Lincoln Healthcare Group Limited

Lincoln Healthcare Group Limited is a domiciliary care agency providing personal care and support to people living in their own homes. The service provides support to people living with a range of conditions including dementia, learning disabilities and autism. At the time of our inspection there were 42 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support

Staff focused on people's strengths, staff supported people to take part in activities and pursue their interests in the local area. People were supported to maintain a safe and clean environment that met their sensory and physical needs. Staff supported people to make decisions following best practice in decision-making.

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

Right care

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. The service had enough appropriately skilled staff to meet people's needs and keep them safe.

People were happy and content. They received person-centred care where they were at the heart and focus of the support provided to achieve positive outcomes.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture

People were empowered because of the ethos, values, attitudes and behaviours of the management team and staff. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff placed people's wishes, needs and rights at the heart of everything they did.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 1 December 2017) and we made recommendations around medication procedures and records. At this inspection we found improvements had been made.

Why we inspected

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

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 Lincoln Healthcare Group Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection took place on 17, 19 and 23 October 2017 and was announced as we intended to visit people in their own homes and wanted to ensure management were present in the main office. We last inspected this service in July 2015, at which time we found them to be meeting all the regulations and rated the service as good overall.

The service had a registered manager who had been registered with the Care Quality Commission (CQC) since 2012. During the inspection we were informed that the current registered manager had changed roles within the organisation and intended to deregister. There was a new manager who was in the process of applying to the Commission to become registered. 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 staff managed their medicines safely although procedures needed to be updated, including records kept. We have made a recommendation about this.

People told us they felt safe living at their homes with support from staff. Staff understood their responsibilities to report any safeguarding concerns to the manager. People and staff told us they felt there were enough staff employed at the service and we confirmed this through records.

Risks had been identified and measures put in place to minimise the risks to people and staff. Accidents and incidents were recorded and monitored.

People told us they were supported by staff to maintain their nutritional needs. Staff were trained and received support from the management team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People and their relatives knew how to complain if they felt this was necessary.

People were respected and their dignity was maintained. Staff displayed kind and caring attitudes and treated people as individuals. People’s care needs were detailed, recorded and reviewed by staff with input from people, relatives and other relevant individuals. The provider was in the process of reviewing its care recording procedures.

Staff told us they worked well as a team. They felt supported by the manager and the provider who staff said were approachable and made them feel valued.

Audits and checks of the service were in place to monitor the quality and safety of the service and the manager was in the process of reviewing their medicines audits and checks. Surveys were used to gather feedback from people about the service they received.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

We found that significant improvements had taken place in the recording of people's prescribed medicines, and in the policies and procedures for administering such medicines. This meant that people's medicines were now being safely administered.

Is the service effective?

We found that care workers were being given better guidance in their duties regarding recording and administering people's prescribed medicines. Care workers told us the new systems were straightforward and clear, and that this allowed them to meet people's needs effectively.

Is the service caring?

Care workers we spoke with were caring and compassionate when they talked about the people they supported. We found no evidence suggesting the service is anything other than caring towards the people it supports.

Is the service responsive?

We found the service had responded promptly and professionally to deficits identified at our last inspection. Improvements had been made within the timescale set down for action. Care workers we spoke with told us the office was responsive to any concerns or other issues they raised about people's medicines and their care, generally. They told us the service incorporated their views, as well as the views of the person receiving care, in improving the way care was delivered.

Is the service well-led?

Staff spoke highly of the manager, and said she always took their views into consideration. Care workers told us they were now clear about their roles and responsibilities regarding assisting people with their prescribed medicines, and had been given improved guidance. They told us they knew they could always ring the office if they needed advice about any issues regarding people's care. We found the manager was pro-active in seeking out new and improved guidance and documentation to support care workers in delivering good quality care.

People and/or their representatives were involved in assessing their care needs, and in describing how they wished their care to be given. People were asked to give their written consent to their package of care, and care workers checked they still had the person's consent before every personal care intervention.

The systems in place for ensuring people were supported to take their prescribed medicines safely were not operating properly, and potentially put people at risk.

Care was taken to match care workers to individual service users, and new staff 'shadowed' more experienced staff until they were fully competent to meet all the person's needs. Staff training was thorough and comprehensive. Staff were given good levels of support in terms of one-to-one and group supervisions and an annual appraisal, and spoke highly of the management of the service.

Good systems were in place for listening to, and responding to, the views of people using the service, their representatives, and staff.