14 May 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was completed by one adult social care inspector and an assistant inspector on the first day and one adult social care inspector on the second day.
Service and service type:
This service is a domiciliary care agency. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care; help with tasks relating to personal hygiene and eating.
There was no registered manager at the time of our inspection. A manager registered with the Care Quality Commission and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection:
We gave the service 48 hours’ notice of the inspection visit because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
Inspection site visit activity started on 2 April 2019 and ended on 3 April 2019. We visited the office location on 2 April 2019 to see the provider and office staff; and to review care records and policies and procedures and we made phone calls to people in their homes and visited one person at their home. On 3 April 2019, we visited two people at their homes and returned to the office to review further information.
What we did:
Before the inspection, we looked at information we have received in relation to the service. We looked at any information the provider sent us in relation to the service. We also requested feedback from the local authority. We used this information to help us plan how our inspection should be carried out.
During the inspection, we spoke with four people, five relatives and seven members of staff. This included the provider, the care co-ordinator and five members of the care team. We visited three people in their homes. We looked at three people’s care plans, three staff files, medicine administration processes, complaints and other records relevant to the quality monitoring of the service.
14 May 2019
About the service:
Lilyrose Care Group is a domiciliary care agency which supports people in their own homes. At the time of our inspection 14 people were in receipt of the regulated activity ‘personal care’.
People’s experience of using this service:
We found three breaches of regulation at this inspection in relation to recruitment, consent to care and governance.
People and their relatives raised issues about some inconsistencies between office staff and care staff, however they felt the service they received from care staff was good. People told us that staff were kind and friendly and knew them well.
We have made a recommendation about medication records. Care records were not always updated to reflect changes made to people’s medication. There was no written guidance for staff about the administration of medication prescribed to people to be taken when required.
Recruitment was not consistently managed safely. The necessary checks were not completed prior to staff starting work. The provider had found some of these issues prior to our inspection and had taken corrective action to address this.
The registered provider was not acting within the principles of the Mental Capacity Act 2005. Where necessary, the provider had not recorded that people’s capacity was assessed, or that decisions were taken and recorded in people’s best interests looking at the least restrictive options.
Care plans contained some detail and information to assist staff in meeting people’s needs. However, these had not been regularly updated and the information contained at the office did not always match the care plans in people’s homes. Records in general were disorganised. Care records had not always been updated to reflect changes in people’s needs. Staff were aware of the changes via weekly email updates and care was provided by the same group of carers, so the impact on people was reduced. The provider had identified this issue prior to our inspection and was taking steps to improve records.
There was no manager in place at the time of our inspection. The systems in place to monitor the quality and safety of the service and make improvements were not always effective. They failed to identify issues we found in this inspection. The provider did not maintain a record of checks they carried out on the service. There was no evidence to show that the provider had oversight of the service as there were no quality assurance systems in place for the provider to monitor and improve the service. The systems in place at the service had not been followed recently and this had led to documentation being out of date or procedures not being followed by staff. Some documentation could not be located that was requested. Following the inspection, the provider confirmed management arrangements and sent an action plan of how and when they intend to make the required improvements.
Staff received an induction when they started work and received ongoing training. Staff felt supported, but they were not provided with supervisions in line with the providers procedure. We made a recommendation about supervision.
People and their relatives felt the care was safe. People received visits at the times they requested, and they knew which staff would be attending their homes. Staff stayed with people for the correct amount of time and met all their needs in a timely way. Staff had access to personal protective equipment and followed good practice to reduce the risk of the spread of infection.
People were treated with dignity and their privacy and independence was respected. Staff were clear of their responsibilities to maintain people’s confidentiality.
People’s healthcare needs were effectively assessed and monitored. The service worked with other healthcare professionals to assist people to maintain their health and wellbeing.
People knew how to complain and stated they had no complaints at present.
More information is in the full report below.
Rating at last inspection: Good (Report published 4 April 2018). This is the first time the service has been rated requires improvement.
Why we inspected: This inspection was brought forward due to concerns that had been raised with us.
Enforcement: We have asked the provider to send an action plan of how they will address the breaches in regulation. Full details are at the back of this report.
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