Background to this inspection
Updated
13 March 2021
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 had a manager registered with the Care Quality Commission. This means that they and the provider are 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 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 23 September 2020 and ended on 25 September 2020. We visited the office location on 23 September 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This included actions plans the provider had sent us and statutory notifications received by the commission. A statutory notification is information about important events which the provider is required to send us by law.
We contacted health and social care commissioners who have a responsibility to monitor the care of people at Lighthouse Care agency. We used all of this information to plan our inspection.
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
During the inspection
We spoke with 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 three people's care plans, risk assessments and records of care provided, multiple medication records and feedback from people and their relatives about the quality of the service they received. We also looked at other information related to the running of and the quality of the service. This included quality assurance audits, training, four staff recruitment files and information relating to business insurance.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at insurance policies and multiple staff identification documents. We spoke with one professional who had visited people using the service.
Updated
13 March 2021
About the service
Lighthouse Care Agency is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection three people were receiving support with personal care.
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.
People’s experience of using this service and what we found
The provider and registered manager of the service had not made sufficient improvements to the safety and governance of the service since the last inspection.
There was a continued lack of understanding, competency, oversight and governance systems to ensure people received a safe service. Systems that were in place were not implemented effectively and audits did not identify ongoing concerns with the service.
Records relating to people's risks and care needs were incomplete and contained misleading information. As a result, staff did not receive all the information and guidance they required to provide care that met people's needs.
Medicine administration records were not completed appropriately. Staff did record the administration of peoples’ medicines.
Safe recruitment practices were not always followed. Records relating to staff recruitment were disorganised and staff files did not contain up to date information.
People provided positive feedback about the individual staff who provided their care. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted.
We have identified breaches in relation to people’s risk assessments and care plans, medicines, staff recruitment, and the governance of the service at this inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection (and update)
The last rating for this service was inadequate (published 8 February 2020) and the provider was in breach of four regulations. Conditions were placed on the providers registration. Previously, the provider had been rated requires improvement on three consecutive occasions. The provider continued to complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
We previously carried out a comprehensive inspection of this service on 21 and 23 October 2019. Breaches of legal requirements were found.
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. The overall rating for the service remains inadequate
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 monitor the service.
We have identified breaches in relation to people’s risk assessments and care plans, medicines, staff recruitment, and the governance of the service at this inspection.
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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service remains 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.