About the service London is the only branch of The Social Care Ltd, a domiciliary care agency located in the London Borough of Ealing. They provide personal care and support to people living in their own homes. At the time of our inspection, there were 118 people using the service. The agency cared mostly for older people, adults with disabilities and people with mental health needs.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is 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 and what we found
People's medicines were not always managed in a safe way. The risks relating to medicines had not been fully assessed, information about people's medicines needs were not clear and staff were not always recording when they had supported people to take their medicines. This was partly due to confusion over guidance from commissioners. However, there was a risk people were not receiving medicines safely because this support was not properly planned or monitored.
The provider had not always maintained clear records to evidence they were effectively monitoring the quality of the service and mitigating risk. For example, there were no records to show the staff had been assessed as competent in administering medicines or moving people safely. Nor were there records of their induction when they started working at the service. The provider had not always recorded assessments of the risks within people's home environment. This meant they may not always have taken steps to reduce these risks.
People told us they were happy with the care they received and had the same familiar care workers who they liked and had good relationships with. People were involved in planning their care. Their needs were regularly reviewed, and the agency had liaised with others (such as healthcare professionals and commissioners) when they identified a change in someone's needs.
The staff felt well supported and told us they had the information and training they needed to carry out their roles. There were appropriate systems for recruiting staff to make sure they were suitable.
The agency had an experienced management team who worked closely with the staff to monitor people's needs. They responded appropriately to complaints, incidents, accidents and other adverse events to make sure these were dealt with and could be learnt from. People using the service, family members and staff told us they felt managers were approachable and helpful.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The rating at the last inspection was good (Published 6 February 2019).
Why we inspected
This was a planned inspection based on the previous rating.
We undertook this focused inspection to look at the Key Questions of Safe, Responsive and Well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.