Archived: Care Outlook (West London)

Care Outlook (West London) is a domiciliary care agency that provides personal care to around 140 people in their own homes in the London Borough of Hounslow. The majority of people receiving care had their care packages funded by the local authority and other people were funding their own care.

We previously inspected Care Outlook (West London) on 26 and 27 September 2016 where we identified breaches of regulations in relation to the management of medicines, recruitment practices, mental capacity assessments, person-centred care planning, quality assurance and records. During the October 2017 inspection we found improvements had been made in relation to recruitment and person-centred care planning. Some improvements had been made in relation to the other areas but further improvements were required.

At the time of the inspection a registered manager was 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.

The provider had a procedure in place for the safe management of medicines but care workers did not always complete records relating to medicines use as required by the provider’s own systems. We have made a recommendation to the provider regarding this.

Care workers used an electronic call monitoring system to record their arrival and departure times to monitor the visits but some care workers were not always deployed so they had travel times included in their rota. They therefore did not always arrive, leave on time or stayed the full length of the visits.

The provider had procedures in place in relation to the Mental Capacity Act 2005. The process in place to assess a person’s capacity to make decisions relating to their care did not always ensure people rights were upheld. This was being reviewed by the provider.

Improvements had been made in relation to the effectiveness of the audits completed but there were a few areas where further improvements were needed and where the governance systems needed to be more robust.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to need for consent (Regulation 11), staffing (Regulation 18) and good governance of the service (Regulation 17). You can see what action we told the provider to take at the back of the full version of this report.

The provider had robust recruitment practices in place which provided information to enable them to assess an applicant’s suitability for the care worker’s role.

People told us they felt safe when they received care in their own home. The provider had processes to respond appropriately to any reported safeguarding concerns as well as incident and accidents.

Care workers had received the necessary training, supervision and appraisals they required to deliver care safely and to an appropriate standard.

People felt the care workers were kind and caring as well as respecting their privacy and dignity when they provided support.

The care plan identified the person’s religious and cultural needs as well as their preference for a male or female care worker.

Care plans identified how the person wanted their care provided. An assessment of a person’s support needs was carried out before home care started to ensure the person’s care needs could be met.

The provider had a complaints process in place and people receiving support from the service or relatives of people using the service knew how to raise a concern if they needed to.

People told us they felt the service was well-led but did raise some concerns regarding care workers travel time.

People using the service had been asked their views on the quality of the service provided.

Care Outlook (West London) is a domiciliary care agency that provides personal care to around 180 people in their own homes in the London Borough of Hounslow.

We previously inspected Care Outlook (West London) on 16, 17 and 23 June 2015 and we identified issues in relation to managing risk and staff training and supervision. During the inspection in September 2016 we found improvements had been made in relation to these areas.

The service had a registered manager in place. There were also two managers who had recently joined the service who were in the process of registering with the Care Quality Commission to replace the existing registered manager. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

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

The provider had suitable recruitment practices but information was not always accurate in relation to the previous work experience of new care workers.

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.

Improvements had been made in the recording of incidents and accidents and the development of risk assessments related to specific health or support needs.

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.

The provider had a policy in place in relation to the Mental Capacity Act 2005 but they did not undertake assessments to identify if a person using the service was unable to make decisions about their care and ensure the appropriate actions were taken to support them.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns.

The provider had a range of audits in place but the audits in relation to the administration of medicines, recruitment and other records relating to care did not provide appropriate information to monitor quality.

Care workers told us they felt the culture of the service was open and fair.

At the time of this inspection there were approximately 200 people using the service. We spoke with 20 people who were using the service and five relatives. We also spoke with the director of the service and 12 other members of staff including 10 care staff.

We found that people or their representatives were asked to consent to the care agreed. Staff were able to demonstrate how they considered people's individual wishes. For example, one member of staff said, "I check the person's care plan but I always ask them what they want too."

We found that people had care plans in place that provided guidance for staff about how to meet their needs. People told us that staff were polite and respectful when providing care for them. For example, one person said, "they (staff) are very good; they are very nice and very kind." Another person told us, "my carer gives me a bath and makes my breakfast and does everything for me, she is a very nice, polite girl."

There were systems in place to monitor the assistance given to people who needed support to take their medicines.

Quality assurance systems were in place to ensure that people were happy with the service provided and to ensure that staff were meeting people's needs.

The service has systems in place to protect people from the risk of abuse. Staff receive training and could demonstrate their understanding of their responsibilities in relation to reporting any concerns they have about a person's welfare.

People, relatives and staff told us that they were not always kept informed of any changes and said that communication with the office was sometimes poor as calls were not returned and matters not followed up when reported. We found that care records were not always complete or up to date and the completed recruitment checks were not sufficient to ensure the suitability of new staff. Quality monitoring systems were not being used consistently to ensure that any issues were addressed.