Care Outlook (West Wickham) is a domiciliary care agency. It is registered to provide personal care to adults and older people living in their own homes, including people with a physical disability, learning disability and dementia. 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. The manager of the service was going through the registration process and became registered manager during the inspection process. A registered manager is a person who has registered with the CQC to manage the service. This means that they and the provider are legally responsible for how the service operates. As the manager was undergoing the registration process during the course of our inspection, they are referred to as ‘manager’ throughout the body of the report. At the time of the inspection there were 213 people receiving personal care. 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. We found the provider was not meeting the principles of Right support, right care, right culture. Date of inspection: 19 June 2025 to 25 September 2025. This was an announced inspection. we looked at all the quality statements. At the last inspection in April 2022, the service was rated Requires Improvement. We found 3 breaches of the legal regulations in relation to safe care and treatment, staffing and governance. We undertook this inspection to check the provider had followed the action plan they completed after the previous inspection. Following this comprehensive inspection the overall rating for the service is now requires improvement. We found the provider remained in breach of the previous 3 legal regulations of safe care and treatment, staffing and good governance. In addition, we found 1 new breach in relation to need for consent. We spoke to 39 people who used the service, 20 relatives, 10 care staff members, the registered manager, (became registered during the inspection process) regional manager, quality manager, medicines auditor, and care coordinator. We reviewed 14 people’s care records . We looked at 6 staff files in relation to recruitment and supervision. We also looked at policies and procedures and records related to the management of the service. At this inspection we found risks were not always identified and mitigated. Safe medicine practices were not always promoted; staff were not always punctual.The service did not always within the principles of the Mental Capacity Act 2005 (MCA). Management governance and oversight and the provider’s quality assurance processes were not always effective. This was because they had failed to identify the concerns we found at this inspection. People were safeguarded from potential abuse, people's independence was promoted, infection control was effectively managed, and staff were kind and caring. We have asked the provider for an action plan in response to the concerns found at this assessment.
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Care Outlook (West Wickham) was rated Requires Improvement following a focused inspection of Safe and Well-Led, triggered by concerns about late visits, neglect, and poor medicines management. Breaches of Regulations 12, 17, and 18 were identified, covering unsafe risk management, ineffective medicines oversight, chronic late visits, and systemic governance failures.
Concerns (8)
criticalCare planning: “Risks to people in relation to diabetes, falls and choking were not always identified and there were no risk assessments or guidance for staff on what to do to minimise these risks.”
criticalMedication management: “Medicine risk assessments and risk management plans were not always in place. For example, there were no risks identified or guidance in place for staff as to what they should do if people refused their medicines.”
criticalStaff competency: “The provider did not have a regular formal process to assess whether staff were competent to administer and manage people's medicines safely.”
criticalMissed or late visits: “One person said, "Some come when they feel like. They don't think of me. One should have come at 10.30am but came at 2.45pm."”
criticalGovernance: “The provider's governance of the service was not effective or robust. There was a lack of oversight, leadership and governance at the service.”
moderateRecord keeping: “Records were not completed fully and accurately. The lack of risk assessments and risk management plans did not demonstrate the provider always understood how to assess and manage risks.”
moderateIncident learning: “Accidents and incidents were recorded, however the provider failed to carry out any analysis and disseminate any learning to staff on how to minimise these in the future.”
minorCommunication with families: “People told us that communication with management could be better. One person said, "They [management] don't always get back to me."”
Strengths
· Robust recruitment process with appropriate pre-employment checks including references, identity verification, and DBS checks.
· Appropriate adult safeguarding procedures in place; staff trained in safeguarding and able to identify types of abuse.
· Effective infection control measures including regular COVID-19 testing, PPE supplies, and staff training.
· Service worked in partnership with key organisations including local authority, GPs, and District Nurses.
· Out-of-hours on-call management support system in place for staff.
Quality-Statement breakdown (10)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
well-led: Continuous learning and improving careRequires improvement
well-led: Managers and staff are clear about their roles and understand quality performance, risks and regulatory requirements
Care Outlook (West Wickham) was rated Requires Improvement overall at its first CQC inspection in June 2015, with three regulatory breaches identified covering recruitment (Reg 19), Mental Capacity Act compliance (Reg 11), and governance (Reg 17). Caring and Responsive were rated Good, reflecting positive feedback from people about kind staff, consistent care teams and responsive care planning, but significant gaps in record keeping, MCA implementation, staff training currency and quality monitoring undermined the service's safety and leadership.
Concerns (8)
criticalStaffing levels: “the provider did not ask for a full employment history to protect people from the risk of being supported by unsuitable staff. This was a breach of Regulation 19”
criticalConsent / capacity: “Arrangements for staff to follow the Mental Capacity Act (2005) Code of Practice were not in place and staff did not have sufficient knowledge of their roles”
criticalGovernance: “records related to the monitoring of the service and staff records were not always available. Some policies were inaccurate or not available for staff as guidance”
moderateRecord keeping: “Of the 11 care plans we looked at five had no record of telephone monitoring or quality visits for this year.”
moderateMissed or late visits: “Seven people told us they had experienced late calls on occasions...Three people told us their calls were more regularly late.”
moderateStaff training: “six care workers safeguarding adults training was overdue and five care workers manual handling refresher was also overdue”
moderateIncident learning: “Regular staff meetings to share any learning had not been held for the last year.”
minorMedication management: “The medicines policy did not give staff any guidance about what to do in the event of a medicines error.”
Strengths
· People told us they felt safe and well cared for, describing the service as 'safe, reliable and wonderful'.
· Staff were trained in safeguarding, knew how to raise concerns, and whistleblowing procedures were understood.
· Risks to people were identified and risk assessments were in place and reviewed when circumstances changed.
· Sufficient numbers of staff were deployed and the service used local staff to reduce travel time and late arrivals.
· The service tried to maintain consistency by assigning small teams of carers to individuals.
Care Outlook (West Wickham) achieved an overall Good rating at its November 2016 comprehensive inspection, demonstrating significant improvements in medicines management, risk assessment and recruitment following previous enforcement action and warning notices. The Well-Led domain was rated Requires Improvement due to insufficiently embedded quality monitoring processes, reactive rather than proactive training refreshment, and inconsistent call monitoring.
Concerns (5)
moderateGovernance: “the process for checking these records had then recently started and it was not possible to judge its effectiveness. This remained the case at this inspection and so this system was not yet working satisfactorily.”
moderateStaff training: “The provider did not refresh care workers training for areas such as food hygiene, Mental Capacity Act, dementia care and infection control to ensure that care workers remained up to date.”
minorRecord keeping: “We found two care plans that were hand written and difficult to read in parts.”
minorMissed or late visits: “We noted that there were some late running calls and the office manager told us the reasons for the late calls had yet to be identified.”
minorGovernance: “Staff meetings were not held which meant opportunities to discuss consistency or common issues were limited.”
Strengths
· People told us they felt safe and well cared for; safeguarding training was in place and staff knew how to raise concerns.
· Medicines were safely and consistently managed following previous enforcement action and warning notices.
· Risk assessments were completed and regularly updated with clear guidance for care workers.
· Care workers received regular supervision, annual appraisals, and competency checks following training.
· People were treated with dignity and respect; cultural, spiritual and dietary needs were addressed in care plans.
This focused follow-up inspection of Care Outlook (West Wickham) found partial improvements following Warning Notices issued after the April 2016 inspection, with progress on risk assessment and medicines management, but ongoing inconsistencies in MAR returns and daily care record monitoring. Both Safe and Well-Led remain rated Requires Improvement pending a future comprehensive inspection to verify sustained compliance.
Concerns (5)
moderateMedication management: “one MAR record for prescribed creams had not been returned to the office for checking in July and we identified two gaps that needed to be reconciled”
moderateMedication management: “a body map inaccurately showed the location where the prescribed cream needed to be administered. There was a risk this could be incorrectly applied by unfamiliar care workers.”
moderateGovernance: “not all MAR had been returned for the month of July and this had not been identified as there was no system to check for this.”
moderateRecord keeping: “regular checks were not always carried out on the daily notes being returned to the office to confirm that people received their care as planned.”
minorCare planning: “the service had yet to complete its full review of people's care and support needs... this process was three quarters of the way through had not yet been fully completed.”
Strengths
· Risks to people were individually identified, assessed and monitored with detailed guidance for care workers on risk reduction.
· Monthly medicines audits were completed and discrepancies followed up with additional training and competency assessments for care workers.
· Regular telephone monitoring and spot checks on care workers were carried out to ensure support needs were met.
· No medicines errors had been identified since the last inspection and no unexplained gaps found in the July 2016 audit.
· Care workers had been issued clear reminders of procedures for late or emergency calls, with no incidents of non-compliance since the last inspection.
Care Outlook (West Wickham) was rated Requires Improvement overall at its April 2016 inspection, with Safe rated Inadequate following Warning Notices for breaches of Regulations 12 and 17 relating to unsafe medicines management, inadequate risk assessment, and poor record keeping. Caring and Responsive were rated Good, reflecting positive feedback from people about their care workers, though continued governance failures and staff training gaps in MCA understanding required urgent remediation.
Concerns (11)
criticalMedication management: “Medicines were not managed safely and people did not always receive their medicines as prescribed.”
criticalMedication management: “medicines errors had occurred due to missed calls or calls occurring too close together and the risks in relation to medicines had not been identified or assessed.”
criticalCare planning: “risk assessments for four people did not identify risks from their respective health conditions or other associated risks.”
criticalRecord keeping: “communication logs for two people did not always evidence that the care and support provided was in line with the support plan.”
criticalRecord keeping: “For one person there was no record of calls provided on four occasions.”
criticalGovernance: “Systems to assess, monitor quality and mitigate the risks relating to the health, safety and welfare of service users were not operated effectively.”
moderateStaff training: “care workers did not always demonstrate full understanding of the code of practice and their responsibilities under the code.”
moderateConsent / capacity: “Some support plans had been signed by relatives when it was unclear if the person concerned lacked the capacity to make this decision.”
moderateStaff competency: “Checks to ensure new care workers had completed their shadowing and were skilled enough to carry out the work had not been completed or signed off for one person.”
moderateMissed or late visits: “missed and late visits had not been promptly identified for someone using the service in the other local authority where no call monitoring service was provided.”
moderateSafeguarding: “personal references for two new staff members had not been verified and a risk management plan for a new employee and checks on their induction completion had not been followed.”
Strengths
· People and relatives felt safe and well cared for, with consistent regular care workers who were described as caring and kind.
· Sufficient staffing levels with care workers having adequate travel time between calls and people receiving their full call duration.
· People's dignity, respect, and independence were actively promoted and cultural needs were addressed in care plans.
· Complaints were generally handled appropriately and in line with policy, with people satisfied by responses.
· Staff demonstrated knowledge of safeguarding signs and reporting procedures, and the service cooperated with safeguarding investigations.
Quality-Statement breakdown (17)
safe: Medicines managementInadequate
safe: Risk assessment and mitigationInadequate
safe: Staffing levelsGood
safe: SafeguardingGood
safe: Recruitment practicesRequires improvement
effective: Staff training and competencyRequires improvement
Care Outlook (West Wickham) was rated Good across all five key questions at this June 2019 inspection, serving 117 people with personal care in their own homes. The well-led rating improved from Requires Improvement to Good since the previous inspection, reflecting effective quality monitoring systems and strong registered manager leadership.
Strengths
· People felt safe and staff demonstrated clear understanding of safeguarding procedures and reporting responsibilities.
· Robust recruitment procedures in place including DBS checks, references, and health declarations.
· Medicines managed safely with individual MARs, regular audits, and competency-assessed staff.
· Staff received training relevant to people's needs including MCA, safeguarding, moving and handling, and infection control.
· Care plans were personalised, regularly reviewed, and reflected people's individual needs, backgrounds, and preferences.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
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
Requires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Working in partnership with othersGood
effective: Healthcare needs monitoring
Good
caring: Staff attitudes and kindnessGood
caring: Consistency of care workersGood
caring: Dignity and respectGood
responsive: Care planning and individual needsGood
responsive: Timeliness of visitsRequires improvement