This inspection of Westminster Homecare Limited (Norwich) took place between 14 June 2018 and 2 September 2018. Our visit to their office was announced to make sure staff were available.

Westminster Homecare Limited (Norwich) is a domiciliary care agency that provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our visit 145 people were using the service.

Not everyone using Westminster Homecare Limited (Norwich) 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 at this agency who was supported by an office staff and other senior staff. 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 rated this service as Requires Improvement. The rating remains Requires Improvement at this inspection. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-led to at least good.

The provider’s monitoring process did not effectively identify issues or take action to resolve these, in particular in relation to medicine recording errors. Medicine administration records were not always completed correctly and this put people at risk that they had not received their medicines as prescribed.

Staff knew how to respond to possible harm and how to reduce most risks to people. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Staff used personal protective equipment to reduce the risk of cross infection to people.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). 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. People received support with meals, if this was needed.

There was enough information for staff to contact health care professionals if needed and staff followed the advice professionals gave them.

Staff were caring, kind and treated people with respect, although the agency did not always respect people’s right to be cared for by staff of the gender of their choice. People were listened to but were not always asked about their care. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and care records were in place and contained enough information to guide staff in how to do this.

A complaints system was in place and there was information available so people knew who to speak with if they had concerns. Staff had adequate guidance and support to care for people at the end of their lives, if this became necessary.

People’s views were sought but no action was put into place to improve issues that were raised.

Staff were supported by and supportive of the registered manager and office staff.

We found a breach of Regulation 12 and of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regard to medicines management and to the governance of the agency. You can see what action we told the provider to take at the end of this report?

Further information is in the detailed findings below

This announced inspection took place on 9 and 13 February 2017. Westminster Homecare Limited (Norwich) provides support to people in their own homes. It does not provide nursing care. At the time of our inspection the service was supporting approximately 150 people.

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 2008 and associated Regulations about how the service is run.

At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We identified a breach of Regulation 12 because risks were not always adequately assessed and actions were not always taken to mitigate the risks to people. Concerns for people’s safety were not sufficiently analysed to help identify patterns of concern. The service had not always ensured they had current and up to date information regarding staff they employed. Medicines were not always safely managed or always given as the prescriber intended.

We found the service was also in breach of Regulation 17. This was because the provider’s quality assurance systems had failed to identify the improvements needed. Recording regarding people’s care needs and how the service had taken action in response to concerns was poor. People’s care records did not always contain sufficient guidance and information for staff.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA. Not all staff understood what the MCA was and how this impacted on their practice. We found the provider was in breach of Regulation 11 as the service was not consistently working within the requirements of the act. This was because mental capacity assessments were not carried out to determine if people were able to make decisions, and if not, a best interests process was not always followed.

Staff spoke positively regarding their training, however we found training was not always provided that was specific to staff role or people’s specific needs and health conditions. New staff were provided with a comprehensive induction and the service carried out checks to ensure they were confident and able to carry out their role.

The service liaised with health care professionals to support people’s health care needs, where required. However, it was not always clear if this was always done appropriately or when required.

The majority of people received support from regular and consistent staff. This helped staff to provide support in accordance with people’s needs and preferences. However, we found some examples where this was not always the case and people did not always receive support that met their individual needs or preferences.

People told us they knew how to complain and raise concerns. Some of the people we spoke with told us they did not always receive an apology or a clear response to the issues they raised. Formal complaints were investigated and responded to, however where issues were raised in a less formal manner they were not always responded to.

There was mixed feedback from staff regarding the support and leadership of the service. Some staff felt adequately supported by the service managers and administrative staff whilst others did not feel management were always approachable. We also received conflicting feedback from staff regarding morale in the service.

People were supported by caring staff who treated them respectfully and with dignity. Staff supported people to be as independent as possible and consulted them regarding

This inspection took place on 10 February 2015. The inspection was announced.

At the last inspection of this service on 24 January 2014, we found that the provider was meeting all of the Regulations inspected.

Westminister Homecare Limited (Norwich) is a care agency that provides care and support to people living in their own homes. At the time of the inspection, 110 people were receiving care and support.

This service requires a registered manager to be 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. At the time of our inspection, there was not a registered manager in place. However, we had received an application to register a manager that was being processed.

The majority of people were positive about the care they receive and felt supported safely. However, a minority felt the service could be improved to help them feel safe. The staff understood how to keep people safe. They understood what abuse was and how they should report on any concerns. The provider had reported any incidents relating to the safety of the people living at the service to the relevant authorities as is required.

Guidance was in place within people’s care records for staff to follow on how to support people when they became distressed or upset. Where a risk had been identified, there was clear guidance available for staff to follow to help them reduce the risk of harm to the person. Staff understood what action to take in the event of an emergency such as contacting the emergency services when the person was unwell or alerting their

The provider of the service had systems in place to ensure the staff they employed were suitable and of good character. There were suitable numbers of staff available to provide support but there were occasions when people did not receive care from consistent members of staff who knew them well.

People spoke positively about the skills and knowledge the staff had. The provider had their own trainer who specialised in providing staff with induction and training and all staff received regular supervision. Staff were happy with the support provided

The provider had complied with, and the staff understood the principles of the Mental Capacity Act 2005 (MCA) and people’s rights where protected when they lacked capacity to make their own decisions.

Staff were aware of the importance of good nutrition and hydration. They encouraged people to eat and drink what they preferred. Concerns found of people not eating or drinking were reported on and action was taken.

Staff had a good knowledge of people’s individual preferences and care needs including

whether people had any cultural or diverse needs such as religious beliefs. They ensured people were respected and listened to. People were encouraged to plan and aim for their own independence as much as possible. Staff had contact details for health professionals who were involved with those people receiving the service and had contacted them when people’s health became a concern.

People did not always receive support that was responsive to their needs. Communication with the office was not always good and phone calls from people using the service were not always acted on.

The provider completed an assessment of need for all people using the service. Records were held to guide staff on the care needs of each person and had been updated to reflect current needs.

The provider had visions and values based on people’s individual needs that staff understood and followed. Staff were supported and happy to be working for this agency. Concerns and issues raised by staff were acted on by the manager and senior team.

The service provided was regularly audited and quality was measured using various methods that included all staff who took responsibility for the quality of the service provided. Incidents and accidents were monitored closely and positive action was taken to improve the service to ensure the service was running well.

People's privacy, dignity and independence were promoted. One person, who we visited during this inspection, commented “It’s a terrific service, my independence is respected; the carers allow me to do things I’m capable of.” Another person stated “They are very respectful, I look forward to them [the carers] coming” and a third person commented “They [the carers] are respectful of you, the care I receive is very dignified.”

People we spoke with told us that the carers met their needs. One person commented “They are very efficient; I generally get to see the same carers which means I have been able to build good relationships.” Another person stated “I have a decent team of carers that come and see me, they know my routines and how I like things done.”

We spoke with five members of staff about their knowledge of infection control practices. Each person spoken with had a good understanding of the requirements. These included the need to wear personal protective equipment such as gloves and aprons. Staff were also aware of the requirement to maintain good hand hygiene.

Appropriate checks were undertaken before staff began their employment at this service. This meant that only suitably vetted people were employed to work with vulnerable adults.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used a postal survey, telephone interviews and home visits to people who use the service and to their main carers (a relative or friends) to gain views about the service.

We visited four people in their own homes as part of this review and spoke with them about the support they had received. We also spoke with the manager, senior staff and three care workers during our visit to the office.

We spoke over the telephone with 25 people who received a service from this agency. The majority spoke positively about their care workers and felt that nearly every staff member supported their care needs. They told us that their regular care workers spoke with them in a pleasant, calm and respectful way. However some less experienced care workers were not so skilled.

We received positive comments from most people and two people said after they had complained things had improved.

We received a number of positive comments telling us that people had improved in their health and well being since having the support from this agency.

We were told the staff in the office were good and that any request would be acted upon. They also told us they had got to know the care workers well as they had received help for a number of years from the same agency and would not want to change. They said "I feel so much better now."

Our visit to the office provided us with the opportunity to check some questionnaires that people who use the service filled in and returned as the part of the organisations quality review. We were also sent a summary of the results of the survey which contained direct results of the people’s responses based on outcomes of care for them.