Westminster Homecare Limited (Colchester) is a domiciliary care agency. It provides personal care to people living in their own home in the community. It provides a service to older adults and younger disabled adults. The service supports people in the Colchester area, Harwich, Clacton, Walton on the Naze and Frinton. At the time of the inspection they were supporting seventy seven people.

There was a registered manager in place who was present at the inspection. 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 service had its last comprehensive inspection in November 2017 and we rated the service ‘requires improvement.’ We met with the registered manager and the providers representative and asked them to take action in response to our findings. They sent us an action plan setting out what they would do by when. At this inspection we found that improvements had been made and the provider had addressed the concerns that we identified.

Detailed care plans were in place which outlined people’s needs and preferences. Summaries were also available for staff in an assessible format so that they could see at a glance what support was required. The information provided was person centred and people’s care needs were regularly reviewed, and plans amended as required. Staff were provided with guidance about how risks to individuals wellbeing should be managed and steps that staff should take to reduce the likelihood of harm.

There were systems in place for the management of safeguarding concerns and staff were clear about the actions that they should take if they had a concern.

There were procedures in place to guide staff in the administration of medicines and regular audits to check that people were receiving their medicines as prescribed. During the course of the inspection we identified a small number of shortfalls regarding recording and we have made a recommendation about this.

People told us that they received care from a consistent team of staff who knew them well. There were clear systems in place for people and staff to seek advice and support out of hours. A missed call tracker had been introduced to enable the registered manager to have greater oversight of any missed calls and to identify the reasons and any patterns.

Staff had received training which provided them with the necessary knowledge and skills. Staff received regular supervisions and appraisals to reflect on their practice and explore how their skills could be developed.

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

People were supported to eat and drink in line with their care plan and their nutritional needs. People had good access to health care support when they needed it. The agency sought advice appropriately from health professionals when people’s needs changed.

People told us that they were supported by a regular team of staff with whom they had good relationships. They described staff as kind and caring. Staff understood the importance of privacy and dignity. Care plans set out what people could do to maintain their independence and how staff could support people to retain their skills.

There was a complaints policy in place and people’s concerns were investigated. People told us that they felt comfortable raising concerns.

Staff told us that they were well supported, and the management of the service was approachable and helpful. Staff performance was monitored to ensure that they were working to the required standards and checks were undertaken on how care was being provided.

There were systems

Westminster Homecare Limited (Colchester) was inspected on 7, 9 and 16 November 2017. The inspection was announced. Westminster Homecare Limited (Colchester) had a comprehensive inspection in September 2016 and we identified a number of concerns and rated the service ‘requires improvement.’ We asked the provider to take action in response to our findings. We undertook a focused inspection in January 2017 to check what actions they had taken to improve the management of medicines. At the focused inspection we found that some progress had been made and medicines were being managed in a safer way, the overall rating remained ‘requires improvement.’

Westminster Homecare Limited (Colchester) is a domiciliary care agency. It provides personal care to people living in their own home in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection they were supporting 102 people. There was a registered manager in post who was present at the previous inspection. 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 this inspection we found that some of the improvements that they had previously made to the management of medicines had been sustained. There were greater levels of oversight and checks undertaken on the records and the medicines being administered to people.

Governance and auditing had also improved across the service and overall people’s experience was better. However the management of the service had not yet ensured consistency of practice across the service. People and staff continued to have some concerns about the scheduling of visits and how changes to the schedules were communicated. The operational management team told us that they intended to undertake further analysis of travel times for staff to address these concerns.

Risks were identified but risk management plans were not always clear or specific to the individual. Care plans were large and difficult to follow which placed people at risk of receiving inconsistent care.

There were clear systems in place to manage safeguarding concerns. Staff were clear about the procedures in place and we saw that where there were concerns referrals were made appropriately to protect people.

Staff recruitment systems were robust and staff did not staff work until these were complete. Staff spoke positively about the induction and training they received when they started to work for the agency. Ongoing training was provided to all staff to ensure that they were up to date with best practice and changes to the law. Staff received regular supervision and spot checks were undertaken to ensure that staff were meeting people’s needs and working to the required standards.

People were supported to eat and drink sufficient amounts and were offered choice. Where concerns were identified in people’s wellbeing the agency made appropriate referrals to other professionals. People had good access to health care support.

People had good relationships with the care staff who supported them and told us that they were kind, caring and treated them with dignity. There were clear systems in place to respond to complaints. Investigations were undertaken and apologies given when necessary.

The manager was approachable and there were arrangements to respond to people who used the service and staff outside of office hours. Staff understood their responsibilities in supporting people to live a full and independent life; however staff morale varied with some staff positive but others reporting a lack of team work across the service. People’s views on the quality of the service were sought in a number of ways including telephone monitoring and questionnaires.

The inspection took place 19 January 2017 and was announced.

Westminster Homecare is a domiciliary care agency, delivering services in the Colchester and Clacton area of Essex. At the time of our inspection the agency was supporting 121people.

The service has 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.

Following our last inspection in September 2016 we issued a warning notice because the service had failed to ensure the safe and proper management of medicines and these concerns had been ongoing for some time. The warning notice included a timescale by which compliance with the legal requirements must be made.

We carried out this focused inspection to check that the provider had made improvements. This report only covers our findings in relation to the warning notice and those requirements. You can read the report from our last comprehensive inspection on our website at www.cqc.org.uk

Actions had been taken to improve medicines management. Staff had been provided with clear instructions on when and what they should administer. Advice had been obtained from the pharmacy regarding the administration of specific medicines and there were systems in place to address changes and variable doses. There was a greater awareness of risks regarding medication and care plans outlined the arrangements to reduce the likelihood of harm.

Audits were undertaken by office staff to check that staff were recording correctly and medicines management was explored as part of spot checks undertaken by senior staff. We found that the audits could be further strengthened to safeguard people.

Other issues identified in the September 2016 Inspection under the domain Safe were not followed up at this inspection. We will review our rating for Safe at the next comprehensive inspection. To improve the rating to “Good” would require a track record of sustainability.

The inspection took place between the 12 and 28 September 2016 and was announced.

Westminster Homecare is a domiciliary care agency, delivering services in the Colchester and Clacton area of Essex. At the time of our inspection the agency was supporting 130 people.

The service has 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.

Following our last inspection in September 2015, we asked the provider to take action to make improvements as we found risks to people’s health, welfare and safety had not been identified and monitored and people’s medicines were not being managed safely. We also identified that complaints were not responded to and managed effectively. The provider provided us with an action plan in which they set out what steps that they were going to take to ensure improvement. We rated the service Requires Improvement

We carried out this inspection to check whether the actions that they told us they had taken had led to improvements. We found at this inspection that they had provided additional training for care staff on medicine management and increased the spot checks of staff. However, whilst there were improvements in some areas, we continued to find issues with the management of medicines which meant that people continued to be at risk. We found that complaints were logged and investigated but the concerns that people raised about scheduling of their care calls and the timings of their calls were not always taken seriously. This meant that people did not have their concern acknowledged or addressed.

There were adequate numbers of staff however people expressed concerns about consistency and communication. The regional manager told us that they were working on this and there were flexibility with the timings. However travel time was not always programmed into staff schedules and this meant that the times they supported people could vary.

Risks such as those associated with the environment were identified and there were plans in place which set out how they should be managed. Care plans were in place but they were not always sufficiently detailed which combined with a changing workforce meant that people were at risk of receiving inconsistent care.

The provider had policies in place with regard to the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) 2005. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. Care staff had a good understanding of the importance of obtaining consent and protecting people’s rights.

People were supported with meals and staff worked with health professionals to support people with their health care needs.

People’s independence was promoted by staff and people felt involved in their care. People had good relationships with the staff and were treated with dignity and respect.

Staff told us that they were supported and trained. There were effective systems in place to respond to staff and people who used the service outside office hours.

Staff were positive about the manager who was accessible and had started to implement change.

There were systems in place to monitor the quality of care which included spot checks and audits. However these were not always comprehensive or effective at identifying and addressing the issues such as those that we identified around medication, infection control, complaints and scheduling.

During the inspection we identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 an

This was an announced inspection carried out at the office on 30 September 2015. We also visited people receiving a service on that day. During October we contacted people by telephone to learn their views about the service. This was the first inspection of the service.

Westminster Homecare Limited – Colchester is registered to provide personal care to people in their own home and at the time of our inspection was providing in excess of 1600 hours of support per week and was employing over 60 staff. The service was previously based in Great Bently and had taken on the work of another provider shortly after the move to the new location.

At the commencement of our inspection there was a registered manager in post. 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. The registered manager left the service on 04 November 2015 and the provider had commenced the recruitment process for a new registered manager.

We found people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We found an example when a member of staff had not followed the support plan regarding keep people safe. The complaints system was not being managed as per the company policy and we found times when service staff were either late for arranged visits and failing to inform people that staff could not visit them for the arranged call.

A number of senior appointments had been made in the month prior to our inspection and these staff were begining to address the areas above. In particular re-organising the areas in which staff worked. Where this had happened people reported to us that staff were attending on time with regard to the call visit.

Overall, there were effective systems in place to ensure people’s safety and manage risks to people who used the service. Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm. The recruitment practices were robust and thorough.

Many people who used the service told us they were happy because the staff were kind and understanding. People told us, they felt safe and staff treated them well. The staff we spoke with on the whole thought they had enough time to travel between arranged calls and there were sufficient staff employed. It was felt that the service may struggle to meet its commitments at times of staff sickness or when a number of additional contracts were taken on by the service. The service had invested in staff training and provided staff with the knowledge and skills to support people.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People on the whole spoke positively about the support they received to ensure their dietary needs were met.

Staff were aware of how to support people to raise concerns and complaints. Systems were in place to monitor the quality and safety of service provision; however the service had not always acted upon this information.

We found a breach of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of this full version of this report.