Archived: Lifecare Qualifications Limited

Updated 18 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 9, 10 and 12 April 2018 and the first day was unannounced. Three inspectors were involved in the inspection. We visited the office location on these dates to see the registered manager and office based staff, to review care records and other documentation. After we had visited the office, two experts-by-experience spoke to people who used the service and their family members by telephone. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The experts had experience of caring for some who received personal care in their own home.

Before the inspection we sought feedback from the commissioning local authorities and local Healthwatch groups. We reviewed the action plan the provider had submitted in response to our previous inspection and other information we held about the service in the form of notifications they had submitted to us. Notifications are reports of events or incidents that provider are required to tell us about by law.

During the inspection we spoke with the registered manager, the quality manager and the deputy manager. After the inspection we spoke with six care workers. After the inspection we also spoke with 21 people who used the service, one family member and three professionals who were also involved in supporting people who received care from Lifecare Qualifications Limited. During the inspection we reviewed 16 people’s care records including their needs assessments, risk assessments, care plans and records of care delivered. We reviewed 16 staff records including recruitment, supervision and training. We reviewed call monitoring information, quality audits, action plans, incident reports, meeting records and various policies, procedures and other documents relevant to the management of the service. After the inspection we asked the provider to send us further documents regarding audits and additional care plan records which they did within the required timescales.

Updated 18 August 2018

The inspection took place on 9, 10 and 12 April 2018. The first day of the inspection was unannounced.

We last inspected Lifecare Qualifications Limited in September 2017. At that inspection we found breaches of eight regulations. We issued requirement notices for breaches of Regulations 10, 11 and 19 regarding dignity and respect, need for consent and fit and proper persons employed. We issued warning notices requiring the provider and registered manager to be compliant with the regulations by 30 November 2017 for Regulations 9, 12, 13, 17 and 18 regarding person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. The provider had complied with one warning notice and two requirement notices. We found continued breaches of five of these regulations and one new breach of regulations.

When we completed our previous inspection in September 2017 we found concerns relating to the assessment of people’s needs. At this time this topic area was included under the key question of ‘Responsive.’ We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is now included under the key question of ‘Effective.’

Lifecare Qualifications Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger disabled adults. At the time of our inspection they were providing care to 174 people.

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.

Care plans and risk assessments contained insufficient information to ensure people received safe, personalised care. There was not enough information about people’s medicines, mobility or health conditions to ensure they received the right support. People were not asked about their wishes about end of life care. People’s preferences for how they wished to be supported were not captured and the impact of their religious beliefs, sexuality or gender identity were not incorporated into their care plans. Care workers recorded when people’s needs had changed, and raised this with office based staff, but care plans were not updated to reflect this.

People gave us mixed feedback about whether their care workers attended on time. Some staff told us they were given crowded rotas and this was confirmed by the records seen. Staff were not consistently deployed in a way that ensured people received their care at the right time.

Staff received regular supervisions and training in areas considered fundamental knowledge for staff working in a care setting. However, they did not receive sufficient training in areas where people had specialist needs.

People told us they had made complaints, but the provider had not followed their complaints policy and there were no clear records of these complaints.

There were no clear systems for the audit or analysis of incidents, accidents, safeguarding concerns, or complaints. Although care plans had been reviewed, and there was a system in place for tracking outstanding actions, there had been a very limited improvement in the quality of the records. Spot checks were poorly completed and did not lead to actions to improve the quality of the service. The systems and processes had not operated effectively to improve the service.

The provider had improved the working knowledge about safeguarding adults from harm. They were now appropriately identifying and escalating allegations of abuse to the appropriate safeguarding authority.

Staff told us they were provided with sufficient personal protective equipment to ensure people were protected by the prevention and control of infection.

People told us care workers prepared their meals for them. Records showed there was clear information about people’s dietary preferences and care workers recorded that people ate a varied and nutritious diet.

People told us they felt their care workers treated them with dignity. Care workers and people told us where they worked with each other regularly they were able to establish caring and compassionate relationships.

We identified breaches of six Regulations regarding person-centred care, consent to care, safe care and treatment, staffing, display of ratings and good governance. 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.

The overall rating for this service remains ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.