Light Care Services Limited Hampshire

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

This is the first assessment for this service. This key question has not been fully assessed, therefore an overall rating for this key question can not be given.

We reviewed 3 quality statements for this key question. People and relatives were complementary about the kind and caring nature of the care staff. However, we had mixed views in relation to promoting independence, choice and control. Systems and processes were not in place to ensure people received care and support that met their needs and wishes.

The leadership team were unable to provide evidence that robust processes were followed to respond to people’s immediate needs and there was a lack of processes in place to demonstrate how the service treated people as individuals.

This service scored 20 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Kindness, compassion and dignity during this assessment. There is no previous rating for the Caring key question so we cannot yet publish a score for this area.

We did not look at Treating people as individuals during this assessment. There is no previous rating for the Caring key question so we cannot yet publish a score for this area.

People and relatives were complementary about the kind and caring nature of the staff with their comments including, “[Persons] carers are very kind”, “They [carers] are respectful” and “I am happy enough with what they do as they are kind to me.” However, we had mixed views in relation to promoting independence, choice and control. Positive comments included, “We have a good routine as they [staff] now understand what I like and how I like things done”, “We have got to know them [staff] well as continuity of care is very good” and “The carers are brilliant and are helping keep Dad independent.” Where other people and relatives told us, “They [staff] are supposed to be keeping [person] mobile as well as assisting them with personal care…they are not encouraging them to try to do things to keep their independence” and “They will mash up all my food and I have told them not to.”

Some records reviewed demonstrated staff supported people to do things they chose to do. This included going out to the local shops or visiting friends and family.

The leadership team told us they ensured people’s needs, preferences and choices were assessed to effectively provide care and support to people, however, they were unable to provide robust evidence this was done for all people. Care records reviewed lacked up to date detail about people’s strengths, abilities, aspirations, culture and backgrounds and protected characteristics which are an important part of care provided.

Independence was promoted in some parts of care plans, however the lack of information in care plans and lack of reviews meant it was difficult to assess how up to date or accurate the information was. For example, in one person’s plan it was documented, “Likes a strip wash daily, shower on Thursdays.” However, records of care delivered did not reflect this preference. We discussed this with the leadership team and were told the person no longer had showers, but the care plan had not been updated to reflect this. Other people’s care plans contained statements such as, “Washes face independently and carer to help dry and apply some face cream” and “Can brush teeth [themselves] but needs staff to pass the toothbrush and toothpaste.” We were unable to establish if this information remained accurate.

A member of the leadership team told us care plan reviews were completed every 6 months or more often if a complaint was received, however records did not reflect these reviews resulted in up to date, individualised plans.

Processes failed to demonstrate how the service treated people as individuals. Care plans lacked detail on how people prefer to be supported and limited person-centred details were recorded in care plans. The leadership team had failed to identify the shortfalls we found as part of our assessment.

Care plan reviews were scheduled as a visit on the electronic system and documented in daily notes section. However, care plans did not consistently provide an up-to-date assessment of people’s needs, for example there were gaps in some plans and no skin integrity plans, seizure plans, or diabetes plans had been implemented as required.

Most people and relatives told us staff responded to changes. One relative stated, “They [staff] are very diligent as they made me aware of a rash … that looked very sore, and they arranged for the district nurse to visit and now apply special cream.” However, another relative told us, “In the first 2 weeks of care [person] had 30 different carers, this greatly impacts on [persons] stress levels causing greater anxiety and making his condition worse.”

From the information we reviewed we could not be assured people were always referred in a timely way to health care professionals as needed or that action was taken to mitigate risk of harm or improve health and wellbeing when required. Staff had not always escalated concerns appropriately. Records showed staff did not always escalate concerns to partners in a timely manner. For example, staff had recorded one person’s blood sugar was raised but did not escalate this for 3 days. Additionally, when staff identified bleeding sores on a person skin, no records were available which demonstrated this concern had been escalated to the leadership team or if external advice was sought in relation to pressure relieving equipment. Additionally, one person who had a catheter in place was recorded to have no urine output since the previous staff visit had taken place, yet there was no information available that this concern was escalated to medical professionals.

The leadership team told us they put people's needs, views and wishes first and responded to changes quickly. However, during verbal discussion they were unable to explain what and how they achieved this.

The leadership team were unable to provide evidence that robust processes were followed to respond to people’s immediate needs.

We could only gather minimal direct feedback from care staff in relation to workforce wellbeing and enablement as the leadership team was unable to provide us with up-to-date staff lists of staff employed and correct contact details. This is further highlighted in the Safe section of this report. It was evident through discussion with the leadership team that they were unclear about the number of staff they employed including those from overseas. Leaders could not provider a credible explanation of how staff wellbeing was considered.

During the assessment we received an anonymous call from a staff member who declined to give their name saying they were scared. This staff member told us they hadn’t been paid and that this was a common occurrence. This staff member told us, the staff have been told they were not allowed to look for other jobs. This staff member told us they often work from 07.00-23.00hrs and never get given set hours per week. This staff member said leaders at the service told staff someone from CQC will be calling them and felt this may impact whether they would be willing to speak with us due to fear.

The management team told us supervision was provided to staff 3 monthly but was unable to provide evidence these had occurred as described. We could not be assured all staff had received support or training to equip them in their role and to ensure they could provide safe care to people.

The provider did not have processes in place to support staff. The service had various policies to support staff for example an appraisal policy and a supervision policy. However, policies were not followed, for example there was little or no evidence of staff supervisions, appraisals or staff meetings during our assessment.

While reviewing records during our assessment we identified a complaint a relative had made about a staff member being tired. The complaints log identified action taken by the leadership team was, “Staff were told not to tell people they were tired”. However, there was nothing to show if the service had assessed the staff’s working hours and workload to prevent them feeling tired or if any additional support may be required.

During our assessment we found records of incidents of physical or verbal abuse towards staff. There was no evidence that these incidents had been investigated by the leadership team or action taken to protect the staff from harm and abuse, or that staff had the opportunity to be debriefed following incidents or that reflective practice was encouraged.