Liral Veget Training and Recruitment Ltd

About the service

Liral Veget Training and Recruitment is a domiciliary care service which provides personal care to people living in supported living settings. Not everyone who used the service received personal care. The Care Quality Commission (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 there were 18 people receiving care and support for personal care. The service is also registered to provide nursing care, however, this was not being delivered at the time of our inspection.

Right Support: The model of care did not maximise people's independence and people were not always protected from the risk of harm. Risks to people were not always identified and mitigated. People's medicines were not always managed safely. The provider's systems did not ensure staff received suitable training to ensure they had the skills and abilities to meet the needs of autistic people and people with learning disabilities. The provider did not always work in line with the MCA. We have made a recommendation about ensuring capacity assessments and best interests’ meetings are conducted.

Right Care: People's care was not always person-centred. There was limited information about how people were being supported to pursue interests and hobbies and people were not supported to acquire/maintain daily living skills. There was a lack of support towards aspirations and goals. People’s eating and drinking guidelines were not up to date.

Right Culture: The quality assurance and governance processes were not always effective as they had not identified the issues we found with care plans and risk assessments and staff training. The provider had not identified care plans and risk assessments contained out of date information. The provider was not clear about the roles and responsibilities of the service. There were processes in place to gather feedback from people and their relatives. Despite the issues we found we received mainly positive feedback from staff and relatives of people receiving care.

Rating at last inspection and update

The last rating for this service was good (published 21 January 2021).

Why we inspected

The inspection was prompted in part due to concerns we received about allegations of abuse which is currently being investigated by the safeguarding team. This inspection was carried out to seek assurance that people were being protected from harm.

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. Please see the safe, effective, responsive and well-led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safeguarding, the management of risks and medicines, staff training, good governance and person-centred care. You can see what action we have asked the provider to take at the end of this full report. We have also made recommendations about conducting capacity assessments/best interests’ meetings, staff recruitment and ensuring people have health action plans.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Liral Veget is a domiciliary care service providing personal care to 14 people at the time of the inspection. The provider gave personal care to younger people with learning disabilities and other conditions.

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

Systems were in place to minimise the risk of abuse and risks to people’s health and safety were appropriately managed. There were enough staff available to provide people with care. The provider conducted appropriate pre-employment checks with candidates to ensure they were safe to work with people. The provider had appropriate medicines and accident and incident policies and procedures in place.

Care plans were holistic and staff communicated effectively with people. There was a clear complaints policy and procedure in place and people’s relatives told us they felt confident raising a complaint if required. People engaged in activities they enjoyed.

People’s privacy and dignity, equality and diversity was respected and promoted. People were involved in decisions about their care and supported to be as independent as they wanted to be. The registered manager took reasonable steps to determine people’s end of life care needs.

People’s needs were assessed before they used the service and care was delivered in line with current standards and professional advice. People’s health and nutritional needs were met and they had access to healthcare services. 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.

People, their relatives and staff were consulted in relation to their care and their views were taken into account. The registered manager understood their duty of candour responsibilities. All staff understood and fulfilled their roles. The provider assessed the quality of the service and took reasonable actions to improve the quality of care.

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 29 March 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 15 August 2017, we found one breach of regulation relating to concerns about the provider’s staff recruitment practices. We rated the service Requires Improvement. At this inspection we found improvements had been made in relation to recruitment practices and care workers were recruited safely. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

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.

The provider conducted appropriate checks of candidates prior to employing them to help ensure they were safe to work with people using the service.

The registered manager visited people in their homes to monitor service provision. The provider carried out an annual survey to ascertain people’s views in relation to the care being provided. Where issues were identified, action plans were put in place to rectify these and improve the service.

The provider conducted safe medicines management. There were appropriate procedures in place for administering and recording the medicines given and care workers were given appropriate training. Records indicated that procedures were adhered to as stipulated within the policy.

Risk assessments were conducted to safely manage known risks. These included risk management plans with clear advice for care workers about how to mitigate risks.

Care workers were aware of their responsibilities to safeguarding people from abuse. They had received appropriate training and were aware of the procedures to follow if they suspected someone was being abused.

We undertook an announced comprehensive inspection on 15 August 2017. We gave the service 48 hours’ notice as we needed to be sure they would be available for the inspection. At our previous inspection of the service on 8 July 2015, the service was rated Good.

At our inspection of 15 August 2017, we found one breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to concerns with the provider’s recruitment practices. We rated the service Requires Improvement.

There was no registered manager in post. The manager was in the process of completing their application with CQC to become 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 service did not carry out appropriate and robust checks to make sure that only staff suitable were allowed to work with vulnerable people. We found a number of inconsistencies and irregularities in the provider’s recruitment practices.

The manager carried out visits to people’s homes to monitor service provision. The opinions of people, their relatives, staff and professionals were surveyed and were used to drive improvements at the service. However, the systems for checking quality and compliance had not picked up the issues we found with recruitment practices.

Records showed medicines were managed safely. Staff had received training on medicine management. There was a medicine policy and procedure in place for staff to follow. Medicine administration records were clearly completed.

Risk assessments were in place and detailed actions for staff to take to manage identified risks and keep people safe. These were reviewed regularly to reflect people’s current needs and any associated risks. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse. They also knew how to escalate concerns to external authorities if needed. Staff told us staffing levels were sufficient to meet people’s needs. They also confirmed the time allocated to them to support people was enough and enabled them to support people safely.

Staff were supported through effective induction, supervision, appraisal and training. We saw evidence that people or their relatives consented, where appropriate, to their care before it was delivered, and were involved in making decisions about their support. We noted however that staff were not knowledgeable about the Mental Capacity Act 2005. We have made a recommendation about this.

The service worked with health and social care professionals. People were supported to arrange appointments to ensure their health needs were met. Relevant professionals were involved to ensure people received appropriate support and care that met their needs. People were supported to prepare their meals and eat and drink where required.

Relatives told us staff treated people with kindness, consideration and respect. Staff provided support to people in the way they wanted to be cared for. People’s dignity and privacy was promoted.

People received care and support customised to meet their individual needs. People and their relatives were involved in planning their care. Care plans were reviewed and updated regularly to reflect people’s changing needs.

Relatives knew how to complain about the service. The service sought feedback from people, their relatives, staff and professionals about the service and feedback received were used to improve the service.

The individually tailored care plan gave detailed information about how the person was to be supported. It contained information about what aspects of personal care they were able to do for themselves. Staff encouraged the person to do as much as they could to maintain their independence.

There were appropriate recruitment and selection processes in place. Staff were skilled, experienced and knowledgeable. They all had previous experience of working a care setting and assisting people with their personal care. There were enough staff to meet the needs of the person using the service.

There were processes in place to check the quality of the service provided. The manager undertook unannounced spot checks. There were processes in place to obtain the views and feedback of people using the service and their relatives.