Westminster Homecare Limited – Greenwich and North Kent

About the service

Westminster Homecare Limited (Bexley) is a homecare agency providing personal care to people living in their own homes and specialist housing in the Dartford and Bexley area. At the time of the inspection the agency supported 247 individuals with their personal care. The agency provided care mainly to older people living with dementia and some people with physical support needs or learning difficulties.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People’s care records were sometimes disjointed, and details on people’s needs and risks were included in different pieces of care documentation. Staff knew people and the provider’s recording systems well, hence there was no impact on the quality or safety of the service people received. However, the recording systems could make it difficult, especially for new staff to retrieve the essential information quickly which could affect the consistency of the care provided. The provider took action to review those records and to consolidate them.

People felt safe receiving care and support from Westminster Homecare Limited (Bexley) and were protected from avoidable harm. Staff were aware of safeguarding and individual risks to people and able to support them safely. This included safe administration of medicines where people required support. People were protected from infections. The provider ensured staff adhered to the Covid-19 national guidance.

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. Staff enabled and supported people to be as independent as possible and respected their individual choices.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The agency supported some people living with learning difficulties in their own homes and everyone had individual person-centred care plans and care package in place. The service worked in partnership with people, their representatives and local social services which enabled people to live in the community as independently as possible. People’s care plans were person-centred and promoted their independence, dignity and human rights.

People told us staff were kind, attentive to their needs and took effort to get to know them. When people shared concerns, the provider took prompt action to address and resolve those to improve people’s experience of care. Staff knew people well and encouraged them to be involved in their day to day care.

People were involved in planning of their care and regular reviews. They told us care was tailored to their individual needs and preferences and most felt the support they received was person-centred. Their care records confirmed this. People knew how to raise complaints if needed and most people felt listened to by the provider who acted to respond to their comments and improve the service when needed.

People, their relatives and staff were mostly complimentary about the management and leadership of the service. Staff felt valued and supported. The management team completed regular checks of quality and safety of the service and where shortfalls or lessons learned where identified, remedial action was taken. The service worked in partnership with the local authority and other local professionals’ networks as part of the response to the Covid-19 pandemic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update

The last rating for this service was good (published on 25 July 2018).

Why we inspected

This was a planned pilot virtual inspection. The report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the provider.

The pilot inspection considered the key questions of safe and well-led and provide a rating for those key questions. Only parts of the effective, caring and responsive key questions were considered, and therefore the ratings for these key questions are those awarded at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westminster Homecare Limited (Bexley) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is run by a registered manager who was present at the inspection visit to the office. 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.

At our last inspection we rated the service Good. However, we identified a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that staff received appropriate training in Mental Capacity and record keeping, and supervision as is necessary to enable them to carry out the duties they were employed to perform. We asked the provider to send us a plan of action which they returned on 16 November 2017, setting out what they would do to meet legal requirements in relation to the breach.

At this inspection on 4 June 2018 we found that improvements had been made to ensure that staff had received the training they required for their role, knew how to follow the principles of the Mental Capacity Act 2005 (MCA) and received regular supervisions. We found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on- going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Improvements had been made to staff’s understanding of the Mental Capacity Act 2005 and how to put its principles into practice. Staff had received training in this area, understood that people had capacity to make day to day decisions and best interest meetings were held as needed.

Staff felt well supported. They were supported by means of an annual appraisal, regular staff meetings and supervisions. Improvements had been made to make sure that supervisions were completed in line with the service's policies. Staff underwent a comprehensive induction program and regular training to ensure they were up to date with practice.

Care plans continued to be constructed jointly with people and their relatives and included people's social, physical and emotional needs. They were drawn up after a comprehensive assessment and reviewed regularly.

People told us they felt safe and trusted the staff who cared for them. Staff understood how to follow the service’s safeguarding and whistle blowing policy to keep people safe.

People told us they were treated with dignity and respect by staff who were polite and caring. The service had received compliments about the caring nature of the staff team.

Staff were aware of the risk assessments in place for people and their environment and the appropriate management strategies in place to protect people from avoidable harm.

There continued to be enough staff available to support people and an on-going robust recruitment program was in place. Where missed or late visits had been identified, these were investigated and actions taken to minimise their reoccurrence.

Medicines were administered safely by staff that had been assessed as competent. People received the support they required to eat a balanced diet. Staff reported any deterioration or changes in people’s health and care needs so appropriate referrals could be made.

People, their relatives, staff and social care professionals told us that the service was well- run. The registered manager was described as proactive, approachable and supportive. There was regular communication with staff through meetings and newsletters and their best practice was acknowledged through incentive schemes.

People told us they were aware of how to make a complaint and that any issues and concerns raised were investigated and rectified.

There continued to be regular quality assurance systems and audits in place to ensure care was delivered safely. People were asked for their views, these were acted on and most people rated the service overall as ‘good’ or ‘excellent’.

Further information is in the detailed findings below.

Westminster Homecare provides personal care to 347 people, 23 of whom are currently residing in an extra care facility (self-contained flats within a retirement housing development aimed at promoting independence).

The current manager had recently transferred from another branch and was in the process of becoming the 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.

Care plans were constructed jointly with people and their relatives and included people's social and emotional needs. These were drawn up after an assessment and reviewed regularly. However we noted that the section of people’s hopes and aspirations was sometimes left blank. In addition where people lacked capacity to make decisions about their support, there was no record of capacity assessments or evidence that relatives had power of attorney.

Staff were supported by means of annual appraisal, supervisions and regular staff meetings. However, supervisions were not being completed in line with the service's policies thereby breaching the regulation.

Staff underwent a comprehensive induction program and regular training to ensure they were up to date with practice. However, staff had not received the Mental Capacity Act 2005 training and therefore did not have an understanding of how this impacted on people and the way they were cared for.

People told us they felt safe and trusted the staff who cared for them. Staff explained the procedures they would take in an emergency and how and where they would report any allegations of abuse. There was a safeguarding and whistle blowing policy in place and staff told us they would not hesitate to report any concerns to the management.

Staff were aware of the risk assessments in place for people and their environment and the appropriate management strategies in place to protect people from avoidable harm.

People told us there were enough staff to support them and that they always obtained consent before delivering care. We saw that there was an on-going robust recruitment program to ensure there were enough staff to support people. Where missed or late visits were identified, staff involved were met with to discuss and ensure they followed the proper procedures so as to avoid missed visits in future and protect people from avoidable harm.

Medicines were administered safely by staff that had been assessed as competent. There were regular audits and spot checks in place to ensure that medicines were administered as prescribed.

People were supported to eat a balanced diet and maintain their health. Staff reported any deterioration or changes in health and care needs to the office in order to ensure appropriate referrals were made where extra and/ or specialist support was required.

People, their relatives and staff told us that the service was well- run by an approachable management team. They told us they were aware of how to make a complaint and that any issues and concerns raised were investigated and rectified.

There were regular quality assurance systems and audits in place to ensure care was delivered safely. Spot checks (unannounced checks to ensure staff administered care safely) were completed to ensure staff were following appropriate infection control guidelines and delivering individualised care that met people's needs.

People told us they were treated with dignity and respect by staff who were polite and caring.

People or their representatives told us that they had been involved in the assessment and care planning process and their likes, dislikes and preferences had been taken into account. They told us that any change in their needs was addressed quickly. They were all complimentary about the care and support provided by their regular care workers. Comments included 'I receive good care from regular, capable and friendly staff' and 'They look after my relative wonderfully well, treat them with respect and they feel safe'.

We saw that people were supported to receive their medicines safely and as prescribed by appropriately trained staff.

The provider employed sufficient trained and experienced staff to meet people's needs and provide the consistency of care which was highly valued by all the people with whom we spoke.

The provider had effective systems to regularly assess and monitor the quality of its service. They used a variety of methods to collect feedback from those involved and acted on any concerns or complaints they received.

Relatives told us they were happy with the carers they were sent, 'the carers are superb, I can't fault them' and 'the carers are extremely good at their work and they are also very nice people'.

Relatives told us that they were involved in the initial care planning and that staff were well trained and knew what they were doing.