Lewisham Enablement Service

Updated 21 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by one inspector who visited the office premises on 28 September 2021. A second inspector gathered evidence and information about the service remotely and spoke with staff members. Following the site inspection, an expert by experience contacted people using the service and their relatives for their feedback. 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 and rehabilitation services to people living in their own homes.

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

This inspection was announced. We gave the provider 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before inspection

We reviewed information we hold about the service such as notifications. Notifications are information about incidents and events the provider must tell us about by law, such as abuse. 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 used all of this information to plan our inspection.

During the inspection

We looked at a range of records including care records and risk assessments for nine people using the service. We reviewed a sample of the provider's working policies and procedures, looked at service audits and information related to staff recruitment, training and supervision. We spoke with two enablement planners and the registered manager.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke with three members of care staff and received written feedback from four health and social care professionals with a good knowledge of the service and staff. An expert by experience spoke with seven people using the service and one relative.

Updated 21 December 2021

About the service

Ladywell Centre is a domiciliary care agency. The service provides reablement and rehabilitation as well as personal care for people in their own homes. People are referred to the service from local authority representatives and health care professionals. The service aims to maximise people's ability to continue living independently following discharge from hospital, following an accident or illness. At the time of the inspection the service was supporting 75 people.

People’s experience of using this service

People’s care needs and rehabilitation goals were identified by health and social care professionals and discussed with people, their relatives and other relevant representatives before plans were put in place to meet these needs.

Staff assessed risks to people’s health and wellbeing and developed plans to manage these. However, we saw no evidence of people’s care and support needs being regularly reviewed to ensure they received the appropriate level of support at all times.

Staff were required to support people to take their medicines as prescribed where this formed part of their care plan. However, records used in the administration of medicines were not always in place where required and medicines audits were not being completed accurately or reviewed to ensure they were of a good standard.

We were not assured the provider was following safe recruitment processes as staff records lacked important information. Despite requests, the provider/registered manager was unable to provide further evidence in relation to staff work histories and appropriate employment references.

Staff training data showed some gaps in learning. Spot checks to monitor staff performance were not taking place on a regular basis and feedback forms were not being routinely completed by people using the service. Although the registered manager acknowledged that quality monitoring systems had been hampered by the COVID-19 pandemic, operational systems had failed to mitigate and adapt to current circumstances.

Staff had a good understanding of the provider’s safeguarding processes and knew what action to take to keep people safe. People and their relatives told us they felt safe with the staff supporting them. Comments included, “[Staff] are very supportive”, “I feel I get the right support” and “[Staff] have kept me safe.”

There were suitable measures in place to protect people from COVID-19, including the use of protective personal equipment (PPE).

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.

People using the service, relatives, staff and most of the healthcare professionals we heard from, praised the management team for their helpful and professional attitude.

Rating at last inspection

This service was registered with us on 20 July 2020 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we had about this service. This indicated a need to prioritise the service for an inspection to review the quality of care provided.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, good governance and fit and proper persons. We made a recommendation in relation to care review and recording processes. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information we may plan further inspection activity.