Lakeshore Care Ltd

Lakeshore Care Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the present time it provides a service for 29 people. The Care Quality Commission (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:

People and their relatives told us they felt safe and were protected from the risk of abuse. The service had safeguarding procedures in place that staff received regular training about. Staff knew how to safeguard people from abuse and the processes that should be followed where concerns arose. Risk assessments and risk management strategies were in place as part of the assessment and support planning process. This meant risks to people and to staff were minimised.

Staff files showed staff recruitment was undertaken appropriately. The provider had taken steps to protect people from staff who may not be fit and safe to support them.

There were sufficient staff levels to meet people's needs.

People received their medicines safely. Staff received appropriate training on the safe administration of medicines. This together with appropriate supervision and monitoring meant people received their medicines safely and staff had clear guidance to follow.

The provider ensured that all their staff received appropriate training and support to understand and to manage infection control and the use of PPE.

Accidents, incidents and risks were appropriately recorded and reviewed with strategies put in place by the service to reduce the likelihood of events occurring in the future.

Assessments were undertaken by the local authority that funded people’s support to which the provider contributed. Clear outcomes were identified and people’s support plans were revised and updated as people’s needs changed. People were supported by staff to eat and drink according to their dietary requirements taking into consideration people’s preferences.

Staff received training in all the necessary areas of their work. Staff had regular supervision with senior staff and support through team meetings.

People told us they were treated with dignity and respect. This was echoed by people’s relatives. They told us staff had the right skills to deliver appropriate care and support. Staff were able to communicate with people well. Information was provided in various formats where required.

People and their relatives said any concerns they had were addressed appropriately and resolved by the registered manager. They told us the registered manager welcomed feedback and they said complaints were dealt with swiftly and professionally.

People told us they thought the service was well led and that they were very happy with the support they received.

There were effective systems in place to monitor the quality of the service provided to people which ensured good governance. Technology was used effectively by the provider to ensure people were informed promptly about potentially missed or late calls. The service had systems in place to notify the appropriate authorities where concerns were identified. The culture of the service was positive, open and person centred.

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

Rating at last inspection and update:

The last rating for this service was good [published 11 October 2017].

Why we inspected:

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

Follow up:

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

At the time of the inspection, there was a registered manager. 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.

This inspection took place on 21 September 2017. The last inspection was in June 2016 and at that inspection we rated the provider overall as “requires improvement”. We found that best practice guidelines for the recording of the administration of medicines was not followed. This meant it was unclear if people had received their medicines as prescribed. We also found there was a lack of continuity for people in the staff who provided their care. At that inspection people told us they felt their needs were sometimes not fully understood as a result. At this inspection we found the provider had taken action and made appropriate improvements with these areas of service provision. We reviewed the policy and practice by staff for supporting people with their medicines. We saw medicines administration records were kept and maintained on people’s care files. Care plans for people contained clear information about any support they required with their medicines and this matched what staff told us. Staff completing medicines administration records where required to confirm whether or not people had taken their medicines and these were appropriately completed. The registered manager told us that only staff who had received training and support to do with administering medicines were allowed to support people in this way. Staff confirmed this with us when we spoke with them.

People told us they felt safe and were supported by staff who knew how to keep them safe. The provider had arrangements to help ensure that risks to people's health and safety were assessed and well managed by staff.

People told us they appreciated the consistency of staff who now supported them and said they were supported by appropriate numbers of staff. Staff recruitment procedures helped to keep people safe. Staff had the knowledge and skills to care for people effectively and felt well supported by appropriate training and effective supervision. All of this helped to maintain a stable staff team.

People told us staff knew them well and were kind and caring towards them. It was evident staff had established positive relationships with people. People also said staff valued people, treated them with respect and promoted their rights, choice and independence.

People said staff who supported them had up to date information about their needs and this was delivered in the way they wanted. We found there was consistency in the provision of care for people and this enabled caring relationships to be developed.

People and their relatives told us they were involved in the planning and reviewing of their care. There was a clear plan of care available for staff who supported people according to their needs and wishes.

People were provided with support that was responsive to their changing needs. People knew about and were able to make a complaint and were confident the provider would respond appropriately to any concerns they might have.

We received positive feedback about the management of the service. The registered manager and the staff were approachable and fully engaged with providing good quality care for people who used the service. The provider had systems in place to continually monitor the quality of the service and there were arrangements for people to be asked for their opinions via surveys. Action plans were developed where required to address areas for improvements.

Lakeshore Care provides personal care to people living in their own homes. They currently provide a service to approximately 19 people who live mainly in the London Borough of Sutton and pay directly for the service themselves.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

We found the provider was not following best practice guidelines for the recording of the administration of medicines. We found shortfalls in the records which meant it was unclear if people had received their medicines as prescribed.

Furthermore we found people experienced care from a number of different care workers over a short period of time which prevented the staff from developing caring and positive relationships with people. People told us they felt their needs were sometimes not fully understood and they had to repeat the same information to a number of care workers.

Staff were able to tell us how they would keep people safe from harm. The provider had policies and procedures in place to guide them through the process and ensure appropriate action was taken. Care workers had also received training which had been refreshed regularly.

People’s health was monitored. This included making sure people had enough to eat and drink, and contacting healthcare professionals if necessary. There was a system in place for care workers to contact senior staff during out of office hours if they needed advice or support.

The service completed risk assessments which identified possible risks to people and how these could be minimised. There was a record of ‘Client Events’ which logged and recorded any significant events. The registered manager analysed the records to identify any patterns or trends, so the risk of future reoccurrences were minimised.

Care workers knew how to ensure the care they provided maintained people’s rights to privacy and dignity. This included making sure people’s confidentiality was maintained when required.

People were encouraged wherever possible to do as much as they could for themselves. This information was recorded in people’s care plans. In this way people’s independent skills were maintained. People told us care workers sought their permission before providing care, in this way care was in line with their wishes.

The provider had measures in place to ensure only suitable people were recruited into post. Once in post, training was provided in line with staffs roles and responsibilities. This training was regularly refreshed.

There were systems in place to monitor the service, and if shortcomings were identified action was taken to improve the quality of care. The registered manager was aware of their legal responsibilities to inform CQC of significant events.

People had individualised care plans which were reviewed regularly. They emphasised the person’s choice about how care was delivered. There was also information about the person’s links and contacts in the community and what they enjoyed. In this way the risks of social isolation were reduced.

People told us the office staff at Lakeshore were approachable and they felt able to raise any issues or concerns they had. People told us they were encouraged to make complaints and were confident these would be addressed.