Lancaster Leyland Care Limited

This inspection took place on 28 November 2018 and was announced.

Lancaster Leyland Care Limited also known locally as ‘Second to None’ is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using Lancaster Leyland Care Limited receives a regulated activity. Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At the time of our inspection the service was providing personal care to 40 people who lived in and around St Helens.

At the last inspection in April 2016 the service was rated 'Good'. At this inspection we found the service remained 'Good'. We found the manager and the registered provider had continued to maintain the safe standards of care and to ensure people received good levels of care.

The service was managed by a registered manager who was also one of the directors. 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.

The manager used a variety of methods to assess and monitor the quality of care delivered at the service. These included care file audits, regular spot checks, quality surveys, to seek the views of people about the quality of care being provided and staff meetings to seek staff’s views and share best practice. However, we found improvements were required to ensure the quality assurance processes in the service were robust. We found shortfalls that had not been identified by the audits.

Recruitment checks were carried out to ensure suitable people were employed to work in the service. People who used the service told us there were sufficient staff to ensure people received the care they required. However, we found rotas needed to be designed to allow visits to be carried out effectively without overlaps and to allow staff adequate time between care visits.

People who used the service told us they felt safe receiving support from Lancaster Leyland Care Limited. Feedback regarding the care quality was positive. There was a safeguarding policy and staff had received safeguarding training.

There were risk assessments to minimise the potential risk of harm to people who used the service. These had been kept under review and were relevant to the care and support people required. However, we noted that risk assessments for people who had medical attachments such as catheters needed to be robust.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. We noted some improvements were required to the processes for monitoring medicines records to ensure audits were undertaken in a systematic way to help the provider to identify where the shortfalls were in a timely manner. The registered manager took action and started putting corrective measures in place.

Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate their relatives, were involved in decisions and consented to their care. However, records of how mental capacity had been assessed had not been completed. We made a recommendation about this.

People’s independence was promoted.

People were supported to meet their nutritional and hydration needs and they had been assisted to have access to healthcare professionals and their healthcare needs were met.

Risks of infections had been managed. There was an infection control policy and staff had access to personal protective equipment such as gloves.

The provider had regularly sought people’s opinions on the quality of care provided.

People and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available, and we saw how previous concerns had been dealt with.

Staff had received induction and training. There was a policy on staff supervision and appraisals and staff had received regular supervision. The majority of the staff told us there was a positive culture within the service. They told us they enjoyed their work. However, two of the staff we spoke with told us they did not feel the rotas were effectively organised to give them time to travel between visits and did not feel they could always contribute to the effective running of the service. The registered manager informed us they would address these concerns with all staff.

The manager used a variety of methods to assess and monitor the quality of care delivered at the service. These included care file audits, regular spot checks, quality surveys, to seek the views of people about the quality of care being provided and staff meetings to seek staff’s views and share best practice.

The service provides care and support to people in their own homes in and around the St Helen’s area. At the time of the inspection there were 41 people using the service.

The manager of the service had been registered with the CQC since April 2015. 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 told us that they felt safe using the service. Staff had received training in safeguarding vulnerable people, and knew how to report any concerns. The registered provider had an up-to-date safeguarding policy in place, and records indicated that where appropriate any concerns had been reported to the local authority to keep people safe.

There were sufficient numbers of staff in place to keep people safe. Staff commented that they felt well supported by their team, and people reported that staff always attended their calls as planned. We looked at staffing rotas which confirmed that staffing levels were consistent.

Recruitment processes were robust and ensured that people were protected from the risk of harm. New staff were required to complete a written application which outlined relevant experience and qualifications. Staff had also been required to provide two references, one of which needed to be from a previous employer, and had been subject to a check by the disclosure and barring service (DBS). The DBS helps employers make decisions around whether people are suitable to work with vulnerable people.

Staff had been supported to undertake relevant training in areas such as infection control, moving and handling and the Mental Capacity Act 2005. This ensured that they had the appropriate skills and knowledge to carry out their role. New staff were required to shadow more experienced members of staff before working on their own, and were required to complete training in areas such as those listed above.

Staff received supervision and appraisal on a routine basis. This allowed them to discuss their role and further training needs. This also allowed the registered manager to discuss any issues, and address any performance related issues. The registered provider had a disciplinary procedure in place, which we saw was being used appropriately to ensure the professional standards of the service were being maintained.

The registered manager had systems in place to monitor the quality of the service being provided, and ensure any improvements were made where required. These included checks on care records to ensure that they were up-to-date, and spot checks to observe staff interactions with people. The registered manager also reviewed accidents and incidents, in order to identify trends and to ensure that people received the correct support to prevent issues from happening again in the future.

People told us that staff were kind and respectful towards them. Staff had developed positive relationships with people they were supporting, and worked to maintain their privacy and dignity. This helped ensure that people were put at ease and were comfortable during personal care interventions.

The registered provider had a statement of purpose in place which outlined the values of the service. These included promoting people’s independence and treating people with dignity and respect. People gave examples where staff had worked to promote these values in their work, and confirmed that they participated in their care. This helped ensure that people maintained control within this aspect of their life.

People told us that they would feel confident in making a complaint. The registered provider had a complaints policy in place and people were provided with a copy when they first started with the service. The registered manager kept a record of comments and concerns that had been raised, along with the response to the concerns, which demonstrated appropriate actions were taken.

People told us that care and support needs had been agreed with them before the care started. We were told copies of care records were available in people's homes. This was confirmed by people who used the service. The files we looked at contained care plans that were personalised and included people's preferences.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People told us care staff were able to do everything they needed within the allocated time. They also said staff took their time and did not rush.

One person said, 'To all at 'Second To None', we would like to say how much we appreciate all you have done and are still doing for us. It is a pleasure to have you in our home. We are delighted with the care you give, done with efficiency and with a good regard for dignity. The difference this has made to our lives is immeasurable, with appreciation and thanks to all at 'Second To None'.'

People were cared for, or supported by, suitably qualified, skilled and experienced staff and there was an effective complaints system available. Comments and complaints people made were responded to appropriately.

During the inspection we spoke with two management staff and seven care and admin staff. We looked at staff records, including training records, supervision notes and staff meeting minutes. All these records were comprehensive, relevant and up to date.

We also looked at the care records for six people who used the service. These contained clear representations of people's personal choices, likes and dislikes. There was also evidence of consultation around care delivery and review outcomes, as well as evidence of joint working with other professionals, when appropriate.

We subsequently spoke to eight people who used the service, or their representatives, to gain their views. The people who used the service told us that they felt respected by the people who cared for them, and the management of the company. They told us that they felt able to speak to anyone within the company if they had any concerns, and described the staff as approachable and helpful.

One person told us that the company was 'very professional and well organised', another said that 'their experience, advice and help is invaluable' and another said they were 'very satisfied' with the service. All of the eight people we spoke with described the service as very good, and were very happy with the standard of care they, or their relative, had received.