Archived: Libra Domiciliary Care Ltd

People’s experience of using this service and what we found

The provider did not submit a Provider Information Return (PIR) to us within the timescale we gave. Providers are required to send us key information about the service, what they do well, and improvements they plan to make.

People were supported by staff that were caring, compassionate and treated people with dignity and respect. Any concerns or worries were listened and responded to and used as opportunities to improve.

People received person centred care and support based on their individual needs and preferences. Staff were aware of people's life histories and individual preferences. They used this information to develop positive, meaningful relationships with people.

People and their relatives told us they felt cared for by staff who treated them with respect and dignity and encouraged them to maintain relationships and keep their independence for as long as possible.

The provider ensured people had consistency with staff members, as a result people and staff were able to build positive relationships. People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role.

Staff liaised with other health care professionals to ensure people's safety and to meet their health needs.

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.

Staff spoke positively about working for the provider. They felt well supported and they could talk to management at any time, feeling confident any concerns would be acted on promptly. Staff felt valued and happy in their role.

Audits were completed by staff and the registered manager to check the quality and safety of the service.

The registered manager and care coordinator worked well to lead the staff team in their roles and ensure people received a good service.

More information is in Detailed Findings below

Rating at last inspection

The service was given an overall rating of requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

Libra Domiciliary Care Ltd provide care to people in their own homes. Fourteen people were in receipt of personal care at the time of our inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community.

When we last inspected the service on 1 and 8 August 2017 we found improvements were required in all key questions. There were five breaches in the regulations and the provider was rated as 'Inadequate' and was placed in Special Measures. We added a condition to the provider's registration so that they were not able to take on new care packages until improvements were made. 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 Safe, Effective, Caring, Responsive and Well Led. At the time of our last inspection there were 20 people using the service.

During this inspection, we found sufficient action had been taken to address the previous breaches in the regulations and to improve so that the service was no longer rated inadequate. However, there continued to be areas needing improvement and the provider needed to ensure improvements were sustained once more people were using the service.

A registered manager was 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.

People received safe care and were supported by staff who knew how to protect them from harm. Staff had received training and understood who to report any concerns they had to . Risks assessments were completed for staff to refer to that had been reviewed and updated where appropriate. The registered manager monitored calls to ensure staff attended calls and that they had sufficient staff to meet people’s needs. People’s medicines and how staff supported them were reviewed by the registered manager to ensure people received the correct support. Staff recruitment included background checks so that the registered manager understood if staff were suitable to work at the service. Improvements needed to people’s care were shared with staff for staff to implement them.

People were supported by staff that had access to supervision and training and understood how to support people in line with human rights. People were supported to maintain a healthy diet through the choices of meals and drinks staff offered them. Communication between staff enabled staff to support one another and share important information about people’s care. Text messages and messages in care plans ensured this happened. People were supported to access additional advice from healthcare professionals were this was relevant to them. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People knew and liked the staff supporting them. Staff supported people to make decisions about their day to day care needs so that they were involved in their care. People were treated with dignity and respect. Staff understood what it meant to individual people in terms of maintain their dignity.

People were involved in discussions about their care so that their care was tailored to their own specific needs and preferences. Where changes were needed the registered manager worked with people to implement change. People understood how to complain and felt confident their concerns would be acted upon. The registered manager had a system in place for recording communication with people and the action taken to prevent a complaint from developing.

People were assured that if they called the administration office they could speak with the registered manager and make changes to their care. The registered manager had developed systems for communication and governance to improve people’s care, but we could not yet test how the systems worked when the service operated normally and without restrictions in place. People and staff reported improvements to the service in how people’s care was reviewed and monitored. The registered manager explained that since the last inspection they had invested time in developing links with other stakeholders to improve their knowledge and improve people’s care. They had developed a partnership with a new training provider as well as HR Consultants so that that staff had the right training and that all HR processes were undertaken correctly. They had learnt from the last inspection and understood that some of their internal processes were not robust. They also signed up for a number of courses with the local authority aimed at Social Care providers to keep their knowledge up to date. We saw evidence for how the registered manager had improved their knowledge.

Further information is in the detailed findings below.

The service provides personal care to people living either in their own home or the home of a family member. At the time of the inspection, approximately 20 people used the service and a registered manager was 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. The registered manager was also the registered provider for this service.

People did not receive care in a safe way. People and their families experienced missed care calls and calls that were shorter than they expected. Systems in place did not effectively monitor and identify when people had a missed calls so that action could be taken promptly to prevent the incident happening again.

The registered manager also did not have systems in place to monitor how staff supported people with their medicines to ensure they received them in a safe way. People’s Medical Administration Records were not completed fully and no time was listed to indicate when the person received their medicines, despite this being highlighted at the previous inspection.

The registered manager did not assure herself of staff competency in supporting people with their medicines. Staff had received training at their induction but the registered manager told us this had not been reviewed since.

Staff did understand how to support people from abuse and who they needed to report their concerns to. Staff had received training and could explain their understanding of abuse. People were supported by staff that had had checks of their background to assure the registered provider of their suitability to work at the service.

People could not be assured that checks were in place to refer the person to a medical professional if needed. Guidance was not available to staff to direct them on what to do if they were concerned a person was not taking their medicines. Staff understood the importance of obtaining a person’s consent and explaining their care. People received choices in the food and drinks prepared for them.

People liked and valued the care staff but care staff did not always have time to spend with them because they needed to attend the next call. Staff knew about people’s care needs and could explain how people preferred to receive their care.

People did not have confidence their complaints would be listened or responded to. People had tried contacting the administration office did not always receive an explanation to their complaint by telephone or letter.

People were not always involved in reviewing their care to ensure the care met their needs and preferences. Risk assessments did not always show how people were involved in discussing their care needs as well as risks identified.

People’s care was not routinely reviewed and monitored. Systems were not in place to identify how people’s care had been checked to ensure that it had been provided in accordance with their needs. The registered manager could not confidently confirm how many people received care. The registered manager did not have a system for checking that people received care calls and that they received a call for the duration they expected. The registered manager did not also have a system for ensuring people received the help they needed with their medicines at the time they expected. People’s care was not updated regularly and we could not be assured that people received the care they needed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Libra Domiciliary Care Limited provides personal care and support people living in their own homes. At the time of our inspection there were 17 people using the service.

There was 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.

This was the first inspection of this location since it was registered in March 2016.

People received a good quality service in which they had confidence. There were processes in place to monitor the quality of the service. People were asked to comment on the quality of service. However, improvements were needed in recording procedures to ensure the consistency of management of the service.

People received a safe service because the provider had procedures in place to ensure that staff were trained and followed the procedures to ensure the risk of harm to people was reduced. The risk of harm to people receiving a service was assessed and managed appropriately; this ensured that people received care and support in a safe way. Where people received support from staff with taking prescribed medicines, this was done in a way that ensured the risk to people was minimised.

People received care and support from staff that were trained to be effective in their role. People’s rights were protected and they had choices in their daily lives. People were supported to maintain their diet and health needs where required. Staff were caring and people’s privacy, dignity independence and individuality was respected and promoted by staff and the management.

People received care from staff that were suitably recruited, supported and in sufficient numbers to ensure people’s needs were met. This was because the provider had undertaken the relevant checks to ensure the staff they employed were suitable to work with people. The provider had systems in place to ensure people did not experience missed visits and people were confident that the reliability of the service had improved.

People were able to raise their concerns or complaints and their complaints were acted upon, so people could be confident they would be listened to and their concerns resolved.