LIM Independent Living and Community Care Services Limited

Updated 11 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 1 inspector and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 12 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 28 March 2023 and ended on 21 April 2023. We visited the location’s office on 28 March 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also spoke with a local authority that commissions services with the provider. We used all this information to plan our inspection.

During the inspection

We spoke with 5 service users and 1 relative. We also spoke with 4 staff, including the nominated individual, registered manager, care workers and the administrator. The nominated individual is responsible for supervising the management of the service on behalf of the provider. At LIM Independent Living and Community Services Ltd the nominated individual is also the provider and the registered manager. The service was run by the registered manager, a care co-ordinator and an administrator. We reviewed a range of records. This included 7 people's care records and 4 staff records. A variety of records relating to the management of the service were also reviewed.

Updated 11 July 2023

LIM Independent Living and Community Care Services Limited is domiciliary care agency providing personal care to people in their own houses and flats. The service provides support to older people, people living with a learning disability and/or autism and children. At the time of our inspection there were 38 people 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.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service are living with a learning disability and/or autism.

Right support

The provider did not plan people’s care in a personalised and person-centred way or plan for when people experienced periods of distress. There were no specific risk assessments in place for people. This meant there was not sufficiently detailed information for staff about the risks to people and how to safely manage them. People’s medicines were not administered safely. We found no evidence anyone had been harmed. However, the lack of specific and detailed risk assessment information for staff and the provider’s failure to follow guidance for medicines management put some people at increased risk of potential harm.

The provider enabled people to access specialist health and social care support in the community. Staff supported people to play an active role in maintaining their own health and wellbeing. Staff supported people to have the maximum possible choice, control and independence.

Right Care

Not all staff understood how to protect people from poor care and abuse and the provider lacked knowledge of how to work with other agencies to do so. The provider did not deploy enough appropriately skilled staff to meet people’s needs and keep them safe. People’s care, treatment and support plans did not reflect their range of needs. The provider did not assess risks people might face. We found no evidence anyone had been harmed. However, the lack of safeguarding knowledge, detailed information about people’s needs and risk assessments put some people at risk of potential harm.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right culture

People were not supported by a registered manager and staff with a good understanding of best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. The provider did not sufficiently evaluate the quality of support provided to people. The service did not have a person-centred culture or a culture of learning and improvement.

Staff knew and understood people well and were responsive. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes and needs at the heart of everything they did. People and those important to them, were involved in planning their care. Staff valued and acted upon people’s views.

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 4 September 2019) and there were breaches of regulation. This service was rated requires improvement for the last 3 consecutive inspections. At this inspection we found the provider remained in breach of regulations and the rating for this service has changed to inadequate.

Why we inspected

We carried out an announced comprehensive inspection of this service on 11 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the effectiveness and governance of the service.

We undertook a focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there were concerns with the safety, effectiveness, responsiveness and governance of the service, so we widened the scope of the inspection to become a comprehensive inspection.

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

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

Enforcement

We have identified breaches in relation to safe care and treatment, person-centred care, staffing, safeguarding, recruitment, registered manager requirements and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.