Living Glory Social Care

Living Glory Social Care is a domiciliary care agency providing personal care to people living in their own homes, including children, younger adults, older people, and people with learning disabilities. At the time of our inspection 228 people were in receipt of personal care, 44 of these were children. The provider told us at the time of inspection they were not supporting any people in supported living settings.

People’s experience of the 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 who have a learning disability and or who are autistic.

Right Culture

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not have robust systems in place to monitor the quality and safety within the service. This meant the provider had failed to identify some of the issues we found. This included concerns about the lack of care plans and risk assessments for people’s known health conditions, lack of guidance for staff to follow in relation to prescribed medicines and lack of monitoring for people for whom methods of restraint had been approved. Where the provider's systems had highlighted concerns, the systems in place to action and follow up on these were not robust and did not evidence appropriate actions had been taken.

The registered manager told us how they had communicated with staff and people using the service to ensure the culture within the service was open and inclusive.

Right Support

Risks to people were not always well managed which meant risk of harm to people had not always been considered. There was no evidence that people had been harmed. There was little evidence to demonstrate people had been supported with things which were important to them such as their interests. However, staff knew people well. Medicines were not always well managed, including a lack of robust guidance for staff to follow in relation to ‘as required’ medicines.

People were supported to live in their own homes. Although there were adequate numbers of staff to support people, calls did not always take place at the time people wanted and for some, they were often shorter than commissioned.

Right Care

People's care plans and risk assessments did not always provide robust guidance for staff to follow in relation to people’s known health needs. This included how to support people who expressed emotional distress to minimise the risks to themselves and staff. This meant people could be placed at risk as staff may not have information in relation to how known health conditions impact on people’s needs, wishes and abilities. However, there was no evidence to demonstrate people had been harmed. People were not always supported and encouraged, to promote their independence.

We found overall there was a stable team of staff who knew people's needs.

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 02 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, poor care practices, missed, short or late call times, and poor medicines management. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified new breaches in relation to Person centred care, Need for consent, Safe care and treatment, Safeguarding service users from abuse and improper treatment, Receiving and acting on complaints, Good governance, Staffing and Fit and proper persons employed.

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. Once the report has been published, we will arrange a meeting with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. 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 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 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.

Living Glory Social Care is a domiciliary care agency providing personal care to people living in their own homes, including, children, younger adults, older people and people with learning disabilities. At the time of our inspection visit four people were in receipt of personal care.

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

Relatives confirmed people felt safe. Procedures were in place to protect people from harm. Risks had been assessed and staff understood the risks associated with people's care to keep them safe. Strong emphasis was placed upon continually developing the service and learning lessons if things went wrong.

Staff were recruited safely, and enough staff were employed to ensure people received all their care calls, from familiar staff at the times agreed. Staff received the support and training they needed to be effective in their roles.

People received their medicines when they needed them from competent staff. People's nutritional and hydration needs were met, and staff understood people's dietary needs. The staff team worked in partnership with health and social care professionals to ensure people received effective care.

Relatives spoke highly of the caring nature of the staff. People’s needs had been assessed before they started using the service and people were involved in planning and agreeing to their care. Staff knew people well and overall, care plans contained the information staff needed to provide personalised care.

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 supported this practice.

Staff understood people’s methods of communication and understood what gestures and behaviours meant. People’s right to privacy was respected, their dignity was maintained, and people were encouraged to be independent.

Systems were in place to manage and respond to complaints. Relatives were happy with the service provided and the way Living Glory Social Care was managed. Quality assurance systems continually monitored and evaluated the quality and safety of the service provided. Feedback gathered was used to drive improvement.

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 1 March 2017).

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.

We last inspected this service in November 2015 where we identified that the registered provider had not ensured that there were complete and contemporaneous records kept regarding the care of the people who used the service and that systems were not in place to ensure compliance with the new regulations. We found that the registered provider was in breach of Regulation 17 of the Health and Social Care Act (2008) Regulations 2014, Good Governance. After that inspection the registered provider provided us with a plan of how they would ensure they met this regulation.

At this inspection we found that the provider had made some improvements and were no longer breaching regulation. However we found that further improvements were needed to ensure all records were accurate and complete.

People’s relatives told us that people received their medicines safely and we saw that staff had received training in safe medication administration. We found that further improvements were needed in the recording of medicine administration.

There is a registered manager at the service who was present throughout 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 using the service were unable to tell us their views of the care they received. However, we spoke with relatives to seek their views. People’s relatives told us they felt their relative was cared for well. People benefitted from support from regular staff who had got to know people well. People contributed to planning their care to say how they preferred to be supported.

People were supported by staff who were aware of the possible signs of abuse and the action to take should concerns arise.

Staff received training on people’s individual needs to ensure they could support people effectively. Improvements had been made to the support people received under the Mental Capacity Act (2005) and staff had some understanding of what this meant for people they supported.

People received support to have their nutritional and hydration needs met. Staff understood how to treat people with dignity and promote their independence.

Care was reviewed with people to ensure it continued to meet their needs. People were able to request changes to the times of calls to meet their needs.

There were systems in place for people to raise concerns or complaints should they need to.

People’s relatives and staff were happy with the way the service was managed. There were systems in place to ensure the quality of the service was monitored.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the support people received was safe. Staff we spoke with were aware of the care that people needed to keep them safe. One relative told us, 'Personally I'm very pleased. I have had bad experiences with other agencies. I do feel I can trust and rely on them.'

People told us they had not recently experienced any missed calls and that care staff usually arrived on time and stayed for as long as they were expected to. One relative told us, 'We've had no missed calls and it staggers me that the carers are never late.' A person using the service told us, 'Initially there were some missed calls but not now. The carers are usually on time or ring if they are going to be late.'

Staff were recruited appropriately with checks being completed to make sure that they were safe to work with vulnerable people.

We found some staff had received training about the Mental Capacity Act and we were told that training for other staff was scheduled to take place in July. This would ensure all staff had satisfactory knowledge about any implications of the Mental Capacity Act for people they support.

We saw that the management of records needed to be improved. People were not always protected from the risks of unsafe or inappropriate care and treatment because some records relating to people's care were not available, sufficiently detailed or accurate. We have asked the provider to tell us how they will make improvements and meet the requirements of the law.

Is the service effective?

People were involved in planning their support. People and their relatives told us that they were consulted and involved in making decisions about care and support. People and their relatives had regular contact with the manager and director of Living Glory Social Care. One relative told us, 'Our views are sought. The manager often telephones to check if things are okay. There is very good communication.'

We spoke to three care staff and they demonstrated a good knowledge of the needs and health conditions of the people they were providing care to. Care staff told us that care plans were retained at people's houses and were always accessible to them. They also confirmed that they tended to support the same people on a regular basis.

Is the service caring?

Care staff treated people with dignity. All the staff we spoke to referred to the people who used the service with warmth and respect. We spoke with one person using the agency and with the relatives of five people using the agency. They all confirmed that staff were polite and caring. One relative told us, 'The carers are good. They have clicked with [person's name.]

The planning of staff rotas ensured that, where possible, staff were allocated to look after the same people. People using the agency told us that they had regular staff providing their support. One person told us, 'I have one main carer.' A relative told us, 'I'm confident in leaving Mum as she is comfortable with the carer'The manager tries to match the carer with the person.'

Is the service responsive?

People who used the service or their representatives were asked for their views about their care and treatment and they were acted on. We found that customer satisfaction surveys were sent out regularly to people and their relatives seeking their views and feedback regarding the quality of service they received.

We saw that there were policies and procedures for dealing with complaints. We looked at the details of a concern raised and saw that appropriate action had been taken to reduce the risk of further occurrences.

We found evidence to show that learning from incidents took place. We had previously been informed of an incident of poor staff practice resulting in a safeguard referral being made to the local authority. We found that actions had been taken to address the concerns.

Is the service well-led?

A schedule of individual and group staff meetings was in place to help ensure staff received the support they needed for their role. All of the staff we spoke with told us they felt well supported and that they had regular contact and checks from the manager or director to discuss how they were getting on.

There were arrangements for staff to raise concerns. The manager told us that she welcomed suggestions and comments from staff. The staff who we consulted told us that they found the manager and the director easy to talk to. One care staff told us, 'The managers are very approachable. I'm confident to raise any issues, they do listen.' This member of staff gave us an example of something they had raised previously which had been responded to appropriately.

Following our visit, we spoke with one person using the service, the relatives of four people and with six members of staff.

All of the people we spoke with confirmed they were happy with the service they received and had no concerns or complaints about the agency. A person using the service told us, 'The care is excellent, rest assured they do an excellent job.'

During the inspection we looked at three people's care records. It was not evident that care was always planned in a way that ensured people's safety and welfare.

Staff demonstrated a good awareness of the procedures they would follow if they suspected abuse.

We were unable to evidence that the agency had followed robust recruitment procedures before staff started working with people or had all the training they needed. This meant the provider could not fully demonstrate that some staff were suitable to work with vulnerable people.

The agency had some systems to monitor the quality of the service provided but these needed improvement to make sure they were effective.

During our review, we discussed the quality of the service provided by the agency with local authority staff involved in monitoring them. They did not raise any current concerns about the agency with us.