Archived: LIVE IN CARE4U LTD

Live in Care 4 U Ltd is a care at home service that provides live-in care staff for people living in their own homes. The provider is based in Rudgwick, West Sussex and people receiving care at home services were based in other areas of the country. At the time of the inspection there were two older people using the service, one of whom was living with dementia and another who experienced difficulties with their cognition.

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

There were wide spread and significant concerns about the lack of oversight and regard for people’s care. Risks to people’s safety had not been identified, assessed or managed effectively and lessons had not always been learned. This included, falls management, hydration and nutrition, medicines management, safeguarding adults at risk and environmental risks. People were not always protected from the risk of abuse and improper treatment. Following the inspection, we made a safeguarding referral to the local authority about one person’s care.

There was insufficient oversight and systems and processes were not operated effectively to provide assurances of staff’s practice or the care people were receiving. Quality assurance processes were not used to monitor people’s day-to-day care to ensure they were receiving safe care and treatment. The registered manager had failed to continually improve the service. People and relatives had not been asked for their feedback about the service they received. Policies and procedures were not implemented in practice.

Staff had not been supported to undertake robust and thorough inductions and had not received training before providing live-in care and support to vulnerable people who lived alone. Staff’s competence had not been assessed and the registered manager had not always observed staff supporting people to assure themselves staff had appropriate skills and abilities. People’s needs had not always been identified or assessed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

One person did not always receive dignified care that respected their rights. Staff were provided with insufficient guidance to inform their practice and ensure people received support that met their needs. People had not been supported to plan for care at the end of their lives.

We recommended the registered manager sought advice and guidance from a reputable source to ensure there were effective systems to assess, plan and meet people’s needs.

There were enough staff to meet people’s needs. Relatives told us they had confidence in staff’s skills. Staff worked in partnership with external healthcare professionals to support people to maintain their health or seek assistance if they were unwell. Infection prevention and control was maintained.

Relatives praised staff’s caring approach and attentiveness. People were supported with their social needs and had access to the local community as well as pass times they enjoyed.

Rating at last inspection

The last rating for this home was Good (Published 9 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified seven breaches in relation to oversight of risks and safety, risk of abuse and avoidable harm, dignity and respect, consent, staff skills and competence, failure to notify CQC of incidents and the leadership and management of the service. Please see the action we have told the provider to take at the end of this report.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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 is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow-up

We will continue to monitor the intelligence we receive about this service. We will request an action plan from the provider to understand what they will do to improve the standards of safety and governance. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Live In Care 4U Ltd on our website at www.cqc.org.uk.

Live-In-Care4U LTD is a live in domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people and people living with dementia. At the time of our inspection four people were receiving a service.

This was the first inspection since the service was registered with CQC. The provider was also the 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.

The registered manager monitored the quality of the service by the use of checks and internal quality audits. We found audits to be inconsistent in quality and not always recorded when they had been carried out. The absence of detailed auditing also meant the registered manager could not be assured of the quality of service delivered. We have therefore identified this as an area of practice that needs improvement.

Staff had a firm understanding of how to keep people safe and there were appropriate arrangements in place to manage risks. One person told us “I always feel safe with whoever is caring for me and staying here”. There were enough staff employed to care for people safely and the provider had recruitment procedures to ensure that staff were suitable to work with people. People were supported to receive their medicines safely in line with current regulations and guidance.

Staff told us they received training and supervision and were confident in meeting people’s needs. Staff were happy with the level of support they received and told us that communication from the registered manager was good. One member of staff told us “Yes we get updates for training and I have recently completed my care certificate”.

People told us that staff were kind and caring. Comments included “The staff are caring and helpful, what more could one ask for” and “Oh yes, they are very caring and skilled”. People confirmed staff respected their privacy and dignity. Staff had an understanding of respecting people within their own home and providing them with choice and control. People were supported at mealtimes to access food and drink of their choice if required. One person told us “They assist with my meal times and cook what I would like on the day”.

The service had a complaints system in place but had received no complaints. People and relatives told us there was regular contact with the registered manager and they confirmed that any issues raised were dealt with appropriately. One relative told us “I could pick up the phone and speak to the manager if I had any concern and I know they would deal with it for me”.

People’s needs were assessed and regularly reviewed and they received support based upon their needs and preferences. We found the support plans to be person centred and details recorded were consistent. Staff supported people to access health care services if required. Staff told us they knew people well and recognised if they were unwell.

People, relatives and staff spoke positively about how the registered manager was approachable and all felt communication in the service was very good. One person told us “Yes the manager is nice and I find her professional”. A relative told us “We find the manager very caring and always keeps us updated and stays in touch”.