About the service:

London Care Raynes Park is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults in six London Boroughs. At the time of the inspection the service was providing personal care to 300 people. The Care Quality Commission (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 consider any wider social care provided.

People’s experience of using this service:

¿ The service did not always deploy sufficient numbers of staff to meet people’s needs and keep them safe. On-going monitoring of missed and late visits, did not always identify issues and it was unclear what action was taken to address late calls.

¿ Audits carried out by the service did not always identify issues in relation to late visits. Action taken was not always clear.

¿ The service had made improvements to the safe management of medicines. Medicines were administered as intended.

¿ People were protected against the risk of identified harm and abuse as risk management plans in place gave staff clear guidance on mitigating risks. Staff received on-going safeguarding training and were aware of the provider’s policy on identifying, responding to and escalating suspected abuse.

¿ Infection control guidelines in place, gave staff clear guidance on managing cross contamination. Sufficient quantities of Personal Protective Equipment (PPE) were available to staff.

¿ Staff continued to receive on-going training to enhance their skills and experiences, which they put into practice. Staff received regular supervisions, to reflect on their working practices.

¿ Managers and staff were knowledgeable about and adhered to the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s consent to care and treatment was sought and respected.

¿ Where agreed in people’s care packages, people were supported to access food and drink that met their dietary needs and preferences.

¿ People received support from staff that were caring and compassionate to their needs. Where required staff members supported people to access healthcare professional services to monitor and maintain their health and wellbeing.

¿ People were treated with dignity and respect. Staff were aware of the importance of respecting people’s privacy when delivering personal care.

¿ People’s dependency levels were monitored regularly to ensure support provided met their needs. Staff were aware of the importance of encouraging people to do things for themselves where safe to do so to enhance their independence.

¿ People and their relatives were encouraged to share their views in the development of the service.

¿ Care plans were person-centred and detailed people’s health, social and medical needs. Care plans were regularly reviewed to reflect people’s changing needs and changes were swiftly shared with staff members.

¿ People were aware of how to raise a concern and complaints. Complaints were recorded, action taken documented and responded to in a timely manner.

¿ At the time of the inspection, the service was not providing palliative care to people. However, the provider had procedures in place should end of life care support be required.

¿ The registered manager was aware of their roles and responsibilities in relation to notifying the CQC of notifiable incidents.

¿ The service had a clear management structure in place. People confirmed the registered manager had made improvements since the last inspection and was approachable, supportive and available.

¿ The registered manager sought people’s views through spot checks and quality assurance call monitoring. Records confirmed people were generally satisfied with the care and support they received.

¿The registered manager actively sought partnership working through other healthcare professionals and stakeh

This inspection took place on 25 July 2018 and was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults and younger adults with disabilities.

Not everyone using London Care (Raynes Park) receives 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. The service supported around 350 people at the time of our inspection.

At our last comprehensive inspection on 4 and 5 August 2016 we found four breaches of legal requirements in relation to staffing, safe care, person-centred care and good governance. The provider wrote to us with their action plan on 27 September 2016 and told us they would resolve these issues by 30 November 2016 although some actions would be ongoing.

We conducted a focused inspection on 10 March 2017 to check the provider’s actions to improve the key questions ‘Safe’, ‘Responsive’ and Well-led’ to at least good. At the focused inspection, we found that although the provider had made some improvements, they were still in breach of the regulations in relation to safe care, person-centred care and good governance.

At this inspection of 25 July 2018 we found that the provider continued to be in breach of the regulations in relation to safe care. Medicines were still not managed safely in that medicines administration was not always accurately recorded and people’s care files did not reflect any risks associated with the medicines they were prescribed. You can see the action we have told the provider to take with regard to this breaches at the back of the full version of this report.

We have also made recommendations. The first is in relation to the personalisation of people’s care plans, these required review to ensure the tasks people were able to undertake independently were reflected. The second is in relation to communication of the management structure so that people and their relatives are clear on who the manager is.

Some areas of the service required improvements. Staff training, supervision and appraisal required updating to ensure staff were compliant with the provider’s requirements. Complaints had not been responded to in a timely manner, however the new manager had taken ownership of these issues.

Management at the service had recently changed and they were able to show us a robust action plan that had identified these areas that required development. We were satisfied with the improvement plan that the provider had in place.

At the time of inspection the manager had applied for their registration with the CQC. 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.

People and their relatives told us they felt that the care delivered by the service was provided by staff that knew how to keep them safe. There were robust safeguarding procedures in place to ensure that staff were able to report any concerns, and that these were appropriately investigated. Recruitment processes ensured that staff were vetted to ensure they were safe to work with people. Staff took necessary measures to prevent the spread of infection when supporting people.

People were supported with meals of their choosing, prepared to their liking. When support from other healthcare professionals was required the service supported this. People’s capacity was recorded in line with guidance, to ensure people were enabled to make decisions.

People felt well cared for and that staff were considerate of their needs. Where peopl

This inspection took place on 10 March 2017 and was announced. At our last inspection on 4 and 5 August 2016 we found four breaches of legal requirements in relation to staffing, safe care and treatment, person-centred care and good governance. The provider wrote to us with their action plan on 27 September 2016 and told us they would resolve these issues by 30 November 2016 although some actions would be ongoing.

London Care (Raynes Park) provides personal care and support to people living in their own homes. This includes both younger and older adults and people who may be living with dementia. At the time of our inspection there were approximately 450 people using the service. 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.

The purpose of this inspection was to check the improvements the provider said they would make in meeting legal requirements. At this inspection, we found that although the provider had made some improvements, particularly in regards to staffing, they were still in breach of the regulations in relation to safe care and treatment, person-centred care and good governance.

Medicines were still not managed safely. Medicines records contained unexplained gaps, misspellings and other errors so we could not always be sure people received their medicines as prescribed. Some records showed people did not receive medicines at the correct times and some medicines such as topical ointments were missing from medicines records. There was insufficient information about the medicines people took, what they were prescribed for and the support people needed to manage long-term health conditions safely.

People’s risk assessments were not sufficiently personalised and in some cases were completed incorrectly. Some people did not have any assessments of specific risks associated with their care or their health. We did not always find evidence that staff were following risk management plans designed to keep people safe from the risks of skin deterioration.

We also found that care plans still did not contain an appropriate level of detail for staff to provide person-centred care. They did not always take into account the specific support people needed, for example around personal care, continence care or diabetes management. Care plans sometimes contained contradictory information or did not contain any details about people’s preferences as to how staff carried out care tasks. However, the care plans did contain information about people’s preferences in relation to food, their life history and family relationships and some information about communication needs.

Although the provider carried out a range of audits and checks and had taken some action to address the shortfalls we found, the measures they took to do this were not effective. Despite carrying out extra audits and checks, additional staff training and supervision and assigning lead roles to senior staff, the provider had not made sufficient improvements to meet the required standards within an appropriate timescale. However, we did note that the quality of some records, particularly daily records staff kept of the care they provided to people, had improved since our last inspection.

We are taking further action against the provider for a repeated failure to meet the regulations in relation to safe care and treatment, person-centred care and good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to the back of reports after any representations and appeals have been concluded.

There were enough staff to keep people safe. The provider monitored staffing levels on an ongoing ba

This inspection took place on 4 and 5 August 2016 and was announced. London Care (Raynes Park) provides personal care and support to people living in their own homes and in two “extra care” housing schemes. These consisted of individual flats within staffed buildings with some communal areas. At the time of our inspection there were 382 people using the service.

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.

Medicines were not always managed safely, because appropriate information about people’s medicines was not included in people’s files and in several cases records either showed people were not receiving medicines as prescribed or were not clear enough to show that they did. There were gaps in records and insufficient information about medicines to be taken only when required. There were procedures in place to ensure people did not run out of medicines and these were stored appropriately where applicable. Staff supported people to take medicines independently as much as possible and there were risk assessments to cover this.

People had risk assessments and care plans in place but these were not personalised enough for the provider to be sure they were assessing, managing and mitigating risks arising from individual needs such as people’s health conditions and that they were meeting people’s individual needs. People’s risk of malnutrition was not always appropriately assessed. People’s care was not always planned in a way that was personalised and met their individual needs. Information was missing from people’s care plans about their preferences and how staff should carry out care tasks, and tasks that staff performed did not always correspond with the care plans, meaning there was a risk that people were not consistently receiving the care and support they needed.

There were not enough staff on duty to keep people safe and meet their needs at weekends and in the extra care scheme. However, the provider had taken appropriate steps to make sure that staff they employed were suitable to care for people. People felt safe using the service and the provider had appropriate procedures, staff training and monitoring to protect people from abuse and discrimination.

The provider used various checks, audits and a quality team to make sure the service was of good quality and continually improving. The provider’s quality checks had identified the problems that we found, but when we visited the issues had not yet been resolved although work was taking place to address them. Poor record keeping meant that we could not be sure people were receiving the care they needed. Audits showed record keeping was improving but at the time of our visit this did not meet the standards required by the regulations that providers must comply with.

There were systems in place to record, monitor and learn from accidents and incidents. Staff were trained to respond to emergencies.

People were happy with the way staff supported them with their meals. Staff were aware of the importance of respecting people’s preferences and cultural needs around food. Staff helped people to stay healthy and to access healthcare services when they needed it.

The provider met the requirements of the Mental Capacity Act (2005). They followed appropriate procedures to ensure that decisions about the care of people who were unable to consent to them were made in their best interests. Staff obtained people’s consent before carrying out care tasks. Some staff did not understand that they should not deprive people of their liberty without the correct legal safeguards in place but the provider was addressing this through staff training.

Staff were happy