LifeCome Plus

LifeCome Care Bromley is a domiciliary care service providing personal care to adults living in the community. 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. At this inspection the registered manager told us there were two people using the service who received personal care.

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

Some risks to people were identified and assessed and suitable guidance given to staff. However, we found a new breach of regulation as a health risk was not fully assessed or sufficient guidance given to staff to manage this risk safely. There were systems to track and monitor the quality of the service. However, these were not yet sufficiently effective and required improvement to ensure they covered all aspects of the service and that they were effectively operated.

Action had been taken to address the breaches and areas for improvement found at the last inspection in March 2018. Complaints were recorded and investigated appropriately. People and their relatives spoke positively about the care and support they received, and the way staff interacted with them. We saw that people’s preferences in relation to having male or female staff were recorded and respected.

There were enough staff to meet people’s needs and people told us staff were reliable. Some aspects of medicines management were managed safely.

Staff received enough training and support to meet people’s needs. People were supported to have enough to eat and drink where this was part of their support plan. 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 were supported to be as independent as possible and told us staff treated them with dignity and respect. People had a personalised plan for their care which identified and assessed any support needed in relation to their protected characteristics.

People and their relatives told us they thought the service was organised and their views were sought and listened to. Staff told us the registered manager was supportive and approachable.

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 15 June 2018) and there were two breaches of the regulations, relating to complaints and good governance .

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made in relation to the regulations identified at the last inspection, but the provider was in breach of another regulation and there remained some improvements needed. The service therefore remains rated 'Requires improvement' for the second time.

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our last inspection on 25 and 27 January 2017 we found a breach of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the Electronic Monitoring System (ECM) for monitoring visits to people to ensure they received their care visits at the correct times was not effective and staff timeliness needed to be improved. At this inspection we found that the provider had made improvements and the ECM system showed that there had been no late or missed calls.

At this inspection we found that there were processes in place to monitor the quality of the service, but they were not always effective as they did not identify the issues we found during our inspection. Relatives told us staff did not always wear an identity badge or wear a uniform, so they did not always know who was entering their home. Some people and their relatives felt that staff were not always caring, for example, because the service did not always meet people’s preference to have a male or female staff member to provide support. Some people were not happy about the service they received. The service had a system in place to log and investigate complaints, however this was not always followed.

The service had 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.

There were safeguarding procedures in place and staff knew how to safeguard people they supported and how to raise any concerns. Risks to people were assessed and information and guidance for staff on how to support people was provided. Medicines were safely stored, administered and managed. People were protected against the risk of infection and staff had received training in infection control and were aware of the action they needed to take to minimise the risk of infection. There were enough staff employed to safely meet peoples needs. Appropriate recruitment checks took place before staff started work and there were enough staff deployed to meet people’s needs.

Staff completed a mandatory programme of training and were supported through regular supervisions. The registered manager and staff understood the Mental Capacity Act 2005(MCA) and acted according to legislation. 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 told us they asked for people’s consent before providing care and support. People were supported to have a balanced diet when required and had access to a range of healthcare professionals when required in order to maintain good health.

People said staff respected their privacy and dignity and they were encouraged to be independent whenever possible. People were given information about the service in the form of a service user guide before they joined the service to ensure they knew what to expect. People's needs were assessed to ensure the service could meet their needs. Care plans were reviewed regularly and people were involved in planning their care needs.

Staff were complimentary about the registered manager and the service. Regular staff meetings were held and feedback was sought from people about the service which included annual surveys.

We carried out an announced comprehensive inspection of this service on 12 April 2016, and found medicines were not safely managed and risks to people had not always been adequately assessed. We also found that the provider did not have effective systems in place to monitor and improve the quality of the service. Appropriate recruitment checks for staff were not always in place and the provider had failed to submit notifications as required by the regulations.

After the comprehensive inspection, we served a warning notice and requirement notices on the provider and registered manager requiring them to comply with the regulations.

At our focused inspection of 09 August 2016 we found that the provider had taken appropriate actions to ensure compliance with the regulations. Medicines were safely managed. People's records contained full medicines lists and appropriate guidance on how to support them safely with their medicines. Risks to people had been adequately assessed and reviewed, and appropriate risk management plans were in place to mitigate risks. The provider had taken appropriate action to ensure references were sought for those employed to work at the service. Quality assurance systems were in place to monitor and improve the quality of the service.

You can read the report from our previous inspections, by selecting the 'all reports' link for 'LifeCome Care' on our website at www.cqc.org.uk.

At this inspection on 25 and 27 January 2017 we found the system for monitoring visits to people to ensure they received visits at the correct times was not robust. The scheduling of staff to visit people’s homes was not well managed and feedback from people following a survey carried out in December 2016 showed that 33% believed that staff timeliness needed to be improved.

These issues were in breach of Regulation 17 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

The service had 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.

People and their relatives told us they felt safe with staff. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. Senior staff completed risk assessments for people who used the service which provided sufficient guidance for staff to minimise identified risks. The service had a system to manage accidents and incidents to reduce reoccurrence.

The deployment of staff to meet people needs required improvement. The service carried out satisfactory recruitment checks on staff before they started working. There were arrangements in place for staff to access support outside the office working hours. Staff supported people to take their medicines safely. The service provided staff with an induction and training, and supported them through regular supervision, unannounced spot checks and annual appraisal of their performance.

Staff sought people’s consent before providing them with support. The registered manager was aware of the requirements of the Mental Capacity Act 2005 (MCA). At the time of inspection they told us they were not supporting any people who did not have capacity to make decisions for themselves. Care records we saw confirmed this.

Staff supported people to eat and drink enough to meet their needs. Staff were available to support people to access health care appointments if needed or where people did not have relatives to coordinate health care appointments for them.

Staff supported people in a way which was caring, respectful, and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date.

The provider had a clear policy and procedure for managing complaints. People knew how to complain and would do so if necessary. The provider sought the views of people who used the service to ensure they were satisfied with the support they received. Staff felt supported by their line manager and the registered manager. The service worked effectively with health and social care professionals and commissioners.

We noted some areas of good practice in the systems used by the provider to assess and monitor the quality of the care people received. This included unannounced spot checks at people’s homes and audits covering areas such as accidents and incidents, care plans, risk assessments, management of medicines, and staff training.

After the comprehensive inspection, we served a warning notice and requirement notices on the provider and registered manager requiring them to comply with the regulations.

We undertook a focused inspection on 9 August 2016 to check that the provider had met the requirements of the warning and requirement notices.

At this inspection we looked at aspects of the key questions 'Is the service safe?' and 'Is the service well-led?' This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘LifeCome Care’ on our website at www.cqc.org.uk.

LifeCome Care is a domiciliary care provider located in the London Borough of Bromley providing care and support to 40 people across Bromley and the surrounding areas.

There was a registered manager in post 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.

At our focused inspection of 9 August 2016 we found that the provider had taken appropriate actions to ensure compliance with the regulations.

Medicines were safely managed and people’s records contained full medicines lists and appropriate guidance on how to support people. Risks to people had been adequately assessed and reviewed, with appropriate risk management plans in place to mitigate future risks. The provider had taken appropriate action to ensure references were sought for those employed to work at the service.

Quality assurance systems were now in place to monitor and improve the quality of the service. The provider had made appropriate notifications to the CQC since the last inspection, and the registered manager understood when notifications should be made.

As a result of the findings of this inspection, we have reviewed the rating for the key question 'Is the service safe?' which is now rated requires improvement. This was because the provider had made improvement to the management of medicines and risk assessments. However, audit checks to ensure that appropriate reference checks were in place for all staff were ongoing and to review the rating for this key question would require a longer term track record of consistent good practice. The rating for the key question ‘Is the service well-led?’ therefore remains the same. The overall rating for the service is 'Requires Improvement'.

The service had 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 and associated Regulations about how the service is run.

During our inspection we found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of medicines, risk assessments, recruitment practices and good governance. We also found a breach of the Registration Regulations 2009.

Risks to people were not always identified or properly assessed and action had not always been taken to manage risks safely. Risk assessments were not regularly updated. Medicines were not safely managed by the service because records relating to medicines were not always fully completed.

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

Systems in place were not effective in monitoring and evaluating the quality and safety of the service. Quality audits did not identify concerns we identified at inspection.

Staff did not always receive appropriate training to enable them to carry out the duties they are employed to perform.

There was also a breach of regulations as appropriate pre-employment checks were not always carried out.

The provider failed to submit notifications to the CQC about important events that the provider is required to send to us by law.

You can see the action we have asked the provider to take in respect of these above breaches of regulations at the back of this report.

People said they felt safe and staff treated them well. The service had appropriate safeguarding adults procedures in place; however staff were not always able to identify different types of abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Systems were in place to record and monitor accidents and incidents.

The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work, and felt supported by their manager. People had access to health care professionals when they needed them.

People said they were treated with dignity and respect, and felt that staff were caring. People were supported to maintain a balanced diet, and had access to health care professionals when required.

The provider had a complaints procedure in place, and people felt their complaints would be dealt with effectively. The provider regularly conducted annual surveys which showed most people were happy with the service.

We found the provider had suitable arrangements in place to gain people's consent to the care and support provided, including liaising with professionals and relatives when required. We saw that people's needs were assessed and their care was planned and delivered as agreed. The provider had recruitment procedures in place to ensure that people using the service had their needs met by staff of good conduct and who were suitably qualified. We found the provider had systems in place to assess and monitor the quality of care that people received. The provider had a complaints procedure in place which was shared with people using the service, but no formal complaints had been raised.

We found that people were consulted with about their care and encouraged to be independent. Staff had a good knowledge of how to respond to any safeguarding concerns and people told us they felt safe with the staff in their homes. Records were monitored and stored securely.