Lifestyle Care Services Limited t/a Home Instead Senior Care

About the service

Lifestyle Care Services Limited t/a Home Instead Senior Care is a domiciliary care agency providing personal care and support to people living in their own homes. The service is registered to offer support to older and younger adults, adults with learning disabilities, and people with mental health needs.

Not everyone who used the service received personal care. 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. At the time of the inspection, 45 people were receiving support with personal care.

People’s experience of the service and what we found:

Overall, the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture, but found a number of areas where improvements were required.

Right Support: In terms of consent to care, people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff focused on people's strengths and promoted what they could do. People were supported by staff to pursue their interests as part of their care plan. Staff communicated well with people. They also supported people with their medicines in a safe way.

Right Culture: The values of the organisation, management and staff helped people to feel included and empowered. People and those who were important to them were involved in planning their care. The managers evaluated and monitored the care and support people received and involved other relevant people such as relatives, in care planning. However, we found the systems used to monitor service delivery did not always record lessons learnt or consistently identify areas for improvement.

Right Care: Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care. Staff protected and respected people's privacy and dignity. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people's needs and keep them safe.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 16 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Lifestyle Care Services Limited t/a Home Instead Senior Care on our website at www.cqc.org.uk.

During the inspection we found there was a concern with consent to care, so we widened the scope of the inspection to include the key question of effective.

Enforcement and Recommendations

We have identified a breach in relation to good governance. We also made recommendations regarding risk assessments and consent to care.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

This announced inspection took place on 11 September 2018. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure someone would be available to speak with us. The service was last inspected on 24 February 2016 and was rated good.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It is registered to provide care and support to older people including those living with the experience of dementia, to younger adults and to people with a physical disability and/or learning disabilities. At the time of our inspection the service was providing personal care to 43 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.

There were policies and procedures for safeguarding people at risk of abuse and staff were aware of these. Risk assessments were undertaken to identify individual risks and any environmental risks so these could be addressed. People and relatives said they felt safe when staff provided care and support.

Recruitment checks were undertaken prior to staff being employed by the service to confirm they were suitable to work with people. There were enough staff to meet people’s needs and regular staff were allocated to people to ensure continuity of care.

The provider had policies and procedures for medicines management and staff received appropriate training prior to supporting people with medicines. Staff were trained in infection control and followed procedures to protect people from the risk of infection.

People were assessed prior to receiving care to help ensure their needs and wishes were met in a person-centred way. People received care and support from staff who were trained and supported.

People were supported with simple meal preparation if required and had received training in food hygiene. Staff knew what to do if someone became unwell such as calling the GP or the emergency services if necessary.

Staff received training about mental capacity and knew to report any concerns if they thought a person’s mental ability to make decisions for themselves was deteriorating. Where people using the service could make decisions for themselves, they confirmed staff respected their right to do so.

People and relatives said the staff were kind and caring, maintained people’s dignity and treated them with respect. Staff supported people’s right to make choices about their lives and supported them to maintain as much independence as they could.

Care records included the care and support people required and, where relevant, information about their lifestyles and interests and hobbies, so staff could speak with people about their interests.

There was a complaints procedure in place and people and relatives said they were confident to raise any concerns with the provider and that any issues they had raised had been addressed promptly.

People and relatives had confidence in the provider and were happy with the care and support people received and the way the service was being run. Staff felt well supported by the provider and enjoyed working for the service.

There were quality assurance processes in place for monitoring aspects of the service and these were effective. People’s care and support was regularly reviewed and people were asked their opinions about the service they received and given the opportunity to provide feedback.

The provider recognised the importance of working in collaboration with health and social care professionals to ensure all people’s needs were being met.

The managing director was involved with the community and liaised with a range of local organisations, such as Age UK, The Good Care Group and the Alzheimer’s society. They were accredited with City and Guilds to provide training in Alzheimer’s disease. Another senior staff member held a ‘train the trainer’ qualification in this. Together they provided training in the community to raise awareness and invited professionals and family members.

The agency was registered with CQC since 13 May 2011. The last inspection took place on 21 January 2014 and the provider was compliant with the regulations we checked.

Lifestyle Care Services Limited t/a Home Instead Senior Care is a care agency that provides personal care and support to people living with dementia, learning disabilities and autistic spectrum disorder, as well as older people, people who misuse drugs and alcohol and people with an eating disorder, physical disabilities or sensory impairments.

On the day of our inspection, the agency provided support for 61 people out of which 38 were receiving personal care.

There was a registered manager in post, who had been managing the service since June 2011. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager was supported by a director who was the owner of the company and a deputy care manager as well as an administration team that consisted of a care workers’ coordinator, an in-house trainer and a community developer. At the time of our visit, the agency employed 47 care workers.

All people using the service and family members we spoke with told us they were happy with the agency and they described it as caring and responsive.

The agency had effective safeguarding procedures and people using the service were protected from harm and abuse. The agency assessed risks to people’s health and safety. Care workers had access to risk management plans that gave them guidance on how to mitigate/manage these risks.

The agency managed people’s medicine in a safe way and ensured any changes to people’s medicine were promptly noted and addressed. Any medicine errors were reported and investigated.

The agency had a rota system to ensure all care workers knew who they were assigned to visit that week and that all care workers’ planned absences were covered. People said they received regular support from the same care workers and the agency informed them if a different care worker was to attend instead.

The service had robust recruitment procedures to ensure only suitable care workers were appointed to work with people who used the service.

Care workers had sufficient skills and knowledge to provide effective support for people they cared for. Newly appointed workers received induction training before they started working unsupervised. All care workers were required to repeat trainings that the agency considered mandatory on a yearly basis.

Care workers received effective support in the form of regular one to one meetings, yearly appraisals, spot checks of their work and by attending team meetings.

The agency followed the principles of the MCA 2005. The agency discussed people’s mental capacity and encouraged people to make their choices where possible.

The agency carried out initial assessments in which they gathered all information on peoples care needs, health and wellbeing and personal likes and dislikes.

The agency had introduced a variety of systems to ensure that people were involved in planning of their care, they were encouraged to give feedback on the service they received and to take part in the activities organised by the agency.

People told us that care workers, who supported them, treated them with dignity and respect while providing personal care.

The management team introduced a matching service, which enabled them to match a care worker to a person, based on certain attributes. By doing so, the agency encouraged development of lasting and friendly relationships between people using the service and care workers who supported them.

The agency had a complaints procedure and people and their relatives knew how to raise any concerns about the care they received. The agency dealt with complaints promptly and to the satisfaction of people and their relatives.

People using the service and their relatives described the service as well led and that said they would recommend it to others who needed the support.

The management team encouraged care workers, people using the service and their families to discuss any matters related to how the agency was run.

The agency recognized the value of their workforce and introduced a care worker of the month and a care worker of the year award. Therefore, care workers knew that the management team appreciated and noticed their hard work.

The agency had robust quality assurance and audit systems to ensure effective reporting, monitoring, analysis and review of all aspects of the service provision.

The agency had a folder of policies and procedures that were regularly updated and care workers had access to.

Following our inspection the manager submitted an action plan telling us what action would be taken to ensure these issues were addressed. The manager told us that the service would be fully compliant by 19 December 2013.

During this inspection we found that systems had been improved to ensure staff understanding and found more detailed recording in relation to the support people required and received in relation to their medicines.

People's needs were assessed and a personalised care plan developed that detailed their individual preferences, likes and dislikes. People told us that staff were polite and respectful when providing care for them. For example, one person said, "they [staff] are very respectful." Another person told us staff were, "perfectly adequate and very caring." All of the people spoken with told us that they had named staff who visited regularly and knew their needs.

There were effective recruitment systems in place to ensure that staff were suitable to work with vulnerable people and the service had quality monitoring systems in place to identify and address any areas for improvement based on the views and experiences of staff, people using the service and their relatives.

People were not protected from the risks associated with the unsafe management of medicines as instructions for staff in relation to the support people required with their medicines were unclear and medicine recording systems were ineffective.

We spoke with the provider, three members of staff and two people who use the service. People's needs had been assessed and a care plan developed detailing what action staff should take to meet them. Care plans included information about people's individual preferences, likes and dislikes. The care records had been reviewed at regular intervals and updated to reflect people's changing needs.

Systems were in place to ensure that people were supported with medicines safely and any risks associated with the storage and administration of medicines were being managed to ensure these risks were minimised.

Recruitment checks were undertaken before staff commenced employment to ensure that they were suitable to work for the service.

Staff received support and training to enable them to meet people's needs effectively.