Date of Assessment: 26 September to 5 November 2024. London Care (Westminster) is a domiciliary care agency that provides care and support to people living in their own homes. At the time of our assessment 254 people were using the service, although not everyone received support with personal care. The last rating for this service was requires improvement (report published 4 October 2022), when we identified breaches of regulations in respect of safe care and treatment and good governance. We carried out this assessment to follow up these breaches and make sure the provider had made the required improvements. We looked at all the quality statements for safe and well-led and a selection of quality statements for the remaining key questions of effective, caring and responsive. We were satisfied that enough improvements had been made to assessing and mitigating risks to the health and safety of people using the service. In addition, systems and processes were being operated effectively to monitor and improve the quality and safety of the service. This meant the provider was no longer in breach of any regulations and the overall rating for this service is now good. People received a safe service, were protected from abuse or neglect and had their human rights promoted. The service followed safe recruitment processes and there were enough staff deployed to support people. There were effective processes to ensure people’s medicines were managed and administered safely. Care and risk management plans were individual and met the needs of people using the service. Staff knew people well and understood how they liked to be supported with their individual needs. There was a clear management structure and staff felt supported in their roles. The provider sought feedback from people, relatives and staff and used this to develop the service. There were effective systems in place to monitor the quality of the service and identify when improvements were required.
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Focused inspection of London Care (Westminster) downgraded the service from Good to Requires Improvement after finding care staff lacked travel time between visits and people requiring two carers sometimes received only one, breaching Regulation 12. Governance failings around ECM scheduling and false log-ins led to a Warning Notice under Regulation 17, though medicines, infection control and safeguarding remained satisfactory.
Concerns (7)
criticalStaffing levels: “one specific occasion when a person scheduled to receive care and support from two care staff was visited by only one staff member”
criticalMissed or late visits: “21% of calls during this month did not have any designated travel time... one care worker did not have travel time for 108 out of 266 visits”
criticalCare planning: “some people were placed at risk by the provider when they did not receive care from two staff members together, as the provider was not following the person's agreed care plan”
criticalGovernance: “Systems to monitor aspects of the quality of the service were not sufficiently robust as we found many examples of care staff having insufficient time to travel between calls”
criticalRecord keeping: “a care worker logged out of a person's home 2.44 kilometres away from the known address... records showed this journey was made instantaneously”
moderateLeadership: “At the time of our inspection there was not a registered manager in post and the provider had commenced recruitment for a new manager”
moderateIncident learning: “issues which were not thoroughly addressed to facilitate effective learning... the provider had not fully investigated and established the significance of a care worker logging in at a precise distance away”
Strengths
· Safely recruited staff with DBS checks, references and right-to-work verification
· People felt safe and comfortable with their care workers
· Safe medicines support with competency checks and MAR audits
· Good infection prevention and control with appropriate PPE provision
· Equality and diversity training; service marked occasions important to people (e.g. Black History Month, Eid, Pride)
Quality-Statement breakdown (12)
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood