Date of assessment 6 November 2024 to 2 March 2025. Mi Homecare Kensington and Chelsea provides personal care to people in their own homes. There were 208 people using the service when we carried out the assessment, all of which were receiving personal care. The assessment was carried out by 1 assessor. During the assessment we contacted 26 people or their relatives, and 21 care staff for their feedback about the service. We looked at 17 quality statements and found that the service people received was safe, and provided by professional, competent, and well-trained staff. Staff were recruited appropriately, and people were supported, and enabled to take acceptable risks in a proactive, encouraging, way that enhanced their quality of life. It also reduced their social isolation. People were supported by staff working well as a team, and providing joined up, integrated care. This included involving external healthcare professionals. A holistic approach to care was promoted, maintained, and this enhanced people’s independence, by giving them choices regarding the service they received, and control over when they received it. The service gained people’s consent to treatment, and they were encouraged, and supported to maintain healthier diets. The support provided was monitored to encourage people’s improved outcomes. People, and their relatives said the service was generally well managed, and the staff employed, treated people with kindness, compassion, and as individuals, making sure they received equitable service experiences. The service was well led, with good governance, and effective monitoring systems. At the last assessment, the service was rated overall requires improvement with requires improvement in safe, and well-led. At this assessment, the rating has improved to overall good, with good in safe, caring, responsive, and well led.
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MiHomecare Kensington and Chelsea remains Requires Improvement overall following a focused inspection of Safe and Well-led, with a continued breach of Regulation 17 due to ineffective quality assurance that failed to identify conflicting care records, medicines risks, and persistent late visit times of up to two hours. While significant progress was made since the previous inspection — including resolution of breaches in Regulations 12 and 18 — ongoing governance failures and unresolved visit-timing issues mean the service has not yet achieved a Good rating.
Concerns (6)
criticalGovernance: “The provider failed to assess, monitor and improve the quality and safety of the service effectively. Regulation 17 (1) (2)”
moderateMissed or late visits: “ECM showed planned visit times and actual visit times varied up to 2 hours difference for some people's visits.”
moderateCare planning: “We continued to find conflicting information in care and medicine records which had not been resolved through the providers quality assurance processes.”
moderateMedication management: “One person was taking an anti-coagulant medicine but the additional risk of bleeding associated with this medicine were not considered.”
moderateRecord keeping: “One person's MAR indicated the medicines had been left for the person to take later. However, care notes for these days stated that medicines had been administered by staff.”
minorPerson-centred care: “The provider had not made necessary improvements based on feedback from people. One person told us, 'I have spoken to the office several times about the timing for my medication.'”
Strengths
· Sufficient improvement made on risk assessments since last inspection; provider no longer in breach of Regulation 12(1)
· No recent incidents of missed care visits and people receiving more consistent support from regular staff
· Safe recruitment processes in place including DBS checks, right-to-work, employment history and references
· Staff demonstrated good understanding of safeguarding procedures and escalation routes
· Adequate PPE available and infection prevention and control training completed by staff
Quality-Statement breakdown (10)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirements; continuous learningRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Planning and promoting person-centred, high-quality care and openness; duty of candourGood
MiHomecare Kensington and Chelsea was rated Requires Improvement following a focused inspection prompted by concerns about missed and late visits, with breaches identified in safe care, staffing and good governance leading to a warning notice. Inspectors found unsafe medicines management, inadequate risk assessments, 8,379 late visits over six months, ineffective quality assurance, and a negative staff culture, though safeguarding awareness, recruitment and infection control remained satisfactory.
Concerns (12)
criticalMissed or late visits: “the provider submitted a late visits report that showed there were 8,379 late visits between March and August 2022”
criticalMedication management: “People's medicines were not always managed safely. Care plans contained conflicting information about the level of support people required to take their medicines.”
criticalStaffing levels: “The provider had failed to ensure sufficient staff were deployed to meet people's needs.”
criticalGovernance: “Quality assurance systems were not effective as they had not identified all the issues we found with care plans, risk assessments, medicines support and the anomalies with care visit times.”
moderateCare planning: “We found conflicting information in people's care plans about the level of support they required.”
moderateStaff competency: “Staff received training in the administration of medicines, however, their competency had not been assessed in line with best practice guidance.”
moderateLeadership: “The culture of the organisation is unapproachable, rude and dismissive.”
moderateIncident learning: “The provider's investigation into the missed visits did not show what the root cause of this incident was so we could not be assured that the provider was able to learn lessons”
moderateRecord keeping: “The ECM system was recording different times to the times recorded on care notes and MARs so we could not be certain which system was correct.”
moderateComplaints handling: “I have complained about not having a regular carer but the management haven't done anything about it.”
moderatePerson-centred care: “People did not always get person-centred, high quality care.”
minorCommunication with families: “I've never been contacted by the manager to check how things are going”
Strengths
· Safer recruitment processes followed with all pre-employment checks including DBS completed
· Staff had a good understanding of safeguarding procedures and knew how to escalate concerns
· Effective infection prevention and control with appropriate PPE available
· Systems in place to record, analyse and learn from accidents and incidents
· People's religious and cultural needs were well documented in care plans
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staff