Home Instead Westminster

Updated 12 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a routine inspection as we had rated the service ‘Good’ two years ago. We were not aware of any serious incidents or concerns about the service. The inspection took place on 27 February and 5 March 2018 and was announced. We informed the provider of our plan to return on 19 March 2018 to provide feedback following our two home visits to people who used the service and telephone calls to other people, and their relatives where applicable. The provider was given two days’ notice of our intention to carry out an inspection because we needed to make sure that a member of the managerial team would be available to support the inspection process. The inspection was carried out by one adult social care inspector.

During the inspection we visited the office location in order to meet the management team and look at a range of documents. This included four care and support plans for people who used the service, medicine administration records, staff files for training, supervision and recruitment, the complaints log and various policies and procedures. We visited two people who used the service in their own homes, which enabled us to gather their views, observe interactions between people and their support workers and check the quality of record keeping maintained by staff. These visits also permitted us to meet people’s relatives and friends and find out their opinions about the service. We also gathered information through speaking with five members of the care staff, the registered manager, the care manager and the care co-ordinator. The care staff were known as ‘caregivers’ and we have used this job title in the report within the quotes we received from people and their representatives.

Prior to the inspection we reviewed the information the Care Quality Commission (CQC) held about the service. This included any notifications of significant incidents reported to the CQC and the previous inspection report. We also reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with three people who used the service, and the relatives and friends of four other people. Following the inspection we contacted six health and social care professionals with knowledge and experience of the service and received a response from each professional.

Updated 12 June 2018

This comprehensive inspection was commenced on 27 February 2018 and was announced. We spent two days at the provider’s office and also visited two people who used the service in their own homes. The inspection visits were completed on 19 March 2018 and we completed telephone calls to people who use the service and their relatives on 29 March 2018. The service was rated as Good at the previous inspection in December 2015. Safe, caring, responsive and well-led were rated as Good and effective was rated as Requires Improvement.

At the previous inspection on 3 December 2015 we had found that staff were not provided with Mental Capacity Act 2005 (MCA) training, which had meant that we had not been assured that the principals of the MCA were followed when staff assessed people’s capacity. We had made a recommendation for the provider to seek advice and guidance from a reputable source in relation to the requirements of the MCA training for social care staff. At this inspection we found that staff had received relevant training in this area. The staff we spoke with were able to clearly demonstrate their knowledge and understanding in regards to the MCA, and the minutes for staff’s one to one supervision sessions and team meetings showed that this topic was regularly discussed.

Home Instead Westminster is a domiciliary care agency which provides the regulated activity of ‘personal care’ to people living in their own houses and flats in the community. It provides a service to older adults, people with physical disabilities and people living with dementia who reside in the City of Westminster, City of London and some postcodes within the London Boroughs of Brent, Hackney and Southwark. The geographical boundaries were determined by the national franchise organisation. Not everyone using Home Instead Westminster receives regulated activity, the 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. At the time of the inspection the provider was providing services for 40 people, which included six people who received personal care.

There was a registered manager in post at the time of our inspection, who was the owner of the local franchise. A registered manager is a person who has registered with CQC 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.

People and their representatives told us that they received an excellent service and felt confident about recommending the agency to other people. They described staff as being “lovely” and “kind” and spoke about situations where staff had shown enormous compassion and thoughtfulness. People and their representatives stated that the high quality of the service had very positively impacted on their comfort, wellbeing and safety. Staff told us that they had developed good relationships with the people they supported. This was aided by the provider’s policies to carefully match people with their care staff and ensure that all visits were a minimum of two hours duration.

People and their representatives regarded the management team as being dedicated to their roles and committed to providing an exceptionally high standard of care and support. We saw that the registered manager and members of the management team keenly worked towards supporting people living with dementia who used the service and at a wider level in the local community via fundraising, providing free training about dementia for the general public and through active membership of a local dementia care alliance.

Staff informed us that they felt well supported and trained by a provider that valued their contribution, and was interested in their wellbeing and career development. The provider had invested in the staff training to support people who were living with dementia and was in the process of introducing a new training package to support staff to develop their knowledge and skills in the provision of end of life care. The culture of the service was described by staff as being “open” and “supportive.”

There were clear systems in place to ensure the safety of people who used the service. Staff had received training to identify if people were at risk from abuse or harm. People reported that they felt safe with staff. Sufficient staff were deployed to ensure that people received a consistently reliable service and recruitment procedures to appoint new staff were thorough.

The provider ensured that people's needs were assessed before their care and support package commenced. People were provided with person-centred care which took into account their needs, wishes, preferences, and any cultural and/or religious needs. Staff supported people to meet their nutritional and health care needs. Local health and social care professionals informed us that people received extremely well delivered care and support from the provider.

People received support from staff with their medicine needs, in line with their own wishes to remain as independent as possible.

People were supported by staff who respected their privacy and promoted their dignity. Staff encouraged people to take part in meaningful and stimulating activities to promote their wellbeing.

The provider had a straight -forward complaints policy and procedure in place, and people stated that they trusted the provider to investigate complaints in a professional manner.

The provider had developed positive relationships with local organisations in order to develop and improve the quality of the service. This included an initiative to advise people and their representatives about the risks presented by financial scams.

There were rigorous systems in place to seek the views of people who used the service, and monitor the quality of the service through the use of tools that included spot checks, care planning review meetings and audits.