Lizor Care Concept

Updated 3 January 2024

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 Health and Social Care Act 2008.

Inspection team

The inspection was undertaken by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 16 October 2023 and ended on 03 November 2023. We visited the location’s office on 16, 24 and 27 October 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with 10 people who use the service, 6 relatives, 7 staff including the registered manager and nominated individual and a health and social care professional.

The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked at people’s medicine records, assessments of risk and information related to the management of the service.

Updated 3 January 2024

About the service

Lizor Care Concept is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection there were 71 people using the service.

Not everyone who used the service received personal care. The Care Quality Commission 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

The provider has a poor history of compliance with regulation. There have been 5 inspections since the provider’s registration in May 2020. All inspections have been initiated due to safeguarding concerns or to follow up on shortfalls identified at a previous inspection. As a result of the inspections, we have issued requirement notices and a warning notice, to ensure the provider made improvement. At this inspection the provider remained in breach of regulations.

Risks people faced had not been identified, assessed or mitigated. This included the risk of choking, skin soreness and fire hazards when using petroleum-based emollients. Recommendations from specialised professionals such as the epilepsy nurse, had not been added to people’s care plans. This did not ensure staff had the knowledge to support people safely.

Medicines management remained unsafe. Staff had not given a person their prescribed medicine for four days and, once identified, they had not sought medical advice. This put the person at risk of harm. Guidance for staff regarding people’s medicines was not always clear or accurately documented. This meant people were at increased risk of experiencing harm from avoidable medicines errors.

The provider had made some improvement to staff recruitment, but shortfalls remained. Applicants had not always given a full employment history and the performance of one applicant had not been verified. These shortfalls did not clearly evidence the applicants were suitable for their role, which placed people at risk of harm.

Care planning was task orientated and not always person centred. The information did not show how a person’s health condition, such as dementia impacted, on them. Techniques staff should use to best support a person were also not identified. This did not ensure a consistent staff approach to effectively meet people’s needs.

Systems did not effectively monitor the performance of staff. For example, records showed one member of staff required more supervision, but there were no records to demonstrate this. There was no assessment of the staff member’s competence to show they were able to carry out their role effectively. This did not ensure people were supported effectively.

Whilst people and their relatives knew how to raise a concern, records did not evidence a well-managed complaint procedure. The provider was not able to provide evidence of the complaints raised, their investigation or outcome. This did not demonstrate all complaints were addressed or that lessons had been learnt.

There were some auditing systems, but these did not always identify shortfalls in the service. This included those shortfalls found at this inspection, such as staff recruitment and supervision, the safe administration of medicines and risk management. Audits of daily records, care plans and medicines had been completed, but the information had not been used to give an overview of service provision. For example, some lateness of people’s support had been identified, but not analysed to show any patterns or trends. This did not ensure action was taken to improve provision.

Staff had been recruited via the government’s staff sponsorship scheme. The scheme had ensured there were enough staff to support all care packages and had enabled the size of the agency to grow significantly. The provider had divided all staff into teams based on the geography of where they worked. A team leader for each team had been employed, to ensure better overview.

People were happy with the infection control practice staff followed. This included wearing the appropriate personal protective equipment and keeping areas of their home clean. Records showed staff had received training in infection prevention and control.

At our last inspection we recommended that the provider revisited the safeguarding training staff received, and ensured staff were competent to apply their learning in their practice. This recommendation had been acted on and systems were in place to minimise the risk of people sustaining abuse. People felt safe with staff supporting them and were complimentary about the service they received. They said they generally had a consistent staff team, who usually arrived on time and stayed the full allocation of their visit.

Rating at last inspection and update

The last rating for this service was requires improvement (published 05 January 2023) and there were breaches in regulation. This service has been rated requires improvement for three inspections since registration. At this inspection we found the provider remained in breach of regulations and has been rated inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about the number of safeguarding notifications we had received from the local authority and other agencies. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lizor Care Concept on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management, the safe administration of medicines, staff recruitment, person centred care 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service 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 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.