Background to this inspection
Updated
17 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 72 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This included the responses we received from the provider during the Direct Monitoring Activity phone call on 22 September 2021. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with one person who used the service and two relatives about their experience of the care provided. We spoke with five members of staff including health care assistants, care co-ordinators and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included two people’s care records and one person’s medication records. We looked at five staff files in relation to recruitment and staff supervision. Copies of the provider’s policies and procedures were not reviewed during the inspection because the provider did not have any in place at that time.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We obtained feedback from one external professional who had contact with the service.
Updated
17 March 2022
About the service
LMT Support Care is a domiciliary care service providing personal care to 3 people at the time of the inspection. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
People’s individual risks and safety were not effectively monitored by the provider. Medicines checks were not regularly carried out and we were not assured all the staff had received the necessary training. Staff had access to enough personal protective equipment (PPE) to be able to support people safely and in line with COVID-19 guidance.
Processes and procedures were not in place to reduce the potential for abuse, and the provider did not have records available of whether all staff had received safeguarding training. The provider had not carried out necessary pre-employment checks on their staff, which meant there was an increased risk that unsuitable people might be employed to support vulnerable adults.
People’s care plans did not always contain all the relevant information needed to guide staff and ensure the person received appropriate care and had given their consent to be supported. The provider had no training records available for the care staff. No records were kept of any checks to determine staff competency to carry out key tasks; such as the administration of prescribed medicines and moving and handling tasks.
The provider was not open and honest. During the inspection they had attempted to mislead the CQC inspector, about the people being supported and the staff employed. The manager was not clear about their role and responsibilities.
The provider had no policies and procedures in place at the time of the inspection. They also did not have effective systems and processes in place to assess, monitor and improve the service they provided to people.
Relatives told us the manager was not easy to contact and did not routinely provide them with information about the service being provided to their loved one.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Although staff worked in this way, the provider did not have any policies and systems in place to support this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 9 April 2018).
Why we inspected
The inspection was prompted by the provider’s failure to send requested information to the CQC as part of a Direct Monitoring Activity carried out on 22 September 2021.
A Direct Monitoring Activity consists of a review of the information the CQC hold about a service and a structured phone call with the provider. The aim is to use the information from that activity to obtain assurances about the service, and any potential risks, without the need to carry out an inspection. However, adequate assurances were not obtained, and a decision was therefore made for us to inspect and examine those risks.
We had concerns in relation to the provider’s management processes and record keeping. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led key only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for LMT Support Care on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to the care and treatment arrangements at the service, arrangements for protecting people from potential abuse, and the management of the service.
Please see the action we have told the provider to take at the end of this report.
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.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the provider's 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.