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Inspection carried out on 22 May 2019

During a routine inspection

About the service:

LCMB Therahealth Homecare is a domiciliary care service. It is registered to provide personal care to people living in their own homes in the community, including older people and people living with dementia. The service operates in Bourne and surrounding villages. At the time of our inspection,16 people were receiving a personal care service.

People’s experience of using this service:

People were at the heart of the service. The registered manager and a close relative who was one of the directors of the registered provider ('the director') worked daily as members of the care team. Their exceptionally caring, client-focused leadership style set the cultural tone and was admired and appreciated by everyone connected to the service.

Under the leadership of the registered manager and the director, staff cared for people with exceptional kindness and compassion in ways which often went far beyond the provider’s formal contractual agreement. People were treated with dignity and respect and were encouraged to retain their independence. End of life care was provided with sensitivity and compassion.

Staff understood people’s individual needs and preferences and used this knowledge to provide them with flexible, responsive support which enhanced the quality of their lives. People were involved in the development of their individual care plan and met with senior staff on a regular basis to agree any changes.

The registered provider (the 'provider') had a meticulous approach to the deployment of staffing resources. This meant people experienced a high level of staffing continuity which had a positive impact on their safety and well-being. The provider went to considerable lengths to promote the welfare and happiness of the staff team. Staff had the knowledge and skills to meet people’s needs and were encouraged to study for advanced qualifications.

Without exception, people told us they were completely satisfied with the service they received and could think of no ways in which it could be improved. Systems were in place to monitor service delivery and to identify organisational learning from significant events. Any concerns were dealt with effectively and formal complaints were rare. The provider was committed to the continuous improvement of the service in the future.

The provider assessed any potential risks to people's safety and put preventive measures in place to address them. The provider had failed to notify us of a recent incident involving a person using the service. The registered manager apologised for this oversight and assured us this would not happen again.

People who needed staff assistance to take their medicines were supported safely and staff assisted people to eat and drink whenever this was required.

Staff knew how to recognise and report any concerns to keep people safe from harm and were aware of people’s rights under the Mental Capacity Act 2005. 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.

There was a registered manager ('the manager') at the service and the rating from our last inspection was displayed in the office.

Rating at last inspection:

Good (Published October 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we were pleased to find the quality of the service people received had been sustained in some areas and improved in others. As a result, the rating of the service remains Good overall, but with a rating of Outstanding in Caring.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 29 September 2016

During a routine inspection

LCMB Therahealth Homecare provides personal care to people living in their own homes in the Bourne area of South Lincolnshire. The service was first registered with the Care Quality Commission (CQC) in July 2015 and started operating in September 2015.

We inspected the service on 29 September 2016. The inspection was announced. At the time of our inspection 13 people were receiving a personal care service.

The service did not have a registered manager. A new manager had been appointed in May 2016. She had applied to CQC to become the registered manager and, at the time of our inspection, was awaiting the outcome of her application. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers (‘the provider’), 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.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff demonstrated their understanding of how to support people who lacked the capacity to make some decisions for themselves. Staff also knew how to recognise and report any concerns to keep people safe from harm.

People told us that they were highly satisfied with every aspect of the service they received. In particular, the provider’s careful approach to managing staffing resources which meant they were supported by the same staff on a consistent basis. Staff had established warm, friendly relationships with people and went out of their way to help them in any way they could. Staff worked together in a supportive way. They enjoyed working for the provider and felt listened to by the manager and other senior personnel.

People were involved in agreeing the type and amount of care they received and their needs and wishes were understood and followed by staff. Staff treated people with dignity and respect and encouraged them to maintain their independence. Staff had the knowledge and skills required to meet people’s individual needs effectively and supported them to prepare food and drink of their choice.

We identified a number of areas in which improvement was needed to ensure people received safe, effective care. These related to record-keeping and other administrative processes rather than the delivery of hands-on care. Improvement was required in the recording of medicines administration, the completion of people’s individual risk assessments and in some aspects of staff recruitment procedures.

The manager of the service displayed an open and responsive management style and had already identified the areas for improvement we picked up in our inspection. She had the support of the provider to tackle these in a systematic way and make the changes that were required.