Ealing Office, a domiciliary care agency serving 94 people, remained rated Requires Improvement for the fourth consecutive inspection, with repeated regulatory breaches in safe care and treatment (Regulation 12), person-centred care (Regulation 9), and good governance (Regulation 17). Key failures included unsafe medicines management, absent risk assessments for high-risk conditions, inconsistent MCA compliance, and ineffective auditing systems that failed to identify these shortfalls.
Concerns (7)
criticalMedication management
: “Over a period of 23 days, the MAR had been signed nine times and there was no indication why the MAR had not been signed on the other 14 days.”
criticalGovernance: “Quality assurance systems such as audits were not being operated effectively. This is the fourth inspection where the service is rated requires improvement with breaches of regulations.”
criticalRecord keeping: “Two people were only being cared for in their beds and required repositioning, but the provider did not have a risk assessment around skin integrity for them.”
moderateCare planning: “Care plans were not always planned in a person centred way so they reflected people's current needs and preferences.”
moderateConsent / capacity: “For others, we found only the agency's assessor had signed the consent form. The provider's processes for identifying and supporting people who lacked mental capacity were not robust.”
moderatePerson-centred care: “One person's care plan indicated they should have cream applied to their skin but did not name which cream it was and was not clear where on the person's body the cream was to be applied.”
moderateIncident learning: “The medicines management systems and checks were also not very effective as they had not identified the concerns we found with the management of medicines.”
Strengths
· Late and missed calls had reduced since the last inspection; people confirmed consistency and punctuality of care workers.
· Safe recruitment procedures were followed including DBS checks and suitability assessments.
· Staff received appropriate training including safeguarding, moving and handling, infection control and medicines competency.
· Staff were matched with people by language and continuity, supporting consistent and person-appropriate care.
· The provider worked in partnership with local authorities and healthcare professionals to meet people's needs.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Continuous learning and improving careRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
Date of assessment 12 May to 20 June 2025. The service is a care at home service providing support to adults of all ages living with physical disabilities, learning disabilities and mental health conditions. We carried out this assessment as the service had a rating of requires improvement. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. The provider recruited staff safely. Medicines were managed safely. There were effective systems in place to ensure accidents and incidents were recorded and actions taken to address concerns. People were protected from harm or abuse as the provider had a clear system in place to address any safeguarding concerns. Staff were kind and caring. The provider worked with health care professionals to ensure people had good quality care. Care plans were detailed and included people’s likes and preferences. People and relatives told us they were happy with the care and support provided by the service. Governance systems were effective, and the quality of care was checked regularly. At out last inspection of the service the provider was in breach of regulations in medicines, governance and risk plans. At this assessment the provider had made improvements and were no longer in breach of regulations.
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