Archived: London East

London East is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing a service to 20 people.

The service did have a registered manager however the person had been promoted elsewhere within the company. The service had a different member of staff acting in the role of manager with day to day responsibility for running the service. The manager had started the process to apply for the role of registered manager. 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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Responsive, Effective and Well-led to at least good. The service was last inspected in November 2016 when we identified breaches of regulations regarding notifications of other incidents, need for consent, staffing, safe care and treatment and good governance. We asked the provider to take action to make improvements. Although the provider had addressed specific concerns around notifications of other incidents, need for consent and staffing, the breaches of regulations continued on this inspection in relation to safe care and treatment and good governance. We also found on this inspection a breach of regulation for person centred care.

We found care plans lacked detail regarding the specific nature of the support people needed and people’s preferences were not always clearly captured.

Risks people faced had been identified, but the measures in place to mitigate them were not clear. Medicines records for people who received medicines on a ‘when required’ basis (PRN) were unclear. PRN medicines are to be taken as needed instead of on a regular dosing schedule. The governance and audit arrangements of PRN medicines had failed to identify or address the range of concerns found during the inspection.

Staff received regular supervision and records showed staff were able to give feedback and suggestions about how the service should be run. However it was not always clear senior staff provided support and guidance following feedback received in supervision. We have made a recommendation about supervision.

The service was recording complaints however outcomes and learning points identified had not been recorded. We have made a recommendation about the management of complaints.

Staff undertook training to help support them to provide effective care. Staff had a good understanding of the Mental Capacity Act 2005 (MCA). MCA is legislation protecting people who are unable to make decisions for themselves.

People and their relatives told us they were supported with choosing what they wanted to eat and drink with the support of staff.

People’s cultural and religious needs were respected during care planning and delivery. Discussions with staff members demonstrated they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

People who used the service and their relatives were positive about the staff and told us they were caring. People and their relatives were involved in the planning of their care.

Staff, people and their relatives felt the manager and the office staff were approachable and accessible.

We identified breaches of three regulations. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for the service is Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.

London East provides personal care and support for people living in their own homes. In addition to providing personal care, they also provide respite care which helps family carers take a break from their caring responsibilities. At the time of the inspection there were 43 people using the service.

The service had a registered manager. 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.

The registered manager was unavailable during the dates of the inspection, we were told they were attending meetings. During the inspection the service was overseen by the team leader and the branch manager.

The provider carried out risk assessments in people’s homes. We found that risk assessments had not always been reviewed when and updated when people’s needs changed. Care plans lacked detail and guidance for staff to follow when supporting people with their care needs.

Staff understood what abuse was and knew how to report concerns. Safeguarding concerns had been acted on and investigated but the Care Quality Commission (CQC) had not been notified of these.

The provider followed their recruitment procedures to make sure that people employed to work in the service were suitable to do so.

Staff had received training and where further training was required there was a plan in place for staff to complete this. Staff had attended supervision but had not received regular annual appraisals.

There was a suitable number of staff to meet the needs of the people who used the service. However, care calls to people’s homes were not adequately monitored to ensure they received their visits on time and to ensure staff took sufficient rest breaks.

Staff did not always follow the legal requirements in relation to the Mental Capacity Act (MCA) 2005. People told us they were involved in decisions about their care.

People's medicines were not always managed in accordance with safe procedures and improvements were needed. Staff had received the required medicines training.

People were supported with their nutritional and dietary requirements but this was not always recorded in their care plans.

Changes in people’s healthcare needs were identified by care workers and they were referred to healthcare professionals when required.

Systems to assess, monitor and improve the service were in place. However, these were not always thorough in identifying and addressing shortfalls found in the service. Where incidents had occurred actions were put in place to improve the delivery of the service.

Staff understood the importance of treating people with dignity and respect. People and their relatives told us they were supported by caring staff who listened to them. Staff had a good understanding of people’s diverse needs.

Staff spoke positively about the management of the service. People were able to contact the service and speak to staff if they had any questions about their care.

People knew how to make a complaint and were confident any concerns they raised would be acted on. Surveys had been sent to people to obtain their feedback about the services they received.

We have made a recommendation about keeping people’s records safe and secure. We found five breaches of regulations relating to the safe care and treatment, staffing, consent, good governance and notification of other incidents. You can see what action we asked the provider to take at the back of the full version of this report.