Archived: L K Recruitment Limited

The service is a domiciliary care agency which provides personal care to people in their own homes. People received support through scheduled visits. At the time of our inspection there were 53 people using the service.

At our previous inspection in May 2016 we found breaches of the regulations in relation to the arrangements in place to ensure people received their medicines safely, how the provider supported its staff through training and appraisal and the systems in place to assess and monitor the quality of care people received. The overall rating for the service was, "requires improvement." We asked the provider to tell us how and when they would make the required improvements. Some of these actions have been completed. However the provider had not made improvements to the systems in place to assess and monitor the quality of care people received.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Registered providers must notify the CQC about certain changes, events and incidents that affect their service or the people who use it. The provider did not notify CQC of notifiable events such as allegations of abuse. This meant the CQC did not have full oversight of the risks associated with the service.

People told us that staff were regularly late and did not stay for the time allotted. People also told us they had experienced missed visits. This meant that care was not always delivered in accordance with people's care plans.

Staff knew how to recognise abuse and report any concerns. Risk assessments were carried out to evaluate any risks to the person using the service. Where risks were identified, risk management plans were in place for staff to follow.

People told us the staff were caring and treated them with respect. People were involved in planning their care and were asked for their consent before care was provided. Staff understood the main principles of the Mental Capacity Act 2005 and how it applied to people in their care.

People were supported to have a sufficient amount to eat and drink which minimised the risk of malnutrition and dehydration. Staff liaised well with external healthcare providers which assisted people to maintain their health. People told us they received their medicines as prescribed.

The provider did not have an effective system in place to receive, respond to and learn from complaints from people or their advocates. The system in place did not allow for complaints made over the telephone to be recorded, investigated and responded to.

Staff were recruited using an effective procedure which was consistently applied. Staff were appropriately supported by the provider through training, supervision and appraisal. However, staff did not feel listened to by the provider and staff morale was low.

There were a variety of systems in place to assess and monitor the quality of care people received. However these were not always effective in identifying areas which required improvement. Where the provider was aware that an area of the service required improvement they did not always take action to make the required improvements.

We found breaches of the regulations in relation to the provider's failure to protect people from neglect, the provider's failure to notify the CQC of notifiable events and the lack of effective systems to handle complaints and to assess and monitor the quality of care people received. You can see what action we asked the provider to take at the back of the full version of this report.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

L K Recruitment Limited is a domiciliary care agency that provides personal care and support to adults living in their own homes. There were 61 people using the service at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the procedures in place for ensuring people received their medicines safely were ineffective. This was because there was insufficient information recorded in people's care files on the medicines they were taking. Also, the process in place to check people received their medicines when due was not sufficiently robust to identify gaps in medicine administration records completed by staff.

The registered manager and staff knew what constituted abuse and who to report it to if they suspected people were at risk. People were protected from avoidable harm. Risk assessments were conducted and care plans gave staff information and guidance on how to manage the risks identified.

People were supported to stay healthy and well. Staff were knowledgeable about the signs and symptoms to look out for that indicated a person’s health may be deteriorating. If staff had any concerns about a person’s health, appropriate professional advice and support was sought. People were supported to eat healthily, where the agency was responsible for this. Staff also took account of people’s food and drink preferences when they prepared meals.

Staff knew people well. They understood their preferences, routines and support needs. Staff provided people with the support they required in line with their care plans. Staff reviewed people’s needs to identify if the level of support they required had changed, and care plans were updated accordingly.

People were involved in decisions about their care. Where appropriate, staff liaised with people’s relatives and involved them in discussions about people’s care needs. Staff supported people in line with the Mental Capacity Act 2005.

Staff arrived on time and stayed for the time allocated. Staff had developed caring and friendly relationships with people. Staff respected people's privacy and dignity. There was a sufficient number of staff to help care for people safely. People were given the opportunity to express their views on the quality of care they received.

Staff were recruited using appropriate recruitment procedures which were consistently applied. However, we found that the provider did not provide staff with an annual performance review or the training they required to ensure they had the knowledge and skills to undertake their role effectively. Staff were not given the opportunity to obtain further qualifications relevant to their roles.

The provider recognised the importance of monitoring the quality of the service provided to people but the systems in place were not always as effective as they needed to be. Auditing processes did not identify that people's medicine records had unexplained gaps, that people's records of care were not fully completed by staff or that staff training and appraisal were not up to date.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the arrangements in place for people to receive their medicines safely, how the provider supported staff through training and appraisal and the systems in place to assess and monitor the quality of care people received. You can see what action we told the provider to take at the back of the full version of this report.

We found that people's needs were assessed before care and support was delivered.

People's care and treatment was planned to ensure their safety and welfare. We saw comprehensive, personalised risk assessments on all the care files we reviewed. People told us they had a copy of their care plan in their home and that their care and treatment was delivered in accordance with their care plan.

We found that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff were aware of their obligations in relation to safeguarding people who use the service from abuse.

We spoke with two people who use the service and they were satisfied with the way their care was delivered. One person told us, 'I usually have the same carer and they are usually on time.' We also spoke to people's relatives and their comments about the service were positive. One person told us 'the carers do what they are supposed to do.' However, we were concerned that care was not planned and delivered to ensure the safety and welfare of service users. We found the risk assessments carried out by the service were inadequate.

We were concerned that people who use the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found the service operated an effective recruitment process and carried out appropriate checks before staff began work. The provider had an effective system to regularly assess and monitor the quality of service that people receive.