Archived: LMT Support Care

LMT Support Care is a domiciliary care service providing personal care to 3 people at the time of the inspection. 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

People’s individual risks and safety were not effectively monitored by the provider. Medicines checks were not regularly carried out and we were not assured all the staff had received the necessary training. Staff had access to enough personal protective equipment (PPE) to be able to support people safely and in line with COVID-19 guidance.

Processes and procedures were not in place to reduce the potential for abuse, and the provider did not have records available of whether all staff had received safeguarding training. The provider had not carried out necessary pre-employment checks on their staff, which meant there was an increased risk that unsuitable people might be employed to support vulnerable adults.

People’s care plans did not always contain all the relevant information needed to guide staff and ensure the person received appropriate care and had given their consent to be supported. The provider had no training records available for the care staff. No records were kept of any checks to determine staff competency to carry out key tasks; such as the administration of prescribed medicines and moving and handling tasks.

The provider was not open and honest. During the inspection they had attempted to mislead the CQC inspector, about the people being supported and the staff employed. The manager was not clear about their role and responsibilities.

The provider had no policies and procedures in place at the time of the inspection. They also did not have effective systems and processes in place to assess, monitor and improve the service they provided to people.

Relatives told us the manager was not easy to contact and did not routinely provide them with information about the service being provided to their loved one.

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. Although staff worked in this way, the provider did not have any policies and systems in place to support 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

The last rating for this service was Good (published 9 April 2018).

Why we inspected

The inspection was prompted by the provider’s failure to send requested information to the CQC as part of a Direct Monitoring Activity carried out on 22 September 2021.

A Direct Monitoring Activity consists of a review of the information the CQC hold about a service and a structured phone call with the provider. The aim is to use the information from that activity to obtain assurances about the service, and any potential risks, without the need to carry out an inspection. However, adequate assurances were not obtained, and a decision was therefore made for us to inspect and examine those risks.

We had concerns in relation to the provider’s management processes and record keeping. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led key only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. The overall rating for the service has changed from Good to Inadequate. 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 LMT Support Care on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the care and treatment arrangements at the service, arrangements for protecting people from potential abuse, and the management of the service.

Please see the action we have told the provider to take at the end of this report.

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 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.

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 timeframe, 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 provider's 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.

During our last inspection on 30 March and 19 May 2016, we found that there were no systems in place to monitor the quality of the service and ensure records were complete and up to date. Following our last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘well led’ to at least good. During this inspection, we found that the provider had followed their action plan. For example, they had ensured that the necessary recruitment checks had been carried out on staff, that staff were provided with training and supervision.

The service had a registered manager at the time of our inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported to take their medicines. However, improvements were required to ensure that staff had up to date training in medicines and that accurate records of medicines administration were kept. Risks to people’s health and safety were identified and assessed although further information was needed to ensure that information was specific to the person. People were supported by sufficient amounts of staff who had been recruited safely. Staff knew how to recognise abuse and were confident to act to keep people safe from harm.

People were provided with the support they required to eat and drink enough. Staff received training and training had been arranged when gaps in staff knowledge were identified. People were supported with their health care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported by staff who were kind and caring. Staff respected people’s preferences and wishes about how their support was delivered. People were supported to maintain their privacy and dignity. The provider was aware of support available to people to help them express their views and wishes and told us this would be considered if a person needed this support.

People’s needs were assessed before they started using the service and people and their relatives were involved in producing and reviewing care plans. People were offered opportunities to take part in social activities and maintain their interests and independence. People were given opportunities to make a complaint or raise concerns about the service they received.

Systems were in place to monitor and improve the quality of the service. People and staff were complimentary of the management of the service. The provider sought and acted upon people’s feedback in relation to the service they received and staff told us they were supported in their role.

The service had a registered manager in place at the time of our inspection. 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.

People were supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent with as little restriction as possible.

There were not always sufficient staff available to meet people’s needs which meant there were occasions when people were not provided with their care safely. Staff had not been fully vetted to determine their suitability to work with people who used social care services.

There may have been occasions where people received support from staff who did not have the right skills and knowledge to meet their needs. People’s human rights to make decisions for themselves were respected and they provided consent to their care when needed. People received support from staff who understood their health needs.

People were treated with respect by staff who were caring and kind. People were involved in determining their care and support and were treated in the way they wished to be.

People’s plan of care contained information about the care and support they required. People were encouraged to express any issues of concerns they had so these could be acted upon.

There were no systems in place to monitor the quality of the service which would enable the provider to make improvements when needed. The provider did not notify us of certain events when they were required to.

You can see what action we told the provider to take at the back of the full report.