About the service:

• Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London is a domiciliary care agency that provides personal care to around 97 people in their own homes in the London Borough of Ealing and the London Borough of Brent.

People’s experience of using this service:

• The provider had made improvements to the recording and monitoring of the management of medicines to ensure the records identified when care workers supported people with their medicines.

• People told us they felt safe when they received support in their own home from care workers. The provider had a procedure in place to investigate and respond to any concerns raised regarding the care provided.

• The provider deployed sufficient care workers to meet the needs of people using the service and care workers were provided with adequate time to travel between visits.

• Care workers received training and appropriate equipment to help manage risks associated with the spread of infection.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• Care workers completed training identified as mandatory by the provider with regular supervision and an annual supervision.

• People were supported by care workers with preparation/eating of meals.

• People were assisted to access healthcare professionals to support them with their care needs.

• People told us they felt the care workers were kind, caring and respected their privacy, dignity and independence.

• Care plans identified people wishes as to how they wished their care to be provided. People were also aware how to raise concerns or complaints about their care with the provider.

• The provider had robust processes in place to monitor the quality of the care provided.

• People and the care workers we spoke with felt the service was well-led.

Rating at last inspection:

• The overall rating at the last inspection was requires improvement with breaches relating to safe care and treatment and good governance. (Report published 12 December 2018) The service had previously been rated as inadequate and placed in Special Measures following an inspection in February 2017. The service was rated as requires improvement and removed from Special Measures following the October 2018 inspection.

Why we inspected:

• As the service was rated requires improvement with two breaches of regulations at the last inspection, we carried out this inspection to make sure the improvements that had been started in the service had been sustained.

Follow up:

• We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any information is received we may inspect sooner.

We undertook an announced inspection of Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 22 and 23 October 2018. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London is a domiciliary care agency that provides personal care to around 101 people in their own homes in the London Boroughs of Ealing and Brent.

We previously inspected Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 14 and 21 June 2018 and we found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to safe care and treatment, the need for consent, good governance of the service and staffing. The service was rated requires improvement in the key questions of safe, responsive, caring and effective with well-led rated inadequate. The service had an overall rating of requires improvement but remained in special measures. Prior to this the service was rated inadequate.

At the time of this inspection a registered manager was in post. The registered manager was also a company director. 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.

The provider had a medicines policy and procedures that were in the main followed, but the administration of medicines for some people were not being recorded accurately. The quality assurance processes for the management of medicines did not always identify when issues occurred so these could be rectified.

The provider had made improvement to their mental capacity assessment process but it still did not relate to the capacity of the person to make decisions in relation to a specific aspect of the care they received and their daily life. We have made a recommendation in relation to this.

Records relating to people using the service did not always provide accurate information relating to the care and support they needed. The provider told us about their plans to improve this. Other records identified how the person wanted their care provided including their likes and dislikes. People knew how to make a complaint and provider had followed their complaints procedure where complaints had been received.

The provider quality assurance processes were not always effective because they had not identified the shortfalls and areas for improvements we had identified so these could be put right.

Improvements had been made in relation to risk management plans with the levels of risk to people’s safety and wellbeing being reviewed and being based on the person’s current health and care needs. The provider was also reviewing incidents and accidents so learning took place to prevent reoccurrence.

The provider had introduced a procedure to monitor the times of each visit and identify the reason why a visit had not occurred at the planned time. Care workers were allocated visits on their rotas with travel time and the visits did not overlap.

The provider had improved the assessment of staff competency in relation to moving and handling and medicines management to demonstrate that care workers were competent in these areas and had sufficient knowledge to perform these activities safely. Care workers had completed the Care Certificate and training identified as mandatory by the provider. They had a clear recruitment process in place.

We received mixed feedback from people about the care they received with some people telling us they were happy whilst other people identifying times when they were not happy.

People told us the care

We undertook an announced inspection of Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 14 and 21 June 2018. We told the provider three days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London is a domiciliary care agency that provides personal care to around 89 people in their own homes in the London Borough of Ealing and 18 people living in the London Borough of Brent.

We previously inspected Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 4 and 5 October 2017 and we identified issues in relation to safe care and treatment (Regulation 12), need for consent (Regulation 11), good governance (Regulation 17) and staffing (Regulation 18). The provider was rated inadequate in the key questions of Safe and Well-led and overall. As a result, the service remained in Special Measures.

At the time of this inspection a registered manager was in post. The registered manager was also a company director. 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.

The provider had a medicines policy and procedures but medicines for some people were still not managed or administered appropriately as information was not provided for care workers as to how the prescribed medicines should be administered.

Improvements had been made in relation to risk management plans but there was no process for assessing the levels of risk to people’s safety and wellbeing and recorded assessments indicated that all risks were ‘low’ regardless of the seriousness and impact of the particular risk. As a result, the provider did not ensure that appropriate action were in place to mitigate risks according to the severity.

The visit times identified in the agreed care plans did not always reflect those shown on the care worker rota. Therefore, people did not receive care at the times which had been planned meaning that there was a risk that their needs were not being met according to their preferences and wishes.

The provider's mental capacity assessment process was not sufficient because it did not relate to the ability of the person to make decisions in relation to a specific aspect of the care they received and their daily life. Where a relative or representative consented to care being provided it was not clear if the person receiving support did not have the mental capacity to consent to their own care and if the relative had the legal right to make these decisions in the person’s best interests.

The provider's assessments of staff competency in relation to moving and handling and medicines management did not provide appropriate information to demonstrate that care workers were competent in these areas or had sufficient knowledge.

The provider did not always learn lessons, identify themes and act to improve safety for people using the service as their quality monitoring system did not always identify areas for improvement. The information recorded when a visit occurred either earlier or later than planned but the care provision was not reviewed to identify if any changes were required to the visit time agreed with the person or if the care worker had been given enough time to complete their rota.

Records relating to people using the service did not always provide accurate information relating to the care and support they needed.

Improvements had been made to the recording and review of incidents and accidents. Care workers were allocated visits on their rotas with travel time and the visits did not overlap.

The provider had a cle

We undertook an announced inspection of Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 4 and 5 October 2017. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London is a domiciliary care agency that provides personal care to around 127 people in their own homes in the London Borough of Ealing.

We previously inspected Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 22 and 24 February 2017 and we identified issues in relation to person centred care (Regulation 9), safe care and treatment (Regulation 12), safeguarding service users (Regulation 13), staffing (Regulation 18) and good governance (Regulation 17). We issued warning notices in relation to all five regulations. Following the last inspection the provider was rated Inadequate in the key questions of Effective and Well-led. Our concerns were sufficiently significant for us to issue an overall rating for the service as Inadequate and place the service in Special Measures.

At the time of the inspection a registered manager was in post. The registered manager was also a company director. 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.

The provider had made some improvements in relation to risk assessments but information identified in the assessments for specific risks had not been transferred into the care plans. This meant that staff might not have the relevant information to support people safely.

The records for incidents and accidents now identified actions that had been taken to reduce the risk of reoccurrence but we found the incidents and accidents process was not always followed by care workers which meant a review of incidents and accident was not undertaken with a focus on prevention.

The provider had a medicines policy and procedures but medicines for some people were not managed or administered appropriately.

Some care workers had not renewed their DBS check every three years in line with the provider’s policy. This meant the provider was not complying with their own policy as they did not have up to date information about any changes in the care workers criminal records status. We have a recommendation to the provider about this.

Care worker rotas showed some visits overlapped with visits to other people; and travel time was not always allocated between visits.

People using the service felt safe when they received care and the provider had procedures in place to respond to any safeguarding concerns identified.

The provider had introduced a memory test to assess a person’s mental capacity but this did not clearly identify if the person did not have capacity to make specific decisions related to their daily life and there were no records of referrals being made to the local authority for capacity assessments which was indicated as part of the provider’s process.

Some improvements had been made in relation to training as all care workers had completed the Care Certificate but records indicated they had not completed regular supervision, an annual appraisal or had their competency assessed following induction and training. As a result the provider could not demonstrate staff were appropriately skilled and experienced to care for and support people

The provider had implemented a monitoring process to reduce the risk of time specific calls occurring outside the agreed time.

Some of the wording used in care plans, risk assessments and records of care provided was not referring to people in a dignified

We undertook an announced inspection of Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 22 and 24 February 2017. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London is a domiciliary care agency that provides personal care to around 155 people in their own homes in the London Borough of Ealing.

We previously inspected Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 31 May 2016 and we identified issues in relation to person centred care, safe care and treatment, safeguarding service users, receiving and acting on complaints and good governance. Following the last inspection the provider was rated Inadequate in the Well-led key question. The overall rating for the service was Requires Improvement.

Improvements had not been made in relation to the assessment of specific risk and some moving and handling risk assessments had not been recently reviewed.

The provider had a process in place for the recording of incidents and accidents but this was not always followed.

Improvements had not been made in relation to the training, supervision and appraisal of care workers.

The provider had a policy in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act and improvements had not been made.

Visits were not always carried out at the time recorded in the care plan and on the Electronic Monitoring System. People did not always receive care that reflected their needs or met their individual preferences, because the care was not delivered at the same time each day and sometimes people had to wait for food or care without knowing when the care worker would arrive.

Records relating to the care people required were still not up to date and did not provide an accurate, complete and contemporaneous record.

The provider carried out checks on the quality of the service but these were still not recorded.

Care plans were not written in a way that identified each person’s wishes as to how they wanted their care provided. Daily records were focused on the tasks completed and not the person receiving the support.

People told us they felt safe when they received support and the provider had policies and procedures in place to deal with any concerns that were raised about the care provided.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care.

People told us they were happy with the care they received in their home.

The care plans identified the cultural and religious needs of the person using the service.

Improvements had been made in the way complaints were investigated and responded to.

Improvement had been made in relation to the recording of the administration of medicines.

The provider had a suitable recruitment process in place.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider for a breach of the Regulations in relation to person-centred care (Regulation 9), the safe care and treatment of people using the service (Regulation 12), safeguarding service users from abuse and improper treatment (Regulation 13), the good governance of the service (Regulation 17) and staffing (Regulation 18). You can see what action we told the provider to take at the back of this report.

We have rated a domain ‘Inadequate’ again; therefore the service has been placed in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care

We undertook an announced inspection of Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 31 May 2016. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London provides care and support to people living in their own homes. When we inspected, the agency was providing care to approximately 170 people.

We previously inspected Genesis Recruitment Agency Ltd; Nursing & Domiciliary Care; West London on 25 February 2014 and the provider had met all the regulations that were inspected.

At the time of the inspection there was a registered manager in place. 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.

There was a procedure in place for the management of medicines but care workers were not recording the administration of medicines accurately.

Risk assessments did not provide up to date information in relation to individual’s risks when receiving care.

People told us they felt safe when receiving support from care workers.

The provider could not provide accurate records to demonstrate that care workers had received induction, training and support to deliver care safely and to an appropriate standard as identified by the provider.

There was a policy and training in relation to the Mental Capacity Act 2005. However, these did not ensure appropriate actions were taken when a person using the service had been identified as unable to make decisions about their care.

People felt the care workers were caring and treated them with dignity and respect as well as supporting them to maintain their independence while providing care.

Care plans did not include information on the person’s life history to provide guidance for care workers. We made a recommendation in relation to this.

Care plans were not written in a way that identified each person’s wishes as to how they wanted their care provided. Daily records were focused on the tasks completed and not the person receiving the support.

The provider had limited systems in place to monitor the quality of the care provided. These did not provide appropriate information to identify issues with the quality of the service.

Records relating to care and people using the service were not completed accurately to provide a current picture of the person’s needs and the support provided.

We found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to administration of medicines, risk assessment, staff training and support, mental capacity assessment, care plans, complaints management, records and monitoring the quality of the service provided. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we spoke with 10 people using the service, six relatives, the manager and five staff. We viewed five care records and five staff files. People we spoke with had mixed views of the service. One person said, "I'm very happy with the agency and very grateful, I have no complaints." Another person said, "the agency are not very proactive and sometimes not very accommodating or flexible."

Most of the people we spoke with said care workers were polite and treated them with respect. Some people said they had been involved in decisions about their care but others felt they had had little involvement in deciding what support they would receive from the agency, or the times when visits would take place. People said that care workers spent enough time with them and their care was not rushed. However, most people said they were not informed if a care worker was going to arrive late and they were not always informed if their regular care worker was unable to attend.

People were protected from abuse. Staff were aware of the steps to take if they had any suspicions of abuse and they had received training in safeguarding adults. People we spoke with felt safe with their care workers and had no concerns about them. The provider had procedures in place for reporting any concerns to the local authority safeguarding team for investigation. Where safeguarding concerns had been substantiated the provider had taken appropriate action to safeguard people using the service.

Staff received appropriate professional development to ensure they could meet the needs of people using the service. This included an induction when they started working for the agency, mandatory training in topics relevant to their role and regular appraisals.

Procedures were in place to monitor the quality of service provided.

We spoke with ten people who use the service, or their relatives, and eight care workers. People using the service told us that they felt safe with their care staff and they were given the care and support they needed. People’s comments included “I’m very, very impressed with the carer, she is very good and well trained”. ”I’m very happy with them, they are very good carers”. “The carers are very nice, they really help me and I couldn’t manage without them”.

We found that the care needs of people using the service were well assessed and clearly recorded in their care plans. Risk assessments had been completed to make sure that people were cared for safely. We saw that the agency has thorough recruitment policies and procedures to make sure that all required pre-employment checks were carried out. This meant that people using the service were cared for and supported by suitable staff.

As part of this inspection we carried out a satisfaction survey of people using the service and/or their friends/relatives to get their views on the quality of the services provided by the agency. Thirty-one (23 people using the service and 8 friends/relatives) out of 150 questionnaires were completed and returned to us.

Most people who responded to our survey said that they had received enough information to help them understand the care and support choices available before choosing the agency but four people said they did not receive any information. The manager explained that most people had limited choice in choosing an agency because their care was commissioned by the local authority.

Our questionnaires showed that staff asked most people about their care and support needs before starting to provide a service. Two out of the 31 respondents said that they were not asked about their care and support needs. One person said that staff carried out an aspect of personal care that they did not want.

One person said that it was nice to have the same care worker who had fitted well with the family and never rushed the person needing care. Another person said “they [staff] anticipate my needs, are diligent and attentive. They talked to me and are very friendly. I feel cared for”. A third person said “the carer gave a good standard of care and did domestic duties to a very good standard”.

Feedback from people and relatives showed that most care workers were punctual and stayed the length of the visits for them to provide the necessary care and support to people. However, about a quarter of respondents said that this did not always happen with some of them adding that staff did not always complete the required tasks.

Most people said that staff showed them respect and ensured that their privacy and dignity were respected. One person said that staff sometimes talked about other issues among themselves and engaged in private conversation in their own language.

About two thirds of respondents said that the agency had not sought their views about how it did things and about a quarter of them said that their views were not always listened to and acted upon. The manager said that he would consider arranging a people’s forum as a way of involving people in the way the services were provided.