About the service: Careworld London Limited is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults, younger disabled adults and children. At the time of the inspection the service was supporting 327 people in the London Boroughs of Hackney, Newham and Tower Hamlets.

People’s experience of using this service:

¿ Poor practice and ineffective governance systems had resulted in people missing visits and receiving late care calls, which had not been followed up. One person said, “They come at different times and don’t stay the full time. A lot of the time they don’t turn up. I’m constantly having to chase it up and never get a call back.”

¿ The service had ineffective systems in place to protect people from harm. The assessment of risk and medicines management across the organisation was inadequate. Advice and best practice guidance that we had shared with the provider at the previous inspection had been ignored.

¿ People were put at risk as the management team lacked clear oversight and knowledge of what was happening across the service. People continued to receive support from staff who had been suspended pending safeguarding investigations.

¿ The quality of care people received had deteriorated since the previous inspection.

¿ The culture of the service lacked openness, honesty and transparency. The management team were dishonest and provided inaccurate information, which placed people at harm as serious incidents were not acted upon.

¿ People and their relatives highlighted how the lack of communication impacted upon the service they received. One person said, “I call them and they never respond. It is now over a week since they were supposed to call and they haven’t.”

We found three continuing breaches of regulations in relation to safe care and treatment, good governance and notifiable incidents. We found two new breaches of regulations in relation to safeguarding people from abuse and improper treatment and failure to display their ratings. You can see what action we told the provider to take at the end of the full version of this report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (Report published 9 October 2018).

Why we inspected: This was an unannounced focused inspection due to information of risk and concern we had received. At the previous inspection, we found breaches of three regulations and served two warning notices.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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

We undertook an unannounced focused inspection of Careworld London Limited on 21,22, 23 and 29 August 2018. At the previous comprehensive inspection in October 2016 the service was rated as Good. We inspected the service against two of the five questions we ask about services: is the service safe and is the service well- led?

No risks or concerns were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults, younger disabled adults and children. At the time of the inspection they were supporting 348 people in the London Boroughs of Hackney, Tower Hamlets and Newham. Not everyone using Careworld London Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The provider did not have appropriate policies and procedures in place to ensure that people received their medicines safely and effectively. People’s records were not always clear as to what support they received with their medicines and audits did not pick up the issues we found at the inspection.

People who lived with specific health conditions did not always have the risks associated with these conditions assessed and information in care plans was not always accurate to ensure their safety and welfare. Risk assessments did not always provide staff with guidance on how to minimise risk.

Although there were quality monitoring systems in place, they were not always effective in picking up the issues we found during the inspection and improving the quality of the service. Information was not always up to date, accurate or checked to ensure people’s needs were met. The size of the service had increased dramatically since the previous inspection in October 2016 due to the provider securing local authority contracts. The provider acknowledged this had been a factor in the concerns received.

Learning had been shared across the organisation in response to a serious incident that occurred in March 2018. The provider acknowledged improvements were needed and had been proactive in updating and reviewing their policies and procedures. Staff we spoke with were aware of the action that had been taken in relation to this incident and knew how to respond in similar circumstances.

Safeguarding investigations that had been carried out were not always recorded accurately or were clear about the response to the concerns and what the outcome was. The safeguarding log was disorganised with supporting documents relevant to the investigation either unavailable or stored in separate files. Actions from safeguarding meetings had not always been followed.

People and their relatives told us they felt safe using the service and were comfortable approaching the management team if they had any concerns. Staff spoke positively about the management of the service and levels of support they received.

The provider did not meet the CQC registration requirements regarding the submission of notifications about serious incidents, for which they have a legal obligation to do so.

We found three breaches of regulations i

This inspection took place on 18 October 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. This was the first inspection since registration.

Careworld London Limited is a domiciliary care provider, providing personal care to people in their own homes. There were 68 people using the service at the time of our inspection, in the London borough of Newham and Tower Hamlets.

There was a registered manager at the service. 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.

People and their relatives expressed a very high satisfaction with the level of care and support they received from care workers. They told us that care workers had developed caring relationships with them since they had been supporting them. They told us that care workers were knowledgeable and skilled at their jobs.

Feedback about the management of the service was equally praiseworthy. Everyone knew the registered manger and other office staff, they said they were approachable and were visited frequently by them, asked for their views about the service and if any aspect needed to be improved. None of the people or relatives we contacted were able to suggest any improvements to the service.

Staff recruitment checks were thorough which helped to ensure that care workers were suitable to work with people. Staff files were complete and contained appropriate pre-recruitment checks such as criminal record checks, references and identity checks.

New starters completed an induction which was based on their previous experience in health and social care, this included training in the Care Certificate. Ongoing training was refreshed on a regular basis which helped to ensure that care workers had the knowledge and competency to carry out their roles. Staff supervisions were carried out regularly and they were appraised annually.

The provider carried out thorough initial assessments prior to supporting people. These were carried out in the presence of people and their next of kin if appropriate. People were fully involved in this process and consented to the support plans that were developed from these assessments.

Risk assessments were thorough and based on individual needs. They identified potential risks and included guidance for care workers to manage the risk. Support plans contained information about people’s individual care and support needs. People’s preferences as to how they liked to be supported were also recorded.

People were provided with details of how to raise complaints and the contact details of who they could speak with. None of the people or relatives we spoke with had any complaints but were confident that the provider would act if they did.

There were thorough quality assurance checks which took place, these included quarterly and annual visits by the registered or deputy manager and annual surveys that were sent to people. We reviewed the feedback from these which was overwhelmingly positive and reflected the conversations we had with people and their relatives.

At the previous inspection in December 2013, we found that the service was non-compliant in three outcome areas. These were Care and welfare of people who use services (Outcome 4), Supporting workers (Outcome 14) and Assessing and monitoring the quality of service provision. Following this inspection, the provider sent us an Action Plan which stated the actions they were going to take to meet these essential standards within an agreed timescale.

During this inspection we spoke with the manager and the care coordinator, looked at care plans and other records, and spoke with the relatives of five people using the service as people using the service were unable to speak with us over the telephone. We also spoke with five care workers. The relatives told us they were happy with the quality of the care. One relative said, "I would recommend this service. They are kind and caring people and they are very reliable." Staff told us they thought their training and support was beneficial.

We found that the service had addressed the issues of concern at the previous inspection. Records now showed that care plans were reviewed at least once a year. The provider was able to verify that staff received appropriate training and there were now systems in place to monitor and audit the timesheets and invoicing practices.

We spoke with one person using the service and the relatives of six people. They all made positive comments about the care and support they or their relative received from the agency. One person told us, "I am happy with Careworld. I think my care workers are kind and well trained, they understand what I need, “ and a relative said, "I would not hesitate to recommend the agency, it is very good."

They said the agency had provided them with information about the service and they had been asked how they wanted the care and support to be delivered. The agency also took into account people's cultural preferences.

We saw that people's care needs were assessed and recorded in their care plans. Risk assessments had been carried out.

We contacted five care workers and spoke with them about the training and support provided by Careworld London Limited. All of the staff told us they received regular training and supervision, which they found useful.

At the time of our visit Care World London was supporting 20 people with their personal care needs. As part of our inspection we spoke with five members of staff including the registered manager . The people using the service were unable to speak with us over the telephone so we spoke with five relatives to find out what their thoughts of the service were.

All the relatives of people using the service were happy with the care their family member received. One person said, “the care worker is very good.” Another person told us, “we’re happy with the care the agency provides, they do as we ask.” No one had any complaints about the agency but said they knew what to do should they need to.

Relatives told us their family member was asked to sign their consent for the care when they first started using the agency. People's care / support plan was discussed at this point. All the relatives we spoke with told us care plans were reviewed annually. Records showed that care plans had not been reviewed or updated in the last year.

People were protected from the risk of abuse and the provider had procedures in place for safeguarding adults and most of the staff we spoke with were aware of these procedures.

Some staff had received appropriate professional development and undertook mandatory training. Where staff undertook training through alternative agency the provider was unable to verify that those staff had received appropriate training through an accredited agency as they did not have the staff’s certificate of attendance.

The agency sought the views of people using the service through spot checks, telephone calls and an annual survey. We found that the agency was not quality assuring their timesheet and invoicing systems through regular audits.