LH Social Care Limited - Barnsley

L H Social Care Limited is a domiciliary care and supported living service. It provides personal care for adults and children living in their own homes throughout Barnsley and the surrounding areas. People who use this service have a wide range of needs including younger and older people who are living with a learning disability, people living with dementia, as well as people with mental health needs and physical disabilities. At the time of our inspection 33 people were receiving support from this provider.

The service had a registered manager in place. 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 risk assessments in place which covered the environment in which people were supported and person specific risk assessments which identified risks and the measures which were put in place to minimise the risks to people.

People who used the service and their relatives told us people were very safe with their care workers. They also said staff knew what they are doing and were kind and respectful. People were happy with the service they received from LH Social Care Limited.

People were supported with medication and told us they were confident their medication was administered and recorded properly. People with prescribed topical creams said these were applied properly and care workers took appropriate hygiene precautions. We found body maps were not always completed within care plans to show where creams needed to be applied.

Staff recruitment was robust and staffing levels were sufficient to meet people’s needs. People were supported by small teams of regular care workers.

Records showed staff had access to training and regular supervision. Staff we spoke with told us they felt supported.

People told us they were not routinely informed if care workers would be arriving later than the scheduled care visit time. The service was in the process of implementing a rota management system and we will check the effectiveness of the system at our next inspection.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff had undertaken training on the Mental Capacity Act (2005) and deprivation of Liberty Safeguards. Staff were able to explain how this legislation related to the people they supported, which meant people’s rights were being protected.

People told us their care workers are kind and compassionate.

Care workers promoted and respected people’s confidentiality, dignity and privacy. Care workers took time to build a good rapport and got to know the people they supported.

People received support with their nutrition and dietary requirements.

People and their relatives were involved in their care planning and in agreeing the support they needed.

People were supported to retain their independence. People told us they were able to make their own decisions and their preferences were taken into consideration.

The service had a complaints policy and process in place. People told us they knew what to do if they had any concerns or complaints about the service.

Feedback regarding the registered manager was positive. People spoke highly about the management of the service.

A system of audits and checks was in place to monitor the safety and quality of the service.

The service worked in partnership with other organisations and local commissioners.

LH Social Care Limited - Barnsley is registered to provide personal care. Support is provided to adults and children living in their own homes throughout Barnsley and the surrounding areas. At the time of the inspection the service employed 38 staff and care was provided to 28 people, equating to approximately 856 care hours.

At the last inspection on 26 February and 3 March 2016 the service was rated as inadequate and was placed into special measures by CQC. On this inspection we checked to see if any improvements had been made with the breaches of regulation identified at that inspection. These included, regulation 12 safe care and treatment, regulation 17 good governance and regulation 18 staffing. When we inspected LH Social Care Limited - Barnsley we found the registered provider had made improvements in all areas.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a manager at the service who was registered with CQC. The registered manager of this service is also the registered provider. It is a condition of registration with the Care Quality Commission that the service has a registered manager in place. 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 generic and person specific risk assessments in place for most people. We found no risk assessment in place to identify the possible risks in relation to a specific risk for one person, although all relevant information relating to the risk was recorded in their care plan.

People who used the service said they felt safe whilst receiving support and care from staff. People looked forward to their visits from staff. Their comments included, “I get on with them all, they’re great people” and “I don’t know what I would do if this service was taken away. I really rely on them.”

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice. This helped to protect the rights of people who may not be able to make important decisions themselves.

There were enough staff employed to make sure visits were carried out at the agreed time. The registered manager made sure full employment checks were completed for all staff before they were offered a position at the service.

Staff had developed positive and caring relationships with the people they cared for and knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. People felt staff were caring and treated them with dignity and respect as well as supporting them to maintain their independence while providing care.

There were improvements in the way complaints were investigated and responded to since the previous inspection.

People's needs had been assessed when they started to use the service and all care plans we

examined had been reviewed and were up to date.

People using the service had been sent a quality survey asking for feedback on the quality of the service and the comments received had been positive.

Since the previous inspection the registered provider had introduced a range of systems to monitor the quality of the service provided.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

We announced this inspection to the registered manager two days before our visit. We did this because the manager is sometimes out of the office and we needed to be sure that they would be available.

The service has a history of breaches of regulation. The agency was last inspected on 22 and 29 June 2015 and was not meeting the requirements of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We imposed an additional condition on their registration as a service provider in respect of the regulated activity, personal care. The condition states: The registered provider must not provide the regulated activity ‘personal care’ to any further service users not already being provided with personal care without prior written agreement from the Commission until the location has a follow up inspection and we are satisfied the location is not in breach of regulations.

On this inspection we checked to see if any improvements had been made with the breaches of regulation identified at the last inspection. These included, regulation 12 safe care and treatment, regulation 17 good governance, regulation 18 staffing and regulation 19 fit and proper persons employed.

When we inspected LH Social Care Limited - Barnsley we found the registered provider had made improvements in all areas, but these were insufficient to fully meet regulations.

The systems in place to assure quality and identify improvements were not sufficiently robust, which meant people did not benefit from a constantly improving service, where they did not have to continually raise the same areas for improvement.

The registered manager promoted strong values and a person centred culture that staff understood and delivered in practice. Kindness, respect, compassion and dignity were principles on which the service was built and people told us those values were reflected in the day to day practice delivered by care staff. However, care routines and risk assessments that had been reviewed did not always support this with some risk assessments not always being followed and some records containing inaccurate information and/or gaps in information.

People were confident in reporting concerns to the manager, but didn’t always feel they were acted on properly as the same concern often arose again.

Better systems were needed to ensure sufficient numbers of staff were deployed to meet people’s needs.

We found improvements with the training and supervision of staff to maintain and update their skills and knowledge. However, gaps remained with some staff’s training and the actions from supervisions had not always been addressed in a timely way. In addition, we found staff had not received an annual appraisal.

Staff sought people’s consent to care and treatment, but their understanding of MCA and DoLS needed to improve so that people’s rights were respected.

We found the systems and processes to manage medicines in a safe way and recruit staff had improved.

People had confidence in the service and felt safe when receiving support.

People were supported to have sufficient to eat, drink, maintain a balanced diet and access healthcare appointments where this was part of their care routine.

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, the service will be inspected again in six months.

During our inspection on 20 November 2013 we identified concerns about the recruitment of staff and records.

At the time of this inspection, records showed there were 33 people who were supported by the service. We telephoned eleven people that used the service, or their representatives to ask them about their experiences of LH Social Care. We were able to speak with seven people.

We were also able to visit one person in their own home, where a family member and two care staff were present.

We also telephoned seven care staff employed by LH Social Care to ask them about their experiences of working for the agency. We were able to speak with three staff. We also spoke with three staff in person at the agency's office.

In addition to speaking with people who used the service and/or their representatives, staff and the registered provider, we also reviewed a range of relevant documentation.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

Improvements had been made in the recruitment of staff, because in the main, we found recruitment documents were now in place before staff commenced work, which meant the registered provider/manager could be assured staff were safe to work with vulnerable people and what qualifications they had in place to ensure they were safe to do their job.

People were protected from the risk of infection because staff had equipment available to them to control the spread of infection.

Although care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare, the absence of a care plan and risk assessment in people's homes and in some cases the absence of a care plan and risk assessment about aspects of people's care, for example, medication, meant there was a risk to people that accurate and appropriate information about them was not in place.

Safe systems were not in place to protect people against the risks associated with the management of medicines because appropriate arrangements were not in place for the recording, handling, safekeeping and safe administration of medicines for the purpose of the regulated activity.

Some improvements had been made in some records that were required for the management of the regulated activity, for example, the training that staff received and a record of staff's supervision. However, people's personal records did not provide a full and detailed account of the care to be provided, which presented risks in the provision of their care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines and records.

Is the service effective?

People and their families described how they were involved in the assessment and care planning of their health and care needs, so that they received care that met their needs and supported their rights. People who used the service and/or their representatives said, 'there's a care plan and book about tasks they've to do. They're a really cracking firm, they're lovely. It's an excellent service,' 'I was part of the assessment process and the support offered is what's been agreed for years. LH Social Care provide valuable support. They provide my relative with choice. We were introduced to staff and the staff are kind and caring. My relative's communication is limited, but we would know if they were unhappy because of their behaviour. My relative likes routine and that's what LH provide,' 'the staff have a care plan. It's a book they write in, with the care provided. There have been hiccups, but overall it's ok. The staff seem to care. My relative will tell them if they're not happy and they don't complain', 'they were very good with the assessment process and plan of care, which fitted in with our needs. It was spot on for what we wanted. We put the care plan together' and 'my experience with LH has been very good. We always have the same group of staff who are supportive and concerned. I was involved in the assessment and LH got a copy of the care plan from social services. I don't know of a care plan from them'.

Is the service caring?

Comments received by people who used the service and/or their representatives told us that people were respected by staff who delivered care and support. People told us they were able to discuss personal matters with staff without feeling worried.

People who used the service and/or their representatives told us staff helped people with their daily activities such as personal care and social activities as required.

Is the service responsive?

People were supported in promoting their independence. People who used the service and/or their representatives told us that people were helped by staff to maintain their independence.

Care was planned and delivered in a way that was intended to enable people who used the service to live as fulfilled a life as possible.

Is the service well-led?

People who used the service, their representatives and staff were asked for their views about their care and they were acted on. When we spoke with people who used the service, their advocates and staff they all told us that in the main the service listened to their concerns and acted on them. No-one had any concerns about the management of the service or the service provided. One comment received included, 'very impressed with LH and how they 'started off'. The boss visits regularly and leaves me confident of the service with no qualms. I could tell how she spoke it would be good'.

Staff we spoke with also told us they felt supported by the management of the service and that the service was well led. Their comments included, 'LH social is a fantastic company to work for. The manager is very approachable, amenable and helpful. I have no concerns or worries; they are easy to talk to', 'it's a good company. There's always somebody on the end of the phone. I feel well supported. Everyone gets one to one person centred care and people's independence is promoted', 'the best thing about this company is that they are friendly and approachable' and 'staff aren't just a number at LH Social'.

If you want to see the evidence supporting our summary please read the full report.

Recruitment documents were not always in place before staff commenced work, which meant the provider/manager could not be assured staff were properly qualified and able to do their job.

There was enough staff to meet people's needs. Staff confirmed they had set rotas that were agreed with them. People using the service confirmed they had consistency with their team of staff and any changes were discussed with them and they agreed to the staff member then providing care. Everyone using the service had confidence in their team of care staff and felt that they had appropriate skills and experience to care for them.

Records did not support that staff had received all the relevant training appropriate to the work they were to perform and that supervision was taking place.

People's records did not always contain appropriate information and documents in relation to the care provided.

'Always know who is coming, can rely on that.'

'More than happy with the service, they are brilliant.'

'Same consistent group of staff; makes all the difference, we get to know them well and most importantly they know us.'

We saw records that showed people who used the service and their representatives were involved in developing their own plans of care. People we spoke with said they understood their care and support plans and that staff had explained things well to them.

People who used the service and their representatives said staff were knowledgeable regarding their support needs. They said they were treated well. Their comments included:

'They know what they are on with.'

'They seem very well trained, can't fault them.'

Representatives of people who used the service and people who used the service had no concerns over the safety of themselves or their relatives. They said they felt they were 'In good hands'.

We spoke with five staff and the manager of the service. They all said people received good care and their needs were appropriately met. They told us people's rights and choices were respected and good systems were in place to make sure people's privacy, dignity, and independence were promoted.