About the service:

This service 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, some living with the experience of dementia, people with learning disabilities and people with mental health needs. The majority of people had their care funded by either LB of Ealing or LB of Hounslow. At the time of our inspection 137 people were using the service. Ealing Office is a branch of Eleanor Nursing and Social Care Limited, a private organisation which has five domiciliary care agency locations and also operates two care homes.

People’s experience of using this service:

The inspection was brought forward due to information of concern that we received around care workers missing or being late for home calls to people. We received information that there had been a number of late or missed calls to people using the service. However, prior to the inspection, the provider had identified the problem and had begun to take action to minimise the risk of this happening in the future. Actions included new staff being recruited, restructuring, implementing an electronic system to monitor home visit times and an operation manager providing onsite support until a manager for the Ealing location only was employed. After the inspection, the provider made an application to CQC to register a second location, so they would have one in Ealing and one in Hounslow with their own separate managers.

During the inspection, we found risk assessments were not always robust or in place. Some were generic and therefore did not always address risks in a person centred way. This meant the provider was not always assessing, monitoring and mitigating risks to people to help minimise their exposure to the risk of harm.

Medicines were not always managed safely, and audits did not always identify discrepancies to help ensure people received their medicines in a safe way. For example, we saw incomplete medicines administration records (MAR) with gaps which meant we could not be sure people had received their medicines safely.

The provider did not always follow safe recruitment practices to make sure new staff were suitable to care for people using the service. The provider’s audit did not identify this so remedial action took place.

The provider had not sent notifications to the Commission in a timely manner as required by the Regulations. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about.

People’s needs were not always fully assessed prior to beginning their package of care which meant care plans that would provide guidance to staff, were not completed in a timely manner at the start of their support.

People's wishes, views and thoughts about end of life care had not been considered as part of the care planning process.

There were quality assurance systems in place, but the provider had not followed their own procedures to ensure their systems effectively monitored and managed service delivery to improve the care and support provided to people. For example, during the inspection we did not see any audits for the care files of people using the service or staff files to ensure the correct information was present and up to date and medicine audits had not been used effectively to improve delivery.

People using the service and their relatives gave us mixed views about their interaction with office staff. Some people’s experience was that the service did not communicate effectively with them, while other people told us staff in the office responded appropriately to their concerns.

The principles of the Mental Capacity Act 2015 were generally followed.

The provider had an infection control policy in place to help protect people from the risk of infection.

Staff had up to date training, supervision and annual appraisals to develop the neces

This comprehensive inspection took place on 22 and 23 February 2018 and was announced. We gave the registered manager two working days’ notice as the location provided a service to people in their own homes and we needed to confirm the registered manager would be available when we inspected.

The last inspection took place in June 2016. The service was rated ‘Requires Improvement’ in the key question ‘Is the service Well Led?’ but ‘Good’ overall. We found a breach of Regulations relating to good governance because the service did not have a registered manager in post. Following the inspection, we asked the provider to complete an action plan to tell us what they would do, and by when they would make the necessary improvements to meet the regulations. At this inspection we found the Regulation had been met and a registered manager was in post.

This service 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, some living with the experience of dementia, people with learning disabilities and people with mental health needs. The majority of people had their care funded by the local authority or local clinical commissioning groups. At the time of our inspection sixty people were using the service. Ealing Office is a branch of Eleanor Nursing and Social Care Limited, a private organisation which has five domiciliary care agency locations and also manages two care homes.

The service had a registered manager. 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.

During the inspection we found that people had signed their care plan agreements, medicines administration forms and timesheets to indicate consent to the care provided to them. After the inspection, the provider sent us two capacity assessments for people who required support with decision making. However the assessments were generic and not decision specific and therefore did not fully follow the principles of the Mental Capacity Act (2005).

People using the service said they felt safe. The provider had appropriate procedures for keeping people safe including risk assessments and risk management plans to minimise risks.

Care workers we spoke with knew how to respond to safeguarding concerns. They had the relevant training, supervision and appraisals to develop the necessary skills to support people using the service. There were safe recruitment systems in place to ensure care workers were suitable to work with people using the service.

People using the service received their medicines in a safe way.

People were protected by the prevention and control of infections and care workers had access to personal protective equipment that helped to prevent cross infection.

People’s needs and choices were recorded and included information about what was important to the person and how to best support them.

People’s dietary requirements were met and we saw evidence that relevant health care professionals were involved to maintain people’s health and wellbeing.

People using the service spoke positively about the care they received. They were supported to express their views and be involved in making decisions about their care. People told us they generally had the same care workers and this provided consistency of care.

People using the service told us they received personalised care that was responsive to their needs and reviews were completed annually or when required.

The care plans did not however contain any information around people’s wishes, views and thoughts about end of life care but the registered manager said this would be addressed.

Where a concern or complaint was raised

The inspection took place on 14 June 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to make sure someone would be available.

The last inspection took place on 30 October 2015, when we found breaches of Regulation. In particular people were not always supported to take their medicines in a safe way, the provider did not always make adequate checks on the suitability of staff they employed, the staff did not always have the support and training they needed, people's needs were not always recorded or met and there had been no registered manager in post since 2014. At this inspection we found improvements had been made in all areas.

Ealing Office is a branch of Eleanor Nursing and Social Care Limited, a private organisation who provide personal care and support to people in their own homes. The organisation has ten branches in London and South England and manages two care homes. The Ealing Office provided care and support for people who lived in their own homes in the London boroughs of Ealing and Hounslow. The branch had been operating since 2006 and at the time of our inspection provided approximately 1,200 hours of care each week to about 77 different people. The majority of people had their care funded by the local authority or local clinical commissioning groups.

There was a manager in post. They had not applied to be registered with the Care Quality Commission, but they had started this process. 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.

We have made a repeat requirement for the provider to ensure a registered manager is employed at the service.

People using the service were happy with the care they received. They told us care workers were kind, polite and trustworthy. They felt safe and their needs were met. Care workers arrived on time for the majority of the time and people generally did not mind if they were late because of traffic. People using the service told us the care workers stayed for the agreed length of time and made up any extra time if they were late. Everyone told us they had the support they needed with medicines, meals and meeting personal care needs. People were involved in planning their care and had consented to this.

The staff told us that they felt well supported and had the training they needed. They were recruited in a safe way and had the information they needed to care for people. They had regular meetings with their manager and opportunities to review and appraise their work.

The records used by the agency were accurate and up to date. The provider had systems for monitoring the quality of the service and these identified areas for improvement. The provider had taken action to make improvements since the last inspection. People found the office staff approachable and felt their concerns were listened to and addressed. People were able to contribute their opinions about the service.

The inspection took place on 30 October 2015 and was announced. We gave the provider 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure someone was available.

The last inspection took place on 22 July 2014 when there were no breaches of Regulation.

Ealing Office is a branch of Eleanor Nursing and Social Care Limited, a private organisation who provide personal care and support to people in their own homes. The organisation has ten branches in London and South England and manages two care homes. The Ealing Office provided care and support for people who lived in their own homes in the London boroughs of Ealing and Hounslow. The branch had been operating since 2006 and at the time of our inspection provided approximately 1,400 hours of care each week to about 80 different people. The majority of people had their care funded by the local authority or local clinical commissioning groups. The branch provided 24 hour support to one person.

There was not a registered manager in post and the previous registered manager left the service in 2014. 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. A manager had been appointed and they told us they were going to apply to be registered. They started working at the service three weeks before the inspection visit.

Medicines were not managed in a safe way because the staff administering these had not been trained or had their competency to administer medicines assessed.

The recruitment checks on staff did not ensure they were suitable to work with vulnerable people.

The staff did not always have the training, support and supervision they needed to care for people and meet their needs.

People told us their care needs were met, however these were not always reflected in care plans and the records of care given. Some of the information about how care needs should be met was incomplete.

There had been no registered manager in post at the service since 2014.

The provider had a system of audits and checks and they had identified risks associated with the service. However, they had not mitigated these risks.

Risks to people’s wellbeing and safety had been assessed.

The agency employed enough staff to meet people’s needs and people told us care workers usually arrived on time.

People had consented to their care and treatment.

The agency worked with other professionals to ensure people’s health needs were met.

People had good relationships with their regular care worker. They trusted them, and said they were kind, polite and caring.

People told us their privacy and dignity was respected.

People knew how to make a complaint and were satisfied that complaints were investigated and acted upon.

You can see what action we told the provider to take at the back of the full version of the report.

In this report the name of a registered manager appears who was not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. A new manager had been appointed and they were in the process of applying to be registered with us.

We spoke with ten people who used the service, or their representatives and five care workers. At the time of our inspection 47 people were using the service and the agency employed 32 care workers.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

The service was safe. The people who we spoke with said they felt well looked after. The families of people said the care workers offered support in a safe way. The care workers had received training to make sure they knew how to care for people safely and how to use equipment needed to help people move. There were assessments of the risks for each person with regards to their needs and their environment. Where there was an identified risk an action plan was in place to reduce the likelihood of harm. The care workers who we spoke with all knew what to do if someone had an accident, became ill or if they thought someone was being abused.

Is the service effective?

The service was effective. The people who used the service told us they had their needs met. One person said, ‘’they (the care workers) are very efficient and they look after me alright’’. They told us the care workers generally arrived on time and always stayed the agreed length of time and completed all their tasks. We saw that people’s needs had been assessed and these assessments were comprehensive. Care plans had been created to show how the agency would meet these assessed needs. People told us their care was regularly reviewed to make sure this was still meeting their needs and we saw evidence of this.

Is the service caring?

The service was caring. The people who we spoke with told us the care workers were kind and polite. One person said, ‘’I am perfectly happy, the care worker always arrives on time and does everything I ask’’. Another person told us, ‘’they are a great bunch of care workers’’.

Is the service responsive?

.

The service was responsive. People’s needs were regularly reviewed and the agency carried out spot checks to make sure people were receiving a good service. The agency managers also visited, telephoned and surveyed people to ask for their opinions about the agency. We saw that people’s needs had been reassessed when these needs had changed. The care workers told us they contacted the agency if they felt someone’s needs had changed and this triggered a review of their care. One of the relatives who we spoke with told us how the agency managers had worked with another professional to review the equipment their relative used to move around their home.

Is the service well-led?

The service was well led. The manager had been in post for four weeks before the inspection. They had previously worked in a different role for the agency branch. There were clear lines of responsibility and accountability for the staff working at the agency. All of the care workers we spoke with felt well supported and listened to. They told us they were given advice and support if they had any concerns. The care workers said they had the training and information they needed to do their jobs. There were systems to monitor the quality and effectiveness of the service. These included asking people using the service, their representatives and staff for their opinions.

Most of the people we spoke with indicated that care staff treated them with dignity and respect. One person said they had a good experience and that the care staff were ‘’brilliant’’. Another person said that care staff were easy to get on with. One person told us that communication was a problem, as their care worker did not understand them and they were not understood by their care worker due to a language difference. This had been reported to the agency. The agency had listened and acknowledged the problem but had been unable to provide a care worker with English as their primary language.

People we spoke with confirmed that they had a care plan which was kept in a folder in their home. The staff referred to this and made notes at the end of the visit. Two people said that they received consistent care. They told us that if their care worker was not available the agency provided a known alternative and they were happy with this.

The agency had taken steps to protect people against the risk of abuse by ensuring there were guidelines in place to safeguard vulnerable adults. There was a quality assurance procedure in place to assess and monitor the quality of the service.

We spoke with 26 people who use the service, the manager and operations staff. People who use the service gave us mixed views in relation to the care they received. People told us they would be asked what times they would like care staff to call and often they would not turn up at the correct time. Other comments people made were that they had language difficulties with the care staff, and they often felt they were not understood.

Many people spoke positively about the service making comments such as "it's really good, the care is excellent" and "they can't do enough for you when they arrive".

We looked at how people were involved in their care and how they were treated with dignity and respect. We found although people were involved in the planning of their care and care records stated their preferences in relation to the time they wanted care and the gender of their care worker, people’s preferences were not always accommodated.

We looked at the care records of nine people and found that care was planned and delivered in accordance with people's assessed needs. Care plans were updated monthly following discussions with people and where there had been a change in the person's needs this too was reflected in the person's care records.

Staff had received training relevant to their roles and supervision every three months. The provider also carried out "spot checks" to ensure care staff were following people's care records and behaving appropriately towards people. We spoke with three members of staff who had received training in protecting people from abuse and they were able to tell us what they would do if they suspected abuse or witnessed it and how to report any concerns.

The service had a quality and monitoring system in place which meant that the provider continually reviewed the care people received which helped them identify concerns and areas where improvements needed to be made.