Date of Assessment: 26 March to 18 April 2025. Inner City Care, Sherwood House is a care at home service providing support to people under and over the age of 65, some of whom may be living with dementia. Inner City Care, Sherwood House may also care and support for people with a learning disability, although this is not their primary reason for receiving care at home. We inspected this service to follow up on concerns we identified during our assessment in July 2023. The provider was previously in breach of legal regulations in relation to safety and governance. Improvements were found at this assessment and the provider was no longer in breach of these regulations. People's care records and risk assessments had improved. They now reflected people's care needs and were person-centred. Quality assurance processes were now more effective in highlighting areas of concern and improvement. The recording of people’s medicines had improved and there was now a consistent approach to investigating and acting on safeguarding concerns and accidents and incidents. Guidance and assessments provided by other health and social care professionals were now used to form meaningful care plans. Staff training had improved with more face-to-face training being provided. This helped to improve people’s experiences and reduced the risk of harm. People were protected and kept safe. Staff understood, managed, and acted on risks. People were involved in assessments of their needs. Staff worked with external agencies involved in people’s care for the best outcomes and smooth transitions. For example, if admitted to hospital. Staff monitored people’s health to support healthy living. Staff made sure people understood their care to enable them to give informed consent. Staff involved those important to people to assist them with making decisions should they have reduced or no capacity. People were treated with kindness and compassion. Staff supported people’s independence and encouraged and supported them to maintain relationships with family and friends. Staff provided information people could understand. People knew how to give feedback and were confident the provider took it seriously and acted on it. Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable, and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally. Staff understood their roles and responsibilities. Managers were receptive to new ideas and there was a culture of continuous improvement. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence, and good access to local communities that most people take for granted.
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Inner City Care – Lancaster House received a 'Requires Improvement' rating across all five key questions, with two regulatory breaches identified under Regulation 12 (safe care and treatment) and Regulation 17 (good governance), the latter resulting in a Warning Notice. Key failings included non-person-centred and inconsistent care planning, unsafe medicines recording, ineffective governance and quality assurance, and high management turnover (three managers in 12 months), though staff were found to be kind and caring and people reported feeling safe.
Concerns (12)
criticalCare planning: “People's care records and risk assessments were not comprehensive, did not always reflect people's care needs and were not always person-centred.”
criticalMedication management: “Medicine records were inconsistently completed... Some care records were contradictory. For example, for one person it stated they could 'self-medicate', another part stated they needed 'prompting and supervising'.”
criticalGovernance: “The provider did not have effective governance systems in place to assess, monitor and improve the quality and safety of people's care. This was a breach of regulation 17(1).”
moderateIncident learning: “Incidents were recorded; however, there was no review and analysis conducted by the manager or the provider to ensure the on-going risks to people's safety had been addressed.”
moderateConsent / capacity: “People's capacity and assessments around this were poorly documented. It was not clear from people's plan what level of capacity they had and what decisions they could make.”
moderatePerson-centred care: “Care plans followed a standardised format with little evidence of person-centred care planning... daily routines recorded for staff to follow each day lacked specific details of people's preferences.”
moderateCultural competency: “Only 8 of 28 care staff had completed equality and diversity training. This could place people at risk of discrimination.”
moderateCommunication with families: “A care plan stated a person did not speak English... however, no communication care plan was in place. This meant the person may receive inconsistent support.”
moderateLeadership: “The current manager was the third manager in post in the last 12 months. This has contributed to inconsistent and ineffective quality assurance processes.”
moderateRecord keeping: “Records were often not accurate or up to date. Where accidents or incidents had occurred there was little investigation, analysis, or review to try to identify the cause.”
minorComplaints handling: “The provider's complaints policy lacked specific details required to inform people how their complaint would be handled and who by. No timescale was provided.”
minorStaff training: “Additional training... had not yet been completed by all. The provider did not have the processes in place to monitor and address this with staff.”
Strengths
· People felt safe when staff cared for them in their homes and provided positive feedback about staff being kind and caring.
· Safe recruitment procedures were followed, including DBS checks, identity and right-to-work verification.
· Sufficient suitably trained and skilled staff were available at the time of inspection; people reported staff arrived on time and stayed the full length of calls.
· Effective infection prevention and control measures were in place, including use of PPE.
· Staff understood how to identify risks of abuse and neglect and knew how to report concerns internally and externally.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
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effective: Assessing people's needs and choices, delivering care in line with standards, guidance, and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills, and experienceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported, respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity, and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Supporting people to develop and maintain relationships to avoid social isolationRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks, and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive, and empoweringRequires improvement
well-led: Working in partnership with othersRequires improvement