Love In Care

Love in Care is a domiciliary care service providing care and support to people in their own homes. The service was providing personal care to 11 people at the time of the inspection.

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

All the family members we spoke with felt their relatives were safe when receiving care and support. Risks to people’s health and welfare were assessed but some improvements were needed to ensure a robust approach. People received their medicines safely.

Staff were recruited safely and followed an induction and training programme. Family members felt staff were well trained to provide the support their relative needed.

All of the family members were spoke with were complimentary of the care and support their relative received. People said they had “complete trust” in staff. Family members commented very positively about the respect staff showed their relatives and how they maintained their dignity.

Family members said they were “completely” involved in the development and review of their relative’s care plans to make sure care and support was delivered as they needed and as they preferred.

Care plans were person-centred and included information about what staff needed to do to make sure people’s diverse and cultural needs were met.

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.

Staff were responsive to people’s health needs and liaised with healthcare professionals as needed.

Family members appreciated the flexible support their relatives received to enable them to enjoy social events and maintain relationships.

There were systems in place to monitor quality and equip the provider with a robust overview of performance.

Family members and staff gave very positive feedback about the registered manager. Family members said the registered manager welcomed their views and was always responsive.

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 requires improvement (Published 7 December 2018) and there was a breach of regulation 17. At this inspection sufficient improvement had been made, and the provider was no longer in breach of regulation 17.

Why we inspected

This was a planned inspection based on the previous rating.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. Not everyone using the service received a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Service provision was in the Leeds and Durham area at the time of the inspection. There were eight people using the service.

At the last inspection in August 2017 we rated the service as Requires Improvement. At that inspection we found the provider was in breach of Regulation 12, Safe care and treatment, Regulation 17, Good governance and Regulation 18, Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the provider did not have systems for the proper and safe management of medicines and they were not doing all that was reasonably practicable to militate against risk. We saw systems in place to manage, monitor and improve the quality of the service provided were not effective. We also found suitably competent staff were not consistently provided to meet people’s care and support needs and staff were not always provided with appropriate support and training to enable them to carry out the duties they were employed to perform.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in all the domains to at least Good. During this inspection, we saw some improvements had been made. However, continued work was required to ensure the provider was meeting all regulations.

The provider had improved their arrangements for managing people's medicines but needed to make sure the records were accurate at all times. Risk management plans were in place and had improved. They described the risks people faced and the actions needed to keep people safe.

The provider had improved the support given to staff but still needed to develop this further to make sure there was a consistent approach to training and to ensure supervision was recorded. Training records did not indicate what the provider considered mandatory training for staff or the expected interval between refresher training. Staff training records showed some staff had not completed some training courses such as infection prevention and control, food hygiene and the Mental Capacity Act. Staff told us they felt well-supported and had regular contact with the provider. However, this support was not always recorded which meant we could not be sure staff received supervision in line with the provider’s policy.

We have made a recommendation about the on-going the management and recording of staff training and support.

The provider had introduced audits for monitoring quality and safety, however, these were basic and did not always drive improvement. Systems and processes around governance and records needed to improve further. Audits of medicines had not identified the issues with records that we found. No formal audits of training and staff support were in place to check staff’s training equipped them for their role. Care records audits had not identified a person who used the service did not have a completed care plan in place. No records of checks on staff’s performance were made when they completed shadowing (working alongside an experienced staff member) or when spot checks were carried out by the registered manager.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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 they felt very safe with staff and the care they were provided with. There were enough staff to support people safely and provide continuity of care for people. People were supported by staff who could communicate in their preferred language and dialect. This was very important to people and their relatives. We found some concerns with the safety of recruitment procedures and the recording of some processes. The registered manager took action to address these concerns during the inspection.

Staff showed a good awareness of safeguarding and making sure people were treated well. Staff understood their role and responsibilities for maintaining good standards of cleanliness and hygiene.

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 understood their responsibility to seek people's consent prior to care and support being provided.

People received support from health care professionals where they needed this to keep well. There were good systems in place to ensure staff and the provider worked with health professionals to promote and monitor people’s health needs. Where needed, people who used the service received support from staff to ensure their nutritional needs were met.

People told us they or their family members were treated very well. They said care was delivered in a dignified and respectful manner. Staff were described as kind, caring and patient. They understood people’s cultural needs and were respectful of this.

Staff and the provider showed very good knowledge of the people they supported and understood how to maintain people’s privacy and dignity. It was clear they had developed positive relationships with people and encouraged their independence. Care plans were comprehensive to make sure staff had all the information required to support people as they wished.

Staff felt supported by the management team. People, their relatives and staff all spoke highly about the way the service was managed. People were aware of who to speak to if they had any concerns and told us they felt confident to do so. People told us the provider constantly sought feedback from them on their satisfaction with the service. However, we found this feedback was not always recorded.

We found one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to governance. You can see the action we have told the provider to take at the end of this report.

Love In Care is registered to provide personal care to people in their own home.

There was 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 and associated Regulations about how the service is run.

We found medicines were not managed safely. Records of people’s medications were not clear and it was not therefore possible to be sure people had received their medications as prescribed. This put people’s health at risk.

Risks to people who used the service and staff were not fully assessed and risk management plans in place did not always contain the information staff needed to support people safely and manage all risks identified.

Three people told us they could not always communicate in their preferred language of English with some staff. This mean suitably competent staff were not always provided to meet people’s care and support needs and this had led to errors when providing people’s care. Records did not show staff were provided with appropriate support and training to enable them to carry out their job effectively.

There were no effective systems in place to monitor and improve the quality of the service provided. This had resulted in some areas not being monitored and managed properly. This included records of recruitment, medication and care documentation.

Most people who used the service or their relatives told us they or their family members were provided with safe care. People told us staff were caring. However, one person said they were not satisfied with the service and hadn’t always found staff to be respectful. They also said they did not receive satisfactory support with their meals.

People said they received care from familiar and consistent care workers who were punctual and spent the required amount of time with them. The service worked flexibly to ensure people received support at the times they needed it.

The manager had an understanding of the principles and their responsibilities in accordance with the Mental Capacity Act (MCA) 2005. People told us they were asked to consent to their care. Records indicated people were encouraged to be as independent as possible.

Care plans had information that helped staff get to know the person such as their life history, their preferences and what was important to them. We saw some care plans did not give full guidance to staff on how to meet people’s needs. The manager said they would be reviewing care plans to ensure there were no gaps or omissions.

There were procedures in place for responding to people’s concerns and complaints. The provider had not received any formal complaints in the last 12 months.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 with regard to safe care and treatment, staffing and governance. You can see the action we have told the provider to take at the end of this report.