About the service:

Three Sisters Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of our inspection approximately 360 people were using the service. Of those 360 people, 329 received personal care and the remainder received domestic assistance only.

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

People’s experience of using the service:

Where consent to care forms and other documents were signed by relatives or friends, it was not always clear whether they had the legal authority to do so.

People told us they felt safe with staff. People reported that staff were reliable, caring and respectful. Some people and relatives found that members of the care staff team did not have satisfactory English language skills. Structured staff recruitment processes were followed, however the provider needed to check that all criminal record checks were valid.

Risk assessments were in place to reduce risks to people, but sometimes lacked relevant details.Staff had received training to administer medicine, but some staff needed further guidance to correctly complete medicine administration records.

People’s care plans identified the tasks that needed to be carried out but did not demonstrate an individual approach that reflected people’s preferences and personal circumstances that were important to them.

People’s entitlement to confidentiality was promoted and the provider supported staff to meet people’s diversity needs. People and their relatives knew how to make a complaint and thought the provider would respond professionally to any concerns they raised.

Staff generally reported they felt well supported by the management and received the training they needed to carry out their roles and responsibilities.

Positive links had been established with local organisations with similar aims to support the local community. Systems were in place to monitor the quality of the service, which did not always ensure that areas for improvement were addressed in a timely manner.

Rating at last inspection:

At the previous inspection the service was rated as requires improvement (23 Feb 2018). The service was rated as requires improvement at the two previous inspection and continues to be rated as requires improvement.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We found two breaches of regulation in relation to consent and good governance. Please refer to the ‘action we told the provider to take’ section at the end of full report.

Follow up:

We will ask the provider to inform us how they will make changes to make sure they improve the rating of the service to at least good. We will continue to monitor information and intelligence we receive about the service until we return to visit in line with our re-inspection scheduling guidelines for services rated requires improvement. We may inspect this service sooner if we receive any concerning information.

This announced comprehensive inspection was conducted on 28 and 29 November 2017. The provider was given 48 hours’ notice of our intention to carry out this inspection. This is because key personnel are sometimes out of the office visiting people who use the service and we needed to ensure that representatives from the management team were available to participate in the inspection. Following the first two days of the inspection, we advised the registered manager of our plan to return to the service on 14 December 2017 to gather additional information and provide feedback. We continued to speak with people who use the service until 21 December 2017.

At the previous comprehensive inspection on 22 June 2016 breaches of legal requirements had been found, which included safe management of medicines and support of staff, in regards to staff supervision and training. The service was rated overall as Requires Improvement. Following the inspection, the provider had written to us to state what actions they would take in order to meet the legal requirements in relation to the breaches.

We had subsequently carried out a focused inspection on 14 February 2017 to check the provider had followed their plan and to confirm that they had met legal requirements. We had found that although some improvements had been achieved, the provider had not satisfactorily met the breaches for safe management of medicines and support of staff. It had been noted that although staff were now in receipt of appropriate supervision, there were shortfalls in terms of staff receiving suitable training to meet people’s needs. We had issued two Warning Notices for the two breaches of legal requirements and had received an action plan from the provider to explain how they would address the issues within the Warning Notices.

A focused inspection was undertaken on 25 April and 15 May 2017 to check that the provider had adhered to their action plan and to establish if they now met legal requirements. We had found that the provider had achieved the required improvements and concluded that the legal requirements had been met.

Three Sisters Care Ltd is a domiciliary care agency, which provides a personal care service to older adults and younger adults, including people living with dementia and people with a physical disability, learning disability and/or sensory impairment living in their own homes. Most of the people who use the service live in the London Borough of Tower Hamlet, and other people reside in nearby boroughs including Haringey, Islington, Hackney, and Barking and Dagenham. The registered manager informed us that the majority of the 140 people using the service at the time of the inspection received the regulated activity of ‘personal care’. The Care Quality Commission only inspects the service being received by people provided with ‘personal care’; for example, care and support with maintaining personal hygiene, continence, moving and positioning, and eating and drinking.

There was a registered manager in post at the time of our inspection, who was present on each day of the 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 registered manager contacted us and local stakeholders shortly before the final day of this inspection to inform us that she had submitted her resignation to the provider.

We found that the provider’s recruitment practices did not always show that all the required checks were in place to ensure that people were supported by suitable staff.

People expressed that they were happy with how they were assisted with their medicines. The provider carried out monthly audits to protect people from the risk of unsafe medicine practices; h

We had conducted an announced comprehensive inspection of this service on 22 June 2016. Breaches of legal requirements had been found, which included safe management of medicines and support of staff, in regards to staff supervision and training. Following the inspection, the provider wrote to us to state what actions they would take in order to meet the legal requirements in relation to the breaches. We subsequently had carried out a focused inspection on 14 February 2017 to check the provider had followed their plan and to confirm that they had met legal requirements. We had found that although some improvements had been achieved, the provider had not satisfactorily met the breaches for safe management of medicines and support of staff. It was noted that although staff now received appropriate supervision, there were shortfalls in terms of staff receiving suitable training to meet people’s needs. We had issued two Warning Notices for the two breaches of legal requirements and received an action plan from the provider to explain how they would address the issues within the Warning Notices.

This focused inspection was undertaken on 25 April and 15 May 2017 to check that the provider had adhered to their action plan and to establish if they now met legal requirements. We gave the provider short notice of our intention to conduct this inspection, as we needed to ensure that key staff would be available to access the information we required. This report only covers our findings in relation to safe management of medicines and support of staff. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Three Sisters Care Ltd on our website at www.cqc.org.uk.

Three Sisters Care Ltd is a domiciliary care agency located in the London Borough of Tower Hamlets. The agency provided personal care to people living within the borough and other London boroughs. At the time of the inspection 145 people were receiving personal care services; however, there was a structured plan in place for the agency to steadily increase the number of people using its services in line with new commissioning arrangements within 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. The registered manager was present during this inspection.

At this inspection we found that the provider had achieved significant improvements. There were systems in place to ensure that the provider had clearly documented and up to date records in relation to people’s medicine needs. Staff had received medicines training and the staff we spoke with understood how to safely support people to take their prescribed medicines. The registered manager audited people’s medicine administration records every month and staff’s ability to adhere to the provider’s medicines policy and procedures was monitored by field supervisors during ‘spot check’ visits at people’s homes.

The gaps in staff training had been addressed and there was a robust structure in place to ensure that staff adhered to the provider’s training programme. Care staff told us that the management team and senior staff highlighted the necessity to attend mandatory training during their one to one supervision meetings and staff meetings. We received complimentary comments about the quality of the training from staff, and people who used the service and relatives remarked that staff appeared to be suitably prepared and trained for their duties. The provider showed us the plans they had developed in order to ensure that staff transferred from other agencies received an appropriate induction to the values of their new employer in addition to

We carried out an announced comprehensive inspection of this service on 22 June 2016. Breaches of legal requirements were found regarding consent to care, support of staff, suitability of staff, person centred care, safe management of medicines and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Three Sisters Care on our website at www.cqc.org.uk.

There was now 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.

At our previous inspection we found that the provider was failing to obtain references for staff before they commenced work and was failing to assess people’s capacity to make decisions about their care. We found that the provider was now meeting these requirements. The provider had obtained references from staff before they started work and these were checked by the registered manager to ensure they were correct. The provider carried out quarterly audits of staff files to ensure that records were complete. The provider was now carrying out assessments of people’s capacity to make decisions for themselves, although it was not always clear whether relatives were signing people’s care plans in a legal capacity or to reflect their agreement that the provider was acting in the person’s best interests.

At our previous inspection we found that care plans did not accurately reflect the care that people received. We found that the provider was now meeting this requirement. Care plans had been reviewed and the registered manager carried out quarterly audits of care plans to ensure that these were accurate.

At our previous inspection we found that the provider was not managing medicines in a safe manner. This was because medicines recording charts were inaccurate and incomplete and were not checked by managers in a timely fashion, and that risk assessments for administering medicines were not being carried out. At this inspection we found the provider was still not meeting this requirement. Although risk assessments had now been carried out, and records of medicines administration were being checked by the manager, we found that records were still not accurately completed and did not always reflect people’s current medicines. Staff had received training in administering medicines, but the provider had not carried out observations of staff to ensure they were competent to do this.

At our previous inspection we found that staff did not always receive training and supervision. At this inspection we found that staff were now attending team meetings and receiving regular supervision and that there were systems in place to make sure this took place. However, the provider was not meeting this requirement as a significant number of staff had still not received mandatory training in areas such as safeguarding adults, basic life support, health and safety, fire safety and manual handling. The provider had training in these areas scheduled for the coming months.

At our previous inspection we found that the registered manager was not always checking records of care provided to ensure these were accurate. At this inspection we found that the provider was not meeting this requirement. We saw that records were being checked by the registered manager, however although these had improved we found that in some c

This inspection took place on 22 June 2016 and was announced. At our previous inspection on 12 February 2014 the provider was meeting the regulations we inspected.

Three Sisters Care is a domiciliary care service which provides care to people in their own homes, including to older people and people with physical or learning disabilities and people with mental health needs. At the time of our inspection there were 31 people using the service.

The service did not have 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. The manager of the service had been in post since February 2016 and was in the process of applying to become the registered manager.

People who used the service praised their care workers and said that they benefited from consistent staffing from staff who spoke their first language. People were treated with dignity and respect by staff. People understood how to make complaints, and we saw that complaints were handled appropriately by the provider who was responsive to people’s concerns.

Managers took steps to ensure that people were happy with their care. However, there was not enough oversight by managers to ensure that care plans and records of care were correctly completed, meaning that we could not be sure that people were receiving the care they needed.

Staff were not recording when people had received their medicines and there was insufficient information recorded and checks carried out by managers to ensure that people had received their medicines safely. Risk assessments were detailed in their scope, and risk management plans were in place, however some needed revising to ensure they accurately described how risks to people were managed.

Safer recruitment processes were not being followed, and a number of staff had been supporting people despite the provider failing to take up references and ensure that they had a complete work history for the person. Internal audits had identified and addressed this, although one person was still working with incomplete references.

Staff said they were well supported by their managers, however we found that staff supervisions and team meetings were not taking place regularly. Although a number of staff had been supported to achieve nationally recognised qualifications in care, there were significant gaps in staff training and this was not properly identified by managers.

The provider had failed to meet its responsibilities under the Mental Capacity Act (2005), by assessing whether people had the capacity to consent to their care, and frequently sought consent from people’s relatives for their care rather than demonstrating that they were acting in the person’s best interests. People were supported to maintain good health, and staff supported people to access health services as required.

We found a number of breaches of regulations relating to consent to care, support of staff, suitability of staff, person centred care, safe management of medicines and good governance. You can see what action we told the provider to take at the back of the full version of the report.

This was the first inspection of this service. We confirmed that an application for a Registered Manager had been submitted to the Commission.

We met with the Nominated Individual and the care supervisor. We spoke to four family members and looked at seven records of those who used the service. We spoke to four care workers and looked at six staff records.

We noted that the provider made suitable arrangements to ensure that those who used the service were helped to make decisions. A care worker told us "I always do my best to engage with the person. I don't want them to feel that I am imposing something on them."

We found that people's care needs were met. We saw that each person who used the service had a care plan specific to their needs. A family member told us "They give such good care to my relative and have relieved me of all that stress."

We found that people who used the service were protected from the risks of abuse as robust safeguarding procedures were in place.

We saw that there were effective recruitment procedures in place. The Nominated Individual told us "No matter how good the references are or how experienced a new worker might be, we need to be sure they meet our standards of care."

We saw that the provider kept in regular contact with people who used their services and regularly sought feedback information. A family member told us "I am confident that any complaint I might have would be dealt with immediately."