Date of assessment 30 May 2025 to 18 July 2025. Standard Care Limited provides personal care to people in their own homes. There were 39 people using the service when we carried out the assessment, all of which were receiving personal care. During the assessment we contacted 17 people or their relatives, and 6 responded. We also contacted 20 care staff for their feedback regarding how people’s personal care needs were being met. 5 care staff responded, along with 1 healthcare professional. We looked at 18 quality statements and found that the care, and support people received was safe, and supplied by well-trained, competent, and professional staff. Staff were recruited appropriately, and people were supported to take acceptable risks in a proactive, encouraging, way that enhanced their quality of life. This meant their social isolation was reduced. Staff worked well as a team, and provided people with joined up, integrated, care and support. This encompassed involving external healthcare professionals. The provider enhanced people’s independence by adopting a holistic approach to care, which gave people more choice about how it was delivered. This included control over when they received it. People’s consent to care and treatment was recorded, and they were encouraged, and supported to maintain healthy diets. The support provided was monitored, to enhance and drive improved experiences and outcomes for people. People and their relatives, said the service was managed well, and staff treated people with kindness and compassion. Their individuality was recognised, enabling them to experience an equitable service. The service was well led, had good governance, and effective monitoring systems. At the last assessment, the service was rated requires improvement overall, with requires improvement in the domains of safe and well-led. Effective, caring and responsive were rated good. At this assessment, the rating has improved to good, in all 5 domains and overall.
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Standard Care Limited received an overall rating of Requires Improvement, with a breach of Regulation 12 due to inconsistent and incomplete risk assessments across care records, leaving some people at risk of harm. Strengths included robust safeguarding, effective medicines management, no missed care calls, and positive feedback from people and staff.
Concerns (4)
criticalCare planning — “we found in records that had not been updated, there were indications of risk, without clear risk management guidelines in place.”
criticalRecord keeping — “we saw one person had a wound on their body, but it was not clear whether they had ongoing skin integrity issues.”
criticalOther — “we saw a record for a person who was not at risk of choking, but their risk assessment had incorrectly recorded that they were at risk of choking.”
moderateGovernance — “at the time of our inspection had not taken timely action to ensure all risks had been managed.”
Strengths
· People and relatives gave positive feedback about care staff and felt safe with the service.
· Electronic call monitoring system in place with immediate follow-up for missed or late calls; no missed care calls identified.
· Medicines administered as prescribed with fully completed MAR charts audited monthly and no concerns identified.
· Staff received appropriate induction covering Care Certificate principles, quarterly supervision, and annual appraisals.
· Robust safeguarding systems with staff demonstrating good understanding; concerns investigated and reported to local authority and CQC.
Quality-Statement breakdown (17)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives and access healthcare servicesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
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
well-led: Continuous learning and improving careRequires improvement
Standard Care Limited was rated Good overall at its first CQC inspection, with strengths in safeguarding, staffing, person-centred care and quality assurance. A breach of Regulation 11 was identified under the Mental Capacity Act 2005 due to care records not consistently documenting capacity assessments or legal authority to consent, resulting in a Requires Improvement rating for Effective.
Concerns (2)
criticalConsent / capacity — “care records did not always record where people did not have capacity to make decisions. This was a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
criticalRecord keeping — “the social worker for one person had conducted a mental capacity assessment...but they had not requested a copy of this for their file. Their care plan had been signed by this person's next of kin, but they had not determined whether this person had the legal authority to sign th”
Strengths
· Robust safeguarding procedures; staff trained and able to recognise abuse and follow correct reporting procedures.
· Sufficient staffing levels maintained with continuity of care workers important to people using the service.
· All staff completed medicines administration training within the last year and medication sheets were fully completed.
· Risk assessments and support plans contained clear, practical guidance and were reviewed regularly.
· Strong person-centred care with staff demonstrating detailed knowledge of individuals' preferences, routines and cultural/religious needs.
Quality-Statement breakdown (13)
safe: Safeguarding and protection from abuseGood
safe: Risk assessment and managementGood
safe: Staffing levels and recruitmentGood
safe: Medication managementGood
effective: Mental Capacity Act compliance and consentRequires improvement
effective: Staff training, induction and supervisionGood
safe:Insufficient evidence to rateeffective:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted KLOE inspection of Standard Care Limited, a domiciliary care agency serving approximately 60 older adults in London, found that improvements had been made following the previous 'Requires Improvement' rating, with the provider no longer in breach of Regulations 12 or 17. Ratings were not updated as only specific concerns around staffing levels, safeguarding and infection control were examined, leaving the overall service rating unchanged at 'Requires Improvement' from the May 2019 inspection.
Strengths
· Risk assessments were comprehensive and included clear written instructions for care staff across areas such as moving and handling and skin integrity.
· Medicines were managed safely with individual MAR charts reviewed monthly and staff demonstrating good understanding of medicines administration procedures.
· Safeguarding procedures were appropriate, including clear policies on financial abuse and timely reporting to relevant authorities.
· Infection control practices were robust with adequate PPE supplies and up-to-date staff training including COVID-19 guidance.
· Electronic monitoring system was fully utilised enabling real-time tracking of care visits and accurate service user numbers.
Standard Care Limited was rated Requires Improvement overall at its January 2018 inspection, with care records lacking sufficient detail about people's medical histories and the provider's quality assurance systems failing to identify these gaps. Safe, caring, and responsive domains were rated Good, with staff demonstrating strong values, robust safeguarding knowledge, and consistently positive feedback from people and relatives.
Concerns (4)
moderateCare planning — “Care records contained very limited details about people's current healthcare needs and their healthcare histories if these were not directly connected to the care being provided.”
moderateRecord keeping — “one person's care record did not specify that they were unable to communicate verbally. Another person's care record did not include details of a previous procedure they had undergone”
moderateGovernance — “whilst the registered manager told us and records confirmed that people's support plans were reviewed every six months, the issues we found had not been identified.”
minorPerson-centred care — “one person's care record stated they required personal care, but did not specify exactly what their individual needs were or what action staff should take to meet these.”
Strengths
· People felt safe with staff and expressed trust in their carers
· Robust safer recruitment practices with thorough pre-employment checks
· Medicines administered safely with monthly monitoring of daily notes
Standard Care Limited was rated Requires Improvement overall at this March 2019 inspection, with breaches of Regulations 12 and 17 identified for unsafe risk assessment practices and inadequate record-keeping across care plans, daily logs and medicines administration. Staff were described as kind and caring, and the service performed well on caring and responsiveness, but systemic governance failures meant quality assurance was not identifying or addressing significant gaps in documentation and visit monitoring.
Concerns (10)
criticalCare planning — “A fifth person's care plan contained information pertaining to an entirely different person.”
criticalRecord keeping — “logs were not always being completed in full, were not always legible and often lacked sufficient information”
criticalMedication management — “MAR were not in use to evidence the effective management of people's medicines.”
criticalMedication management — “we received a notification informing us of an alleged incident relating to missed medicines...occurred on 11 January 2019.”
criticalGovernance — “Quality assurance systems in place were not always effective and we saw no evidence of auditing taking place in relation to people's care documentation”
moderateMissed or late visits — “electronic call monitoring (ECM) systems were not operating effectively and available data about the timeliness and completion of visits was inconsistent.”
moderateSafeguarding — “we were not always being notified of concerns in a timely manner...a notification relating to a missed medicines event that occurred on 11 January 2019.”
moderateIncident learning — “staff had recorded...that they had vomited and were not feeling well...nothing recorded in the log to confirm that staff had taken appropriate action”
moderateCare planning — “a support plan was yet to be completed, despite staff supporting this person since 20 February 2019.”
minorRecord keeping — “staff were not always following the provider's policies and procedures in relation to the management of people's finances.”
Strengths
· Staff developed positive relationships with people; people spoke highly of staff and felt safe and trusted carers.
· Safe recruitment practices followed with appropriate pre-employment checks including DBS, references and employment histories.
· Staff completed induction with shadowing before working independently, and received training relevant to their roles.
· Staff understood safeguarding policies and whistleblowing procedures and could describe appropriate reporting actions.
· Complaints were logged, investigated and responded to appropriately; provider received numerous compliments.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
caring: Respect for privacy, dignity and cultural needsGood
responsive: Assessment, care planning and individual needsGood
responsive: Complaints handling and service user involvementGood
well-led: Governance and quality assuranceGood
well-led: Leadership and organisational cultureGood
effective: Nutritional support
Good
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Working with external organisationsGood
caring: Kindness, dignity and respectGood
caring: Promoting independenceGood
caring: Involvement in care decisionsGood
caring: Cultural and religious needsGood
responsive: Person-centred care planningRequires improvement
well-led: Learning from incidents and complaintsGood
well-led: Staff culture and valuesGood
well-led: Electronic visit monitoringGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support; duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Working in partnership with othersGood
well-led: Continuous learning and improving careGood