Leicester

Leicester is a domiciliary care agency providing personal care and support to people in their own homes. 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. At the time of our inspection there were 13 adults who received packages of support which included personal care.

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

The provider’s oversight systems and processes were not effectively used to monitor the quality of service being provided and to drive improvements. This included oversight of people's care records, monitoring staff punctuality, training and up to date operating systems including policies and procedures.

Risks to people were not always identified, managed, and monitored. Care plans were not always kept up to date and contain sufficient up to date guidance for staff to follow to keep people safe.

People told us they were safe with the staff who supported them. Staff were recruited to the service safely. Staff were trained for their role and their competency was checked. Staff were knowledgeable in safeguarding procedures and were aware of how to escalate concerns if needed. There were sufficient staff to meet people’s needs. People were supported by regular care staff who knew and understood their needs and routines. People were supported with their medicines safely where this was required.

People told us they felt safe and staff ensured they were safeguarded from harm. People were supported with their medicines when this was required. Infection prevention and control practice was followed by staff to reduce the risk of cross contamination and the risk of infection.

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.

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 good (published 4 November 2020).

Why we inspected

The inspection was prompted in part due to concerns in relation to staff recruitment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm in relation to staff recruitment. However, we have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified a breach in relation to managing risks to people and their care needs and governance systems to monitor the service 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.

Leicester is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection five people were using the service.

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. At the time of the inspection all people were receiving personal care.

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

Since the last inspection the provider had introduced an electronic care monitoring system. This gave the registered manager and the nominated individual instant access to ‘live’ care records and staffing systems.

Systems were in place to safeguard people from abuse and they were followed by the registered manager. People using the service, their relatives and staff spoke positively of the registered manager, reflecting on their commitment to provide reliable and good quality care. Staff followed current guidance to keep people and themselves safe.

Recruitment and selection procedures ensured the provider had the information needed to provide assurances that staff were suitable to work at the service.

Most people and their families took on the responsibility of managing their own medicines. Where the provider took on the responsibility, people’s medicines were appropriately managed. The registered manager regularly worked alongside staff and used the opportunity to carry out regular medicine’s administration checks.

People provided positive feedback about the regular staff who provided their care. They told us they consistently received the care they required.

People and their representatives were involved in the planning of their care and had opportunities to feedback on the service they received. People felt listened to and their views were acted upon.

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 understood infection control requirements and worked in a safe way to limit the spread of infection. This included meeting the COVID-19 infection control guidance. Personal Protective Equipment [PPE] was appropriately used and staff followed infection control procedures.

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

Rating at the last inspection and update

The last rating for this service was Requires Improvement (published 18 April 2019) and there were breaches in two regulations. Regulation 15 Registration Regulations 2009 Notifications – notices of changes and Regulation 17 HSCA RA Regulations 2014 Good Governance.

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 improvements had been made and the provider was no longer in breach of the regulations.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

What life is like for people using this service:

•The provider did not operate effective systems to assess and monitor the service in order to identify and bring about required improvements to the service.

•The provider had not complied with their registration responsibilities with the CQC. They had not notified the CQC, in a timely manner, of changes to the nominated individual and to the address of the registered location.

•Staff understood how to safeguard people from the risk of abuse. Records did not clearly demonstrate the actions taken in the event of suspected safeguarding incidents, or the measures in place to protect people.

•People’s care plans included assessments of risks associated with their care and support. Records were not always sufficiently detailed to guide staff on the measures they needed to take to keep people safe.

•There were enough staff in place who had completed relevant training to give them the skills and knowledge needed to meet people’s needs.

•People were supported to have sufficient amounts to eat and drink and stay healthy. Staff liaised with relatives and health professionals to support people to maintain their health and well-being.

•People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Records did not consistently demonstrate staff had undertaken assessments of people’s mental capacity.

•People were treated kindly and compassionately by staff. People and their relatives were supported to express their views and be involved in making decisions about their care. Staff respected people’s privacy and dignity and supported them to maintain and develop their independence.

•People received personalised care, having their needs, preferences and wishes detailed in their care plans. Staff were responsive to changes in people’s needs and wishes.

•People and relatives were confident any concerns or complaints would be responded to and improvements made as a result.

•People, relatives and staff had confidence in the leadership of the service and felt involved and consulted in the service. They were supported to share their views and these were used to develop the care provided.

Rating at last inspection: At our last inspection in February 2018, we rated the service as Requires Improvement. This is the second time the provider has been rated as Requires Improvement.

Why we inspected: This was a scheduled inspection.

Follow up: We will continue to monitor the quality of the service through the information we receive until we return to visit as per our re-inspection programme. If any information of concern 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

The inspection took place on 16 February 2018. The inspection was announced because we wanted to make sure that the manager was available to conduct the inspection.

A registered manager was not in post. This is a condition of the registration of the service. 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 current manager said that they were in the process of making an application to CQC to become the registered manager. We will monitor this issue to ensure a registered manager is in post.

Management had not carried out comprehensive audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service.

Staff recruitment checks were not fully in place to protect people from receiving personal care from unsuitable staff. Risk assessments were not comprehensively in place to protect people from risks to their health and welfare.

Relatives we spoke with told us they thought the service ensured that people received safe personal care from staff. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Relatives told us that medicines had been prompted so that people could take their medicine safely and on time, to protect people’s health needs.

Staff had received training to ensure they had skills and knowledge to meet people's needs, though more training was needed on some relevant issues.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives. Staff were aware to ask people’s consent when they provided personal care.

Relatives told us that staff were friendly, kind, positive and caring. They said they had been involved in making decisions about how and what personal care was needed to meet any identified needs.

Care plans were not individual to the people using the service, which did not help to ensure that their needs were met.

Relatives were confident that any concerns they had would be properly followed up. They were satisfied with how the service was run.

The staff member said they had been fully supported in their work by the management of the service.

Policies set out that when a safeguarding incident occurred management needed to take appropriate action by referring to the relevant safeguarding agency. The manager was aware these incidents, if they occurred, needed to be reported to us, as legally required.