ILS24Health Care Limited

ILS24 Health Care is a domiciliary care agency providing personal care to adults with complex health conditions and requiring end of life care, and people with learning disabilities, living in their own homes everyone. During our inspection visit, the service was caring for 32 people.

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

People and relatives told us the service provided safe care and had a positive impact on their lives.

We found some aspects of the management of the service had not always been effective. The provider was caring for people with complex health conditions and some required end of life care and we found inconsistency in the quality of care plans. Quality assurance measures in place had not always been effective in identifying the issues found during this inspection.

Most risks to people’s care were well recorded, but we continued to find some risk assessments required further information. Medication was managed well but we found staff’s competency assessment records lacked detail. We made a recommendation for the provider to review this area and implement best practice guidance.

The provider was not always recording when equipment used to move people had passed the relevant safety checks. Most areas of staff recruitment were safe, however, we reviewed evidence confirming that staff had started working before the required DBS checks had been completed.

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. Improvements were required in how the provider was recording relevant discussions and decisions about the care of people who lacked capacity to make decisions. We have made a recommendation for the provider to always complete these records and to consult relevant guidance and best practice in relation to the Mental Capacity Act 2005.

We received positive feedback from people, relatives and staff in relation to the management of the service and the registered manager.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Rating at last inspection and update

The last rating for this service was requires improvement ( published 28 April 2021)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made but the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to recruitment and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ILS24 Health Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

ILS24Health Care Limited is a domiciliary care agency providing personal care and support to people in their own homes. At the time of inspection, the service was providing personal care to 37 people.

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

Where people had support with medicines this was not always managed safely. Records showed inconsistencies which meant medicines may not have been given as prescribed. Records did not clearly show how risk was managed or determined.

Quality assurances processes were not robust enough. They had not been effective in identifying concerns found during this inspection relating to medicines and risk management. Policies and procedures were not always up to date to reflect good practice guidance.

People and their relatives said the care and support provided was safe. People received care from staff who were kind, and who respected their privacy and dignity. The provider had systems in place for responding to allegations of abuse. Overall, staff were knowledgeable about their responsibility in this area. Some staff were not aware of how to report concerns outside of the agency.

People and staff spoke positively about the registered manager and provider and told us they found them approachable. Staff said they received good support and training. Staff had access to personal protective equipment (PPE) and were tested for COVID-19 in line with guidance.

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 4 October 2018).

Why we inspected

We received concerns in relation to conduct of staff and alleged neglect of people’s needs. As a result, we undertook a focused inspection to review the key questions of 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ILS24Health Care Limited on our website at www.cqc.org.uk.

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe management of medicines, risk management and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 19, Fit and proper persons employed, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 and Well-led to at least good. During this inspection we found improvements had been made and recruitment was now managed safely; with systems in place to monitor this.

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. On the first day of our inspection, there were 31 people using the service. On the second day there were 25 people.

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 2008 and associated Regulations about how the service is run.

People told us they felt safe with staff and the care they were provided with. They said they received a good standard of care. There were enough staff to support people safely. Staff had received appropriate safeguarding training and risk assessments had been developed when needed to reduce the risk of harm occurring. We did however find that some risk assessment records needed to be strengthened.

Systems for managing medicines safely were overall, effective. The registered manager responded swiftly to some issues we identified with the records of medicines support to ensure safe medicines management. Staff understood their role and responsibilities for maintaining good standards of cleanliness and hygiene.

Training records showed staff had completed a range of training and staff spoke highly of the training they received. Staff told us they received support, supervision and appraisal to help them understand how to deliver good care and records we looked at confirmed this.

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. However, we recommended the provider reviewed the records of capacity assessments and decisions made in people’s best interests to ensure people’s rights were fully upheld. Staff understood their roles and responsibilities 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. Where needed, people who used the service received support from staff to ensure their nutritional needs were met. Staff were trained to respond to emergencies and said they felt confident to do so. There were systems in place to make sure managers and staff learnt from any accidents and incidents.

People spoke positively about the caring nature of staff and the support they received. People told us they were treated very well. Staff showed a 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.

Peoples care and support needs were reviewed regularly. However, some people's care plans did not always contain sufficient detail about their needs. The registered manager took action at the time of the inspection to rectify this.

The provider had systems in place that were effective in assessing and monitoring the quality of the service provided. People, staff and relatives spoke positively about the management team.

ILS24Health Care Limited 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.

The registered provider did not always take appropriate action to follow safe recruitment practices. We found appropriate checks had not always been carried out before employing workers.

We identified some potential risks with how medicines were being managed and the registered manager responded swiftly and took action to make sure appropriate arrangements were put in place.

Some risk management plans lacked detail and did not give full guidance on how risks were to be managed. We recommend risk management plans are reviewed to ensure full guidance is available to staff on how to minimise risks to people.

Relatives of people who used the service told us they were happy with the support their family members received from the service. They said they felt their family members were safe, received a good standard of care and they would recommend the service to others.

Staff showed a good understanding of promoting choice and gaining consent from people. The registered manager and staff we spoke with had an understanding of the principles and their responsibilities in accordance with the Mental Capacity Act (MCA) 2005.

Arrangements were in place to make sure any dietary requirements were met and a range of other professionals were involved to help make sure people stayed healthy.

There were sufficient numbers of staff to meet people’s needs and keep them safe. People’s relatives told us staff arrived on time and they had a regular team of familiar staff to provide the care and support. We saw people were provided with care and support by staff who had the appropriate knowledge and training to effectively meet their needs. Staff told us they felt well supported and received regular supervision.

People who used the service and their relatives were involved in planning the care and support received. They told us they felt fully involved and listened to when discussing care needs. People’s relatives told us they felt theirs and their family member’s views on how care was to be delivered were fully respected.

Care records did at times lack detailed guidance for staff to follow which meant there was a risk people’s needs would be missed or overlooked. However, staff were very knowledgeable on people’s care and support needs. It was clear they had built positive relationships with people and could describe people’s individual needs well.

There were systems in place to monitor and improve the quality of the service provided. However, these were not always robust enough; our concerns regarding recruitment had not been identified through the checks in place.

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