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Archived: Lifecare Qualifications Limited

Overall: Inadequate read more about inspection ratings

Boardman House, 64 Broadway, London, E15 1NT (020) 8221 4160

Provided and run by:
Lifecare Qualifications Limited

All Inspections

9 April 2018

During a routine inspection

The inspection took place on 9, 10 and 12 April 2018. The first day of the inspection was unannounced.

We last inspected Lifecare Qualifications Limited in September 2017. At that inspection we found breaches of eight regulations. We issued requirement notices for breaches of Regulations 10, 11 and 19 regarding dignity and respect, need for consent and fit and proper persons employed. We issued warning notices requiring the provider and registered manager to be compliant with the regulations by 30 November 2017 for Regulations 9, 12, 13, 17 and 18 regarding person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. The provider had complied with one warning notice and two requirement notices. We found continued breaches of five of these regulations and one new breach of regulations.

When we completed our previous inspection in September 2017 we found concerns relating to the assessment of people’s needs. At this time this topic area was included under the key question of ‘Responsive.’ We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is now included under the key question of ‘Effective.’

Lifecare Qualifications Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger disabled adults. At the time of our inspection they were providing care to 174 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

Care plans and risk assessments contained insufficient information to ensure people received safe, personalised care. There was not enough information about people’s medicines, mobility or health conditions to ensure they received the right support. People were not asked about their wishes about end of life care. People’s preferences for how they wished to be supported were not captured and the impact of their religious beliefs, sexuality or gender identity were not incorporated into their care plans. Care workers recorded when people’s needs had changed, and raised this with office based staff, but care plans were not updated to reflect this.

People gave us mixed feedback about whether their care workers attended on time. Some staff told us they were given crowded rotas and this was confirmed by the records seen. Staff were not consistently deployed in a way that ensured people received their care at the right time.

Staff received regular supervisions and training in areas considered fundamental knowledge for staff working in a care setting. However, they did not receive sufficient training in areas where people had specialist needs.

People told us they had made complaints, but the provider had not followed their complaints policy and there were no clear records of these complaints.

There were no clear systems for the audit or analysis of incidents, accidents, safeguarding concerns, or complaints. Although care plans had been reviewed, and there was a system in place for tracking outstanding actions, there had been a very limited improvement in the quality of the records. Spot checks were poorly completed and did not lead to actions to improve the quality of the service. The systems and processes had not operated effectively to improve the service.

The provider had improved the working knowledge about safeguarding adults from harm. They were now appropriately identifying and escalating allegations of abuse to the appropriate safeguarding authority.

Staff told us they were provided with sufficient personal protective equipment to ensure people were protected by the prevention and control of infection.

People told us care workers prepared their meals for them. Records showed there was clear information about people’s dietary preferences and care workers recorded that people ate a varied and nutritious diet.

People told us they felt their care workers treated them with dignity. Care workers and people told us where they worked with each other regularly they were able to establish caring and compassionate relationships.

We identified breaches of six Regulations regarding person-centred care, consent to care, safe care and treatment, staffing, display of ratings and good governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service remains ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

6 September 2017

During a routine inspection

The inspection took place on 6 and 7 September 2017 and was unannounced. This was the first inspection since the provider registered with us in December 2015. The provider had recently completed an office move and this location registered with us on 7 August 2017.

Lifecare Qualifications Limited is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection they were providing care to approximately 240 people across four local authority areas.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

People were not consistently protected from avoidable harm and abuse. Although care workers escalated concerns about people’s circumstances to the office, office based staff failed to identify these concerns as possible abuse and did not report them on as safeguarding concerns. The provider had failed to identify issues with care worker attendance at care visits could constitute neglect.

Plans in place to mitigate the risks people faced while receiving care were insufficient and did not include enough information to address the risks. Not all risks faced by people had been properly assessed and instructions for care workers to mitigate these lacked detail. Records did not show medicines were managed in a safe way.

People told us their care workers were rushed and often late. Records showed care workers were often late or early and did not stay the full allotted time. There were not enough staff deployed to ensure that people’s needs were met. Recruitment files did not demonstrate staff were recruited in a safe way.

People did not feel confident that all staff had received the training they needed to perform their roles. Training records were incomplete and showed not all staff had received the training required to perform their roles. Records did not show staff received supervision in line with the provider’s policy.

Consent was not always sought in line with the requirements of the Mental Capacity Act 2005 and related guidance. Care workers told us they offered people choices.

People told us care workers were meant to support them with meal preparation and eating and drinking. People’s experiences varied and some people told us this support was not good enough. Staff maintained records of what people had eaten and drunk.

Records showed care workers escalated concerns about people’s health and supported them to access healthcare professionals when required. Information about people’s healthcare needs and usual presentation was limited which meant there was a reliance on individual care worker knowledge to ensure people’s healthcare needs were met.

People told us their relationships with regular care workers were positive and caring. However, they also told us the strength of relationships was affected by changing rotas. Some staff did not demonstrate they understood the importance of kindness and compassion in care relationships.

Care plans did not include information about people’s sexuality and there was no consideration of the impact this may have on their care preferences. Relatives told us their cultural background was not always taken into consideration by the service.

People gave us mixed feedback about the level of involvement they had in writing and reviewing care plans. Care plans lacked detail, were not personalised and did not contain enough information to inform staff how people liked to receive their care.

People and relatives told us it was not always easy to make complaints about the service. Records of complaints showed the provider investigated and responded to complaints but there was no record that lessons were learned and some agreed actions were not clearly completed.

The registered manager and nominated individual told us they were aware of the issues with the quality and safety of the service, and had been working to address them since June 2017. The efforts made to address the concerns had not been effective as issues remained widespread at the point of inspection in September 2017.

Records showed audits did not consider the quality of records. There were plans in place to seek feedback on the quality of the service from staff and people but these had not been completed.

Records showed the culture of the management team was not one that valued staff. Care workers felt under pressure to take on more work than they were able to manage.

We found breaches of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.