Archived: Islington - London Also known as Blue Popies Care and Support Services

Islington – London (also known as Blue Popies Care and Support Services) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults as well as people with physical and mental health conditions. At the time of this inspection, the service supported 22 people. 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. At the time of our inspection there were 12 people using the service receiving the regulated activity of personal care.

The service is owned and managed by Mrs Kalliopi-Popi Galani. There is no requirement for a separate registered manager for this location. For the purposes of this report, we will refer to the 'provider' when speaking about the owner/manager of the service.

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

People who received care from the service told us they were well supported by care workers. People told us they felt safe when in the presence of care workers. Systems were in place to safeguard people from the risk of possible harm. Staff we spoke with understood their responsibilities with regards to safeguarding people. The service had safe recruitment procedures in place.

Medicines were being managed safely. However, we found some improvement was needed in relation to record keeping. Records indicated that staff had received training on the administration of medicines.

Appropriate risk assessments were in place and covered areas such as the environment, physical health and personal care.

When we gave the provider notice of the inspection, she informed us that she was abroad. Although we were able to start some aspects of the inspection, the provider was not available for the site visit part of the inspection for 20 days following our announcement. The arrangements in place whilst the provider was away were not suitable and limited our ability to check information.

There were some instances where the service failed to effectively check various aspects of the service and we found a continued breach of regulation. Together with the fact that the provider’s cover arrangements were of limited efficiency we judged that there was overall poor governance at this service.

Positive relationships had been developed between care workers and people they supported. People told us calls to their home were never missed and that care workers usually arrived on time. Consistency was an important aspect of the care provided. People told us they received care and support from the same care workers.

Accidents and incidents were documented. However, we noted that these lacked information about lessons learnt following an accident or incident.

Care workers we spoke with told us that they felt supported by the provider. They told us that management were approachable and they raised no concerns in respect of this. Staff had completed training relevant to their role.

People were supported to maintain good health and access healthcare services when needed. People were supported with their nutritional and hydration needs.

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. Care plans lacked information about people's level of capacity and we have made a recommendation in relation to this.

Procedures were in place to respond to complaints.

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

Rating at last inspection

The last rating for this service was requires improvement (published 11 February 2020). The service remains rated requires improvement. This service has been rated as requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. The information CQC received about the incident indicated concerns about care provision. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Islington – London (also known as Blue Popies Care and Support Services) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults as well as people with physical and mental health conditions. The service supported 20 people. 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. At the time of our inspection there were 5 people using the service receiving the regulated activity of personal care.

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

Not all care provided to people by staff and spot checks of staff’s direct work with people had been documented.

Improvements were noted in relation to how the service managed medicines and assessed the risk to health and wellbeing of people. Further improvements were needed and we made recommendations in relation to these areas of the service delivery.

The registered manager was responsive to our feedback and took immediate action to address issues identified by us during this inspection.

Staff understood their responsibility in relation to protecting people from harm. The service had systems and processes to safeguard people from abuse, manage accidents and incidents and prevent infection. Staff were safely recruited and there were enough staff deployed to support people.

Staff received training to support people effectively. People needs had been assessed holistically and the review of these needs took place when people health and wellbeing changed. People’s wishes and preferences were considered when planning their care. People received the support they needed to eat and drink and live a healthy life.

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 said staff treated them with dignity and respect. Staff promoted independence and choice when supporting people. Complaints were handled appropriately and to the satisfaction of people who made the complaint.

Staff said they felt supported by the registered manager who they described as supportive, firm and ensuring people received the support they needed.

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

Rating at last inspection

The last rating for this service was requires improvement (published 21 November 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. We have identified breaches in relation to the governance of the service at this inspection. We made recommendations about management of medicines and recording of risk management strategies.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Islington – London (also known as Blue Popies Care and Support Services) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults as well as people with physical and mental health conditions. At the time of our inspection there were 8 people using the service receiving the regulated activity of personal care.

There was a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager was also the owner and had been managing it since it was founded in 2014.

During this inspection we found the service provided good quality support and people’s needs had been met effectively. Staff were appropriately trained and the registered manager had been personally involved in care for each person using the service. We saw examples where care provided by the agency went beyond the usual contractual duties. This was to ensure that people received complete support and to make their life more comfortable.

We also found that some areas of the service required improvement. This was because care and support provided by the service had not been fully meeting the current guidelines and the Health and Social Care Act Regulations. We discussed these shortfalls with the registered manager who was receptive to our feedback.

The registered manager had systems in place to monitor the quality of the service and they maintained them regularly. However, these had not always identified the shortfalls we saw at this inspection.

At our previous inspection in April 2016 we found some issues with the management of risk to the health and wellbeing of people who used the service. At this inspection improvements were noted in how the agency managed individual risks to people. However, further improvements were needed to ensure information about all risks were personalised.

At this inspection we found that the agency had not always managed people’s medicines according to the current guidelines. We could not always say what medicines were prescribed to people and if people had received them as intended by the prescriber. Therefore, there was a risk that people could receive their medicines in unsafe way.

Staff understood their role in safeguarding people and people were protected from harm from others. The registered manager was taking proactive action when they thought people were at risk of harm.

There were further systems in place to ensure people were safe. Accidents and incidents were managed proactively and action was taken to reduce their reoccurrence. There were sufficient staff deployed to ensure people’s needs were met. Safe recruitment procedures protected people from unsuitable staff. Effective infection control measures used by staff protected people from avoidable infection.

Staff had appropriate skills and training to meet people’s needs. The registered manager had provided ongoing formal supervision and informal support to ensure staff cared for people in an effective and safe way.

Staff helped people to have a nutritious diet that met their health needs and preferences. People had access to healthcare professionals when their needs had changed or their health had suddenly deteriorated.

The agency worked within the principles of the Mental Capacity Act 2005. People had been asked for their consent before staff provided any care to them.

People using the service thought staff who visited them were kind and caring. People said they felt respected when receiving personal care. Staff encouraged people to be as independent as they could and supported people in living a comfortable life in their home and in the local community.

People’s care needs and preferences had been assessed by the agency before they started providing care to people. Staff supported people with respect to their changing needs and individual preferences. Some improvements were required to ensure information about changes to people’s care needs could be found easily by staff who supported people.

The agency had a complaint procedure in place and it was known to people. People told us they had no reason to complain. However, they were comfortable to speak to the registered manager if they had any concerns.

At the time of our inspection the agency had not provided end of life care. However, we noted that previously the agency had provided end of life care. We saw compliments from relatives, who were thankful about the support their loved ones had received.

Stakeholders spoke positively about the service provided by the agency. People using the service and their family members said they would recommend the agency to others. Staff felt supported by the registered manager who they could contact at any time with any issues. External health and care professionals felt there was good communication with the agency and they felt the agency could provide appropriate support to people even those with the most complex needs.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have made one recommendation related to risk management. You can see what action we told the provider to take at the back of the full version of the report.

Islington – London (also known as Blue Popies Care and Support Services) provides support and personal care to people living at home. At the time of our inspection there were 30 people using the service. Of those, there were 15 people receiving support with personal care. The provision of personal care is regulated by the Care Quality Commission.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

The agency was not always ensuring that risks to people had been appropriately mitigated. This was in relation to infection control and a clinical task that had been transferred to the agency staff from healthcare professionals.

Staff could explain how they would recognise and report abuse and they understood their responsibilities in keeping people safe.

People told us they were well treated by the staff and felt safe and trusted them.

People who used the service and their relatives were positive about the staff and told us they had confidence in their abilities and staff told us that they were provided with training in the areas they needed in order to support people effectively.

Staff understood that it was not right to make choices for people when they could make choices for themselves and people’s ability around decision making, preferences and choices were recorded in their care plans and followed by staff.

People told us they were happy with the support they received with eating and drinking and staff were aware of people’s dietary requirements and preferences.

People confirmed that they were involved in the planning of their care and support. Care plans included the views of people using the service and their relatives. Relatives told us they were kept up to date about any changes by staff at the office.

People and their relatives told us that the management and staff were quick to respond to any changes in their needs and care plans reflected how people were supported to receive care and treatment in accordance with their current needs and preferences.

People told us they had no complaints about the service but said they felt able to raise any concerns without worry.

The agency had a number of quality monitoring systems including surveys for people using the service and their relatives. People we spoke with confirmed that they were asked about the quality of the service and had made comments about this. They felt the service took their views into account in order to improve service delivery.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

People who use the service and their relatives told us they felt safe when working with staff. One person told us "[My care worker] always knows exactly what to do. I can get myself in a pickle sometimes as I can't walk and rely on staff to move me around but they know what to do and always help me. I feel safer with them about". Each person who used the service had a number of risk assessments relating to their support and their homes.

Staff were thoroughly vetted before they started work, and the provider ensured that each staff member had the appropriate training to perform their role safely. Staff told us they were provided with accurate, comprehensive information about each person and their support before starting to work with them. One staff member said "The care plans are very good, I always have enough information to support the client safely".

Is the service effective?

Care plans we viewed were clearly linked to the person's assessed support needs, and we saw that the provider took extra steps to meet people's needs when necessary. People who used the service and their relatives told us they greatly valued the support they received. One relative said "My relative is totally reliant on the care workers as they can't move without support. The care is a godsend and they are wonderful people, they look after my relative very well". Another relative commented during a quality assurance visit that "The two support workers are very caring, patient and have lots of understanding of my relative's needs and always give them time and space when they are anxious or frustrated. They are very good support workers".

Is the service caring?

One person who used the service told us "I can be very maddening and frustrating, because I am maddened and frustrated by the fact that I can't walk. My care workers are so understanding, even when I am at my most maddening. I have to be taken everywhere and they look after me so well". Another person told us "They help me with absolutely everything, not just washing and going to the toilet. They help me with my money, with shopping and cleaning, going to the doctor and to hospital appointments - they've changed my life".

Is the service responsive?

Staff and people who used the service were asked regularly for their views about the service provided and any changes needed to support people safely, and we saw that these were taken seriously and acted upon. One person who used the service told us "I don't have any cause to complain. If I had any issues I would phone the manager straight away and I know it would be sorted out".

Is the service well-led?

The provider had a comprehensive quality assurance system in place. Spot checks were carried out regularly, and accident and incidents were investigated with learning and outcomes for the service noted. Staff told us they were well-supported by the managers, and records indicated that the managers worked alongside care workers when necessary and to ensure they properly understood the needs of the people who used the service.