Lincolnshire Quality Care

Not everyone who used the service received personal care. Care Quality Commission 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 received care and support at a time and duration that met their needs. There were enough staff with appropriate skills to safely support each person. One person told us, "I do get different [Care] staff but they all know me. I know I can trust them to arrive, every day."

Care and support was tailored to people's need as most staff knew people well. There were some shortfalls within care records to identify people's assessed needs. We made a recommendation about updating people's risk assessments to reflect people's care plans on the new electronic care planning system.

Medicine systems were in place, however there was no 'as and when required' (PRN) medicine guidance to support staff with administration. We made a recommendation to implement PRN protocols to support staff with decision making when 'as and when required' medicines were needed.

Staff members had been recruited safely and the provider had robust recruitment processes and policies.

Staff received safeguarding training and had a good understanding of the principals involved in acting when abuse was suspected.

People's needs were met through assessments and support planning. The service worked with relatives, health and social care professionals to achieve positive outcomes for people. Staff and management had good knowledge and skills; this ensured people's needs were met.

Processes to assess and check the quality and safety of the service were completed. The registered manager and operations manager carried out audits and quality monitoring reports. These identified areas of the service that required improvement and these actions were carried out.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Model of care and setting maximises people's choice, control and independence

Right care:

Care is person-centred and promotes people's dignity, privacy and human rights

Right culture:

The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 19 June 2018).

Why we inspected

This was a planned focused inspection. This report only covers our findings in relation to the review of the key questions Safe and Well-led only.

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. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lincolnshire Quality Care on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

This announced inspection took place on 4 and 5 April 2018.

Lincolnshire Quality Care is a domiciliary care agency that supports people to live in their own homes. The agency also provides care and support services as the preferred provider for an extra-care housing scheme, Strand Court in Grimsby. This includes providing an emergency response to all the people living in the complex. The office is situated in a central area of the town.

The service supports younger adults and older people as well as people who may be living with dementia, a learning disability or autistic spectrum disorder, a physical disability, sensory impairment or mental health needs. At the time of the inspection 200 people were receiving personal care from the Lincolnshire Quality Care.

The service had a registered manager in post at the time of our inspection. 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. The registered manager was also the director of the organisation and the nominated individual.

At our last inspection of this service in March 2017, we gave the service a rating of ‘Requires Improvement' as the provider needed to make some improvements to aspects of staff development, support and quality monitoring. At this inspection, we found sustained improvements had been made and the rating has improved from 'Requires Improvement' to 'Good.'

Overall the service had a safe recruitment system in place, although we found two instances where staff had not always followed the provider’s policies of obtaining two written references for new staff prior to employment. This was addressed during the inspection. There were enough staff to safely provide care and support to people.

People were supported safely and protected from harm. There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to individual people. Incidents and accidents were monitored and action was taken to mitigate risks to people. Positive outcomes included a reduction in falls and hospital admissions.

People received their prescribed medicines. Audits were being used to identify and address shortfalls and errors in recording on medicine administration records.

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.

Staff had completed a range of training to ensure they had the skills and abilities to effectively meet people’s assessed needs. Improvements had been made with staff development to provide staff with more regular supervision and an annual appraisal.

People’s privacy was respected and they were treated with dignity, kindness and compassion. People told us they were supported by caring staff. They received care from small dedicated teams who knew their needs and understood their preferences.

Staff supported people with their nutritional needs. Staff signposted and supported people to participate in social activities within the community and at home.

People’s needs had been assessed and where possible they or their relatives had been involved in formulating their support plans. Staff knew people well and provided person-centred care. Staff worked closely with other social and healthcare professionals to ensure people received a service that met all their needs.

People told us they knew how to raise any concerns and said they felt comfortable doing so. When concerns had been raised we saw the correct procedure had been used to record, investigate and resolve them.

The governance systems had been further developed and strengthened to ensure effective improvements across the service. Questionnaires were completed by people who used the service, their relatives, staff and healthcare professionals and shortfalls followed up. Staff meetings were held regularly which provided staff with a forum to raise concerns and discuss changes to people’s needs. Staff felt well supported and people spoke positively about the service and how staff delivered care.

The service was previously inspected on 10, 16 and 19 May 2016 when it was found to be non-compliant with regulations pertaining to delivering safe care and treatment and operating good governance systems. The service was rated as requires improvement. Following the inspection the registered provider supplied the Care Quality Commission with an action plan stating how they would achieve compliance with the aforementioned regulations.

During this inspection we saw that the registered provider had implemented the necessary improvements and had achieved compliance with the regulations. People received their medicines safely and as prescribed. Governance systems had been enhanced to ensure areas of poor practice were identified in a timely way enabling improvements to be made as required.

The service had a registered manager in post. 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.

Staff had not received effective levels of supervision, appraisal and professional development. People who used the service were encouraged to eat a healthy, balanced diet of their choosing. A number of healthcare professionals were actively involved in people’s care and treatment. Staff supported people to attend healthcare appointments when required. Staff had completed a range of training to ensure they had the skills and abilities to effectively meet people’s assessed needs.

People told us they were supported by caring staff. People received care from small dedicated teams who knew their needs and understood their preferences. Staff treated people with respect and helped them to maintain their dignity and independence. Systems were in place to ensure information was stored confidentially.

People or their appointed representative were involved with the planning and delivery of their care. Care plans and risk assessments were updated as when people’s needs changed or developed. A complaints policy was in place which was provided to people who used the service. We saw evidence that complaints were investigated and responded to appropriately and action was taken to improve the service when possible.

A quality assurance system was in place that consisted of audits, checks and feedback. When shortfalls were identified action was taken to improve the level of service. Questionnaires were completed by people who used the service, their relatives, staff and healthcare professionals. Staff meetings were held regularly which provided staff with a forum to raise concerns and discuss changes to people’s needs. The service was led by a registered manager who fulfilled their responsibilities to report notifiable events to the Care Quality Commission.

The service had a registered manager in post. 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 was the first inspection of the service since they had moved the office location. It is an established agency in the area.

Robust systems were not in place to review the quality of service provision and effectively highlight areas to improve such as the care records and medicines. Action plans had not been produced to address shortfalls. Information from incidents and complaints was not reviewed to identify any trends or themes.

Some care plans did not provide clear guidance to staff in how to support people’s specific needs and people did not have accurate and up to date risk assessments in place for concerns such as accessing the community safely, pressure damage prevention and malnutrition. This meant staff may not have guidance in how to meet people’s needs, staff may not support people in the way they preferred and there was a risk important care could be missed.

Safe systems were not in place for the storage, administration and recording of some people’s medicines.

These issues meant the registered provider was not meeting the requirements of the law regarding monitoring the quality of the service and managing risk, providing accurate and up to date care records and the management of medicines. You can see what action we told the registered provider to take at the back of the full version of the report.

The service has expanded considerably in recent months and the transfer of high numbers of new clients and staff from other local care agencies in November 2015 posed a number of challenges which the management and staff have worked hard to meet. Ensuring sufficient staff were employed and deployed has meant a continued focus on recruitment and staff development. The service had effective recruitment policies and procedures in place which we saw during our inspection. Staff were provided with a range of training to ensure they could meet people’s needs. The majority of people we spoke with told us they received their care from a small group of regular staff and the calls were on time.

People were involved in decisions about their care and were provided with a choice about how they were supported, as well as day to day decisions. They spoke highly of the staff that supported them and told us they believed the staff to be competent, caring and approachable. Staff respected and maintained people's privacy and dignity.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and consent was sought for care support, although formal systems to assess people’s capacity needed to be put in place.

Staff supported people as required with their nutritional and health needs. They encouraged and respected people's independence. Staff were available to liaise with healthcare professionals on people's behalf if they needed support accessing their GP or other professionals involved in their care.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Members of staff spoken with said they would not hesitate to report any concerns they had about care practices.

Staff were well-supported by their seniors and there was good teamwork. Staff felt able to express their views and opinions, and have open conversations amongst the team. They felt able to approach the management team if they had any concerns and felt supported to manage them.