Westminster Homecare Limited (Chelmsford) 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 236 people. A registered manager was in post 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 had been absent for over 28 days on the day of our inspection. The service was being run by two area managers with the assistance of senior staff from the service, and from a neighbouring branch of the service.
We last inspected this service on 18 and 19 July 2016 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of four regulations, relating to person-centred care, safe care and treatment, staffing and good governance. At our previous inspection we had found there were not enough staff to meet people’s needs in a timely way and people did not consistently receive safe care in line with their preferences. The manager had not adequately carried out necessary checks to ensure that the service met people’s needs. Following the inspection in July 2016, the service sent us a plan to tell us about the actions they were going to take to meet the above regulations.
At this inspection in 21 and 22 February 2016, we found four continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person-centred care, safe care and treatment and good governance. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
At this inspection we found there had been some improvements since our last visit. There had been a focus on staff recruitment so there were more staff available to meet people’s needs. Training had been improved and staff were being enabled to develop their skills, particularly in the area of dementia care.
As we had found at our last visit, where people had established staff, they received care which was of consistently good quality. However, poor coordination combined with inadequate care plans meant risk was not well managed and staff did not have sufficient information to manage people’s needs safely and in a person centred manner. Unsatisfactory oversight by the manager meant they had not fully addressed on-going concerns.
Poor scheduling of staff rotas meant that some visits were missed and people did not receive the support their required. There were not effective systems to monitor missed visits and the impact on people. Risk assessments were out of date or inaccurate and did not provide staff with the necessary information to reduce risk.
Whilst improved processes for the administration of medicine were being introduced these were not fully established and staff did not have sufficient information about the support people needed with their medicines.
There had been a positive focus on improved training for all staff and this was leading to improvements in overall skills. However, where people had specific needs, staff did not always have access to specialist training and information.
The CQC is required to monitor the Mental Capacity Act (MCA) 2005 and report on what we find. The service had started improve measures in relation to assessing people who may lack capacity but this was still at an early stage. Staff offered people choice and had a working understanding of supporting people who lacked capacity, however they did not have adequate information in relation to people’s needs in these instances.
Where staff knew people well they supported them positively to maintain good health and wellbeing and access resources as necessary. However, lack of information about how people’s health conditions affected them meant staff did not have enough guidance on how to best meet their needs.
Some people were supported by staff who were caring and knew them well. They became anxious if these staff were not there as replacement staff did not always know about their needs and preferences. Measures to improve care plans were not functioning well and when people’s needs changed their care plans were not revised. As a result, staff, people and their families were often confused about the level of care being provided.
When people complained they received a response from the manager and improvements were made to the service. However, there were limited efforts made to gather to feedback about people’s individual circumstances and so opportunities for understanding peoples experience of care were lost.
A number of new staff had been appointed to resolve concerns we had raised at our last inspection and measures to check on the quality of the service had been put in place but these were not yet operating effectively and any improvements were not yet shown to be sustainable. Communication between the registered manager and the provider had not been open and effective and as a result concerns had not been dealt with in a timely manner. When the provider became aware of concerns at the service they were pro-active about putting things right.