptly noted and rectified.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

People and their representatives informed us that they were satisfied with the care and services provided. They informed us that people had been treated with respect and they were safe when cared for by the service. There was a safeguarding adults policy and suitable arrangements for safeguarding people from abuse.

Care workers were caring in their approach and knowledgeable regarding the individual choices and preferences of people. People’s care needs and some potential risks to them were assessed and guidance provided to care workers on how to care for people. Care workers prepared appropriate and up to date care plans which involved people and their representatives.

The service had a policy and procedure for the administration of medicines. The nominated individual stated that care workers did not administer medicines but only prompted people to take their medicines. We noted that some medicines prompt forms had not been properly completed to indicate that people had been prompted to take their medicines. We have made a recommendation in respect of this.

Care workers had been carefully recruited. The necessary checks had been undertaken prior to them starting work. The service had a training programme to ensure care workers were competent and able to care effectively for people. They had the necessary support, supervision and appraisals from management staff. Teamwork and communication within the service was good. New care workers had been provided with a period of induction. However, full details of the content of induction topics covered were not available. These are needed to provide documented evidence that care workers had received a comprehensive induction. We have made a recommendation in respect of this.

There were arrangements for encouraging people and their representatives to express their views and make suggestions regarding the care provided and the management of the service. Reviews of care had been carried out to ensure that people received appropriate care.

The service had a complaints procedure and people and their representatives knew who to contact if they had concerns. No complaints were recorded. The nominated individual stated that none had been received.

People and their representatives expressed confidence in the management of the service. They stated that care workers communicated well with them and kept them informed if they were held up or running late. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity, providing a high quality care and promoting people’s independence where appropriate.

The service had a system of checks to ensure people received the care they needed. We were provided with evidence of spot checks on care workers, reviews of care and evidence of telephone monitoring. The deputy manager stated that audits of the service had been carried out regularly by nominated individual and visiting professionals. He stated that these professionals visited at intervals and provided feedback on the service. We however, noted that there was no evidence of regular and comprehensive audits being carried out. There was no written evidence of regular audits in areas such as the quality of care documentation, complaints, policies and procedures and staff training. Such audits are needed so that the service can identify and promptly rectify deficiencies. We have made a requirement in respect of this.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

At the time of our inspection there were ten people using the service. We spoke with one person and three relatives of people.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Potential risks to people had been identified and were acted upon by staff so that people were kept safe. People were kept safe from infection because the service had infection control procedures in place. Staff wore protective clothing and took appropriate hygiene control measures. One relative of a person told us, 'The staff are always cleaning. 'Staff understood their role in regards to infection control. We saw the service carried out the required checks on staff's suitability to care for people safely. Criminal record and identity checks were carried out on staff before they commenced work.

People were supported by staff who had the knowledge and skills to deal with foreseeable emergencies. They had received first aid training and had also been trained how to lift people safely. People receiving support and care were given handbooks which had emergency numbers that they could call.

Is the service effective?

People's social, health and support needs were assessed with them and they were involved in reviewing their care plans. People told us the service met their identified needs. One relative of a person said, 'The carer speaks my grandmother's language, they understand her needs.' Staff were able to explain how the Mental Capacity Act 2005 related to their service. People told us staff always involved them in reviews of their care packages and changes were only made with their consent.

Is the service caring?

People were supported by kind and attentive staff. Staff were able to explain how they supported people to maintain their dignity and deliver services in a caring way. Care plans included details of how people liked to be supported. One person said, 'Staff treat me very well.'

Is the service responsive?

We saw the service had a system in place to respond to complaints and comments. The service had asked people's view of the service and responded to what people told them. Records showed people needs were assessed before they received the service.

Is the service well-led?

Staff were clear about the aims and objectives of the service. Quality assurance processes were in place to check what people thought about the service. We saw the service had sent feedback forms to people who used the service and their relatives.

Carers and the person receiving care were positive about the service. We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There were enough qualified, skilled and experienced staff to meet people's needs and people were cared for by staff who felt supported to deliver care and treatment safely and to an appropriate standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People were protected from the risk of abuse and experienced care and support that met their needs because the provider assessed their needs and ensured care was provided accordingly by suitably qualified staff.