LJM - Homecare Lincoln

LJM – Homecare Lincoln is a domiciliary care agency based in the Lincoln area providing personal care to 54 people who live in their own homes at the time of the inspection. 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

There was a new manager who was in the process of applying to replace the current registered manager, who was in the process of moving in to a more senior role with the provider. The registered manager was honest and open with us about recent issues which had caused disruption and affected the governance of the service. The registered manager and manager had developed an action plan and were working to address issues. Staff were complimentary about the support they received from their managers and described a positive working relationship within the team.

Some people told us there had been a noticeable decline of communication and rostering in previous months which had resulted in inconvenience and disruption. The registered manager was aware of the issues and had clear plans to address this. Other people told us their care had not been affected and they were satisfied with the standard of their care and communication with the service.

Managers and staff were clear about their roles. Team meetings took place regularly and the provider actively sought to obtain feedback from the staff team and people using the service. The manager and staff team built good working partnerships with health and social care professionals and were developing and building links in the community.

The service provided sufficient numbers of staff to meet people's needs. People told us the service they received was generally reliable. Some people told us staff were sometimes late and expressed frustration with disruptions. Other people told us there were occasions where staff were late due to traffic but were always contacted and kept up to date. Staff were recruited safely and in line with regulations.

People told us they felt safe and were protected from abuse. Staff received training to ensure they could recognise the signs of abuse and report them confidently. Risks associated with people’s care were managed. Records showed people had risk assessments and these were reviewed regularly. People told us staff supported them safely. People told us they were supported to take their medicines safely. Staff received training to enable them to administer medicines and processes were in place to ensure staff were competent. Accidents and incidents were recorded and reported. Systems to review accidents and incidents were being developed to improve the way lessons were learnt.

Records showed people’s needs were assessed prior to using the service. People confirmed this.

Staff told us they received the training they needed to do their job well. Records confirmed staff were provided with induction and ongoing training. People were supported to access the healthcare they needed. The service worked with people and their relatives to make necessary referrals to healthcare services. People’s consent to care was sought. 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 and relatives told us staff were caring and kind. Staff told us they were happy in their roles and enjoyed spending time talking to people and getting to know them. Most people told us they were given the opportunity to express their views regularly and were involved in their care. Some people told us they had not recently been asked for feedback about their care. Records showed surveys and telephone checks were carried out to see if people were satisfied. Staff were knowledgeable about how to maintain privacy and dignity. People told us staff behaved with professionalism and were respectful of their homes when providing care.

Some people told us inconsistent call times and late calls had resulted in them receiving care which was not responsive to their needs. Other people told us they were totally satisfied with their care and the provider had been accommodating and flexible to ensure their care was responsive.

Care planning reflected people’s basic needs, but some development was required to ensure care planning was tailored to meet people’s needs in a more personalised way. The manager showed us examples of a new care plan format which would improve the quality of information recorded.

Records showed people's care was reviewed regularly. Care was delivered by staff who understood the needs of the people they were supporting. People knew how to complain and raise concerns.

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 requires improvement (published 29 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

This was the first comprehensive inspection for this location.

A process for quality checking was in place but this had not identified some of the issues we found at inspection. There were enough staff on duty, however there were occasions when staff did not have sufficient time between calls to ensure they arrived at people’s homes on time. People told us that they received person-centred care according to their wishes.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their independence was respected. Medicines were managed safely. There were sufficient staff to safely meet people’s needs. However, support was not consistently provided at the times people expected. Background checks had been completed before new staff had been appointed.

Arrangements to prevent and control infection were in place. Action had been taken when things had gone wrong to prevent the risk of them reoccurring.

Staff had been supported to deliver care in line with current best practice guidance. However, records were not consistently clear about people’s ability to consent to care.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were helped to eat and drink enough to maintain a balanced diet. People were supported to access healthcare services so that they received on-going healthcare support.

People were treated with kindness, respect and compassion. They had also been supported to express their views and be actively involved in making decisions about their care. In addition, confidential information was kept private.

Information was provided to people in an accessible manner. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to improve the quality of care. Arrangements had been made to support people at the end of their life.

There was a registered manager who promoted a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. The provider had put in place arrangements that were designed to enable the service to learn, innovate and ensure its sustainability. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.