Lean on Me Community Care Services Ltd (Northolt) retained a Requires Improvement rating across all five key questions following its January 2021 inspection, with continued regulatory breaches in risk management (Reg 12), person-centred care (Reg 9), and governance (Reg 17), the latter resulting in a Warning Notice. While staff were described as caring and some prior breaches around medicines and complaints were resolved, systemic failures in care plan currency, COVID-19 risk assessment, visit monitoring, and governance oversight remained unaddressed since the previous 2019 inspection.
Concerns (10)
criticalCare planning: “Some people's care plans appeared to be written in standardised terms with little personalised information about the person on how they preferred to be supported.”
criticalGovernance: “The provider's assurance systems had not identified and addressed in a timely manner that some people's care and risk management plans needed to be updated.”
criticalPerson-centred care: “Some care plans had not been reviewed or updated since our last inspection visit in June 2019. For example, one person's plan was dated 2017.”
moderateMissed or late visits: “The provider did not record, monitor and review late visits to identify how to reduce the frequency of these. This gave the provider only limited assurance staff were always deployed effectively.”
moderateInfection control: “Staff on site were not always able to socially distance and there was no evidence of frequent surface and equipment cleaning.”
moderateSafeguarding: “Two care workers did not know they can also report safeguarding concerns to statutory services and not just the provider.”
moderateRecord keeping: “Some of the daily logs completed by staff were not always complete and accurate records of people's care.”
moderateCommunication with families: “One person's care plan stated 'I have a learning disability which makes it difficult for me to communicate effectively,' and that staff should speak clearly. There was no other information.”
minorStaff competency: “Some recent competency assessments had not been fully completed. We discussed this with the registered manager so they could complete this process with staff.”
minorConsent / capacity: “The provider completed assessments of some people's mental capacity but did not specify what decision they considered a person may lack the capacity to make and why.”
Strengths
· People and relatives felt staff were caring and treated them with dignity and respect, with staff promoting people's privacy.
· Staff felt supported in their roles and were confident they would be listened to if they raised concerns.
· Medicines administration improved sufficiently since last inspection; provider no longer in breach of regulation 12 regarding medicines.
· Complaints handling improved sufficiently; provider no longer in breach of regulation 16.
· Staff provided with suitable PPE and infection control training; people felt protected from COVID-19.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Working in partnership with othersRequires improvement
Lean On Me Northolt was rated Inadequate overall following an April 2015 inspection, with seven regulatory breaches identified including failures in medicines management, care plan reviews, risk assessment updates, and non-notification of safeguarding incidents to CQC. The service was placed in Special Measures due to ineffective governance systems that failed to identify these widespread care delivery failures.
Concerns (7)
criticalMedication management: “two of the care records we reviewed showed care workers regularly gave medicines to people who had not signed the provider's consent form and support with medicines was not included in their care plans.”
criticalSafeguarding: “the provider had not informed the Care Quality Commission of these safeguarding incidents. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.”
criticalCare planning: “the provider told us they had reviewed and updated 100% of client files, information provided during the inspection showed the provider had reviewed only 20 of the 95 service user files.”
criticalGovernance: “audits completed by the provider did not identify service failures. For example, there was no evidence of risk assessment reviews, some recording by care workers was illegible.”
criticalConsent / capacity: “care workers regularly gave medicines to people who had not signed the provider's consent form and support with medicines was not included in their care plans.”
moderateRecord keeping: “some recording by care workers was illegible, care workers did not always follow guidance on the care and support people needed.”
moderatePerson-centred care: “some daily care notes included inappropriate language that objectified or infantilised people using the service...referring to one person as 'deaf and dumb' and references to 'changing nappies.'”
Strengths
· Care workers received regular supervision (one-to-one meetings with senior staff) and an annual appraisal.
· The provider employed a full-time training manager responsible for induction and refresher training; all mandatory training was completed.
· Staff files included application forms, verified references, criminal record checks, identity checks, and English language and numeracy tests.
· People using the service felt safe and expressed positive views about their care workers.
· The provider recorded complaints with details of investigative actions and worked with the local authority to resolve them.
Lean on Me Community Care Services Ltd (Northolt) was rated Requires Improvement overall at its September 2015 inspection, having exited special measures after demonstrating progress against two previous Warning Notices. One breach of Regulation 12 remained, relating to failure to deploy two staff for a person whose local authority support plan required it, and some care plans and risk assessments were not consistently reviewed when needs changed.
Concerns (4)
criticalStaffing levels: “the local authority support plan showed a need for two staff to support a person with all personal care tasks and moving and handling transfers...only one member of staff supported this person for three of the four visits”
moderateCare planning: “the provider had not reviewed one person's risk assessments for more than 12 months”
moderateCare planning: “The provider did not always have up to date information about people's care needs and risk management plans.”
minorRecord keeping: “we did find the provider had not reviewed or updated the risk assessment for one person and the care plan for a second person, in the records we checked”
Strengths
· Effective recruitment procedures including DBS checks, verified references and identity checks
· Staff completed mandatory training including moving and handling, medicines administration and first aid, and were up to date
· Provider improved dignity and respect in care recording following previous inspection concerns
· Regular supervision every six to eight weeks and annual appraisals in place for all staff
· Medicines administration procedures improved with MAR sheets collected and checked monthly
Lean on Me Community Care Services Ltd in Northolt was rated Good across all five key questions at its March 2017 inspection, having remediated a prior breach around risk assessments. Minor issues around occasional late visits, communication consistency, and language barriers were noted but did not detract from an overall positive picture.
Concerns (4)
minorMissed or late visits: “They are often late but they never call to let us know. I try to do what I can so by the time they arrive it's just a quick in and out for them.”
minorCommunication with families: “There's not much contact from the agency or supervisor, you only really see the supervisor if they are bringing a new carer or if they are stepping in to cover.”
minorCultural competency: “If they could get someone who could speak my [family member's] language that would be good... Sometimes there is a language barrier and I feel I am teaching them.”
minorPerson-centred care: “The carers are very task orientated, they come in and have to concentrate on getting the job done. It would be nice to have more time for a chat.”
Strengths
· Risk assessments were up to date, regularly reviewed, and included clear guidance for care workers on mitigating identified risks.
· People felt safe with their care workers and reported competent use of equipment such as bath lifts and rota stands.
· Medicines were managed safely with appropriate recording on MAR sheets and daily care notes.
· Staff received induction training including all 15 Care Certificate modules, mandatory training, and regular formal supervision.
· Consent and Mental Capacity Act considerations were appropriately documented in care records.
Lean on Me Community Care Services Ltd (Northolt) deteriorated from Good to Requires Improvement across all five key questions, with four regulatory breaches identified covering safe care and treatment, person-centred care, complaints handling, and good governance. Key failings included unsafe medicines records, out-of-date care plans, missed care visits, an unresolved backlog of 40 complaints, and failure to notify CQC of three safeguarding allegations.
Concerns (11)
criticalMedication management: “The medicines administration records (MARs) we saw did not provide a clear record of the prescribed medicines people required or received.”
criticalCare planning: “Four people's plans were dated June 2017...these meetings did not inform a recorded re-assessment of people's needs or an update of their plans of care.”
criticalPerson-centred care: “Plans gave basic information about the tasks care staff needed to complete, without always including information about people's preferences or the way they wanted to be cared for.”
criticalComplaints handling: “The local commissioning authority told us it was waiting for information from the provider on how 40 of these had been investigated and resolved.”
criticalGovernance: “This system of checks had not consistently operated effectively as it had not identified the issues we found during the inspection.”
criticalSafeguarding: “We found records of three allegations of abuse the provider was aware of, had responded to, but had not notified the CQC of these.”
moderateMissed or late visits: “The relative of another person told us they had experienced 'many' missed visits. They added, 'The most significant was Christmas day and they forgot [the person].'”
moderateStaff competency: “The provider had not assessed staff to ensure they were competent to give the medicines support being asked of them.”
moderateRecord keeping: “Financial transaction records for one person who had received weekly shopping support for two years had not been collected so they could be audited.”
moderateIncident learning: “Another adult social care professional commented that some incidents kept repeating, such as missed care visits.”
minorEnd-of-life care: “Managers told us the service avoided discussing this with people...Managers said they felt it was not the place of a domiciliary care agency to discuss end of life care.”
Strengths
· Regular carers were described as caring, respectful and promoting dignity and privacy by people and relatives.
· Staff completed a range of mandatory training including dementia awareness, moving and handling, and infection control.
· Staff recruitment included necessary pre-employment checks to ensure fit and proper applicants.
· The provider engaged with local safeguarding processes including attending multi-agency meetings.
· New management team was introduced with a new rostering and digital monitoring system being implemented.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
This focused, unannounced inspection of Lean on Me Community Care Services Ltd (Northolt) examined staff recruitment practices following concerns raised about a separate provider location. The service demonstrated robust recruitment procedures overall, with only minor record-keeping gaps identified in two of nineteen staff files reviewed.
Concerns (2)
minorRecord keeping: “On one of the 19 files we reviewed we noted that the provider had obtained and verified three character references from friends of the applicant. However, in the application form, the person said they had worked for three other care agencies”
minorRecord keeping: “One file did not include a DBS check and the provider had noted that the care worker should only work alongside another carer until they received it.”
Strengths
· Clear recruitment policy and procedures included in all staff files, covering identity, address, employment history and right to work checks.
· Provider sought Home Office advice before employing staff where right to work in the UK was uncertain.
· All reviewed files included a minimum of two references, with phone verification carried out in every case.
· Supervisor had completed online training in safeguarding and safer recruitment, including document validity checking.
Quality-Statement breakdown (1)
safe: Safe recruitment practicesGood
Good
caring: Dignity and respectGood
caring: Continuity of careGood
responsive: Care planning and needs assessmentGood
responsive: Complaints handlingGood
well-led: Governance and quality monitoringGood
well-led: Management structure and oversightGood
effective: Supporting people to live healthier lives and access healthcare servicesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standardsRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about roles, quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Continuous learning and improving care; duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood